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Saturday, December 20, 2014

Dr. Pegs Prescription

Cure warts with clinical care — or with home remedies and the placebo effect

Dear Dr. Peg,

I think I have a wart on my hand. What causes warts and how can I get rid of mine?

Dear Warty,

Is it a skin-colored bump? Firm, but not tender? Warts are usually round with flat tops and can range in size from a couple of millimeters to 10 times that. They are often rough to the touch, and if you look closely you can see little black dots inside.

Warts are extremely common — in fact, what you may have is called a common wart. They are technically an infection caused by a virus called human papillomavirus. This virus has more than a hundred strains, some of which are responsible for common warts, others for venereal warts and still others for cancer of the cervix.

A wart will start small and grow. Because it is an infection, it can spread to nearby skin or to other body parts that rub against it, like your fingers. Often by the time patients come to see us in the clinic, they have several warts. As a wart grows it causes your body to build new blood vessels to nourish it. The black dots you can see in the wart are these vessels, seen end-on. They are not seeds, contrary to what you might have heard.

You don’t necessarily have to do anything to your wart. It might go away on its own. Many of them do, and why this is so remains a mystery. Warts are fascinating to me because there are many ways to treat them, some of them quite magical and amazingly effective.

In Mark Twain’s “The Adventures of Tom Sawyer,” the infamous Huck Finn describes his favorite way to get rid of warts using a bean:
“You take and split the bean, and cut the wart so as to get some blood, and then you put the blood on one piece of the bean and take and dig a hole and bury it ‘bout midnight at the crossroads in the dark of the moon, and then you burn up the rest of the bean. You see that piece that’s got the blood on it will keep drawing and drawing, trying to fetch the other piece to it, and so that helps the blood to draw the wart, and pretty soon off she comes.”

Tom Sawyer has another method, which involves backing up to a soggy stump and immersing the wart in stump water while chanting a spell.

One of my medical school professors, the now-famous Andrew Weil, used to buy warts off kids, literally. Every time a warty child returned to his office, Weil would pay them a nickel if their warts were smaller than the last time. Without ever being touched by Weil, the wart would shrink and disappear. Why? Mind over matter. Our immune system is a wondrous and mighty beast, which apparently will sometimes obey a subliminal or subconscious request.

The folk remedies for treating warts are numerous, from banana peels to duct tape, aspirin to vinegar. I suspect that many of these will actually work if you believe in them — remember, mind over matter — but one remedy in particular deserves further description, because it has some data to back it up. This is the duct tape remedy.

Apply a piece of duct tape the size of the wart directly to the wart. Remove the tape six days later. Soak the wart in water, then use an emery board or pumice stone to scrub the wart. Leave the wart open to the air overnight. Repeat as needed for up to two months. What is really interesting about this method is that in one study, not only did 85 percent of the treated warts disappear, but so did other untreated warts on the same patient.

If you want something more medical, there are several over-the-counter options you can try. Some involve salicylic acid in a paste or plaster. The acid will slowly dissolve the wart. You can also get a home freezing kit. Ask your pharmacist or browse the wart department. Please do not attack your warts with nail clippers or a steak knife — yes, I have seen this — because you won’t be able to get it all and you will risk infection.

If magic or home treatments don’t work, or if you just want to go straight to the professionals, make an appointment with your health care provider. Medical treatment ranges from chemical warfare to freezing to surgery.

I usually treat common warts first with liquid nitrogen. The nitrogen is stored under pressure in a kind of thermos bottle, from which it is released through a narrow nozzle and sprayed onto the wart. Liquid nitrogen is very cold and literally freezes the wart, which then falls off within a few days. Sometimes we have to freeze it more than once, re-treating every two weeks. We can also use acids or other chemicals to destroy the wart. In addition to direct destruction of the involved skin, the treatments appear to stimulate the immune system to come in and lend a hand.

If none of the above are effective, there is always the scalpel.

Scalpel, not steak knife. Call (505) 277-3136 for an appointment to get your warts treated at Student Health and Counseling.

Peggy Spencer is a student-health physician. She is also the co-author of the book “50 ways to leave your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered anonymous, and all questioners will remain anonymous.