Have you ever had a plantar wart? Maybe you felt a bump on the bottom of your foot. Perhaps it hurt to walk on, a bulge pressing into your flesh. Or maybe you don’t notice it at all, until one day you found a little rough patch and realized it wasn’t any old callus, but a virus that had made a home beneath your skin.
They’re not easy to get rid of. When a patient with a plantar wart comes into Ross Radusky’s dermatology office in Dallas, Texas, he tells them, “We’re going to wage war against this wart.”
War starts with a blade, to take away the top layer of skin that has formed over the wart. Then, Radusky sprays it with liquid nitrogen and sends the patient home with a Band-Aid covering the area. Once a blister forms, Radusky’s patients are to soak their foot for 10 minutes in warm water, put salicylic acid on the wart, and bandage it again—not the soft part, but the sticky part, so that in the morning they can rip off as much skin and gunk as possible.
Then, in three weeks—after yet more soaking, salicylic acid, and also some pumice-stone scrubbing—the patient comes back for another round of liquid nitrogen. And the process repeats.
Depending on your dermatologist, the specific instructions might be different. Though a routine involving cryotherapy is a typical first-line treatment, you might see a doctor who specializes in laser removal. You might bravely try home wart remover kits—if this works, congratulations, you have a rather easy plantar wart! Or you might attempt to de-wart with duct tape, or even hypnosis. Yes, there is some (decades-old) evidence that hypnosis might sort of work against warts. It’s not necessarily a good option, but which of these is? “One of the things that we were taught in residency,” says Jason Clark, a dermatologist in Atlanta, “is that when there’s a lot of ways to treat something, none of them work great.”
We’ve been stuck with bad plantar wart treatments for decades, says Jane Grant-Kels, a dermatologist and chief medical officer of a company called VeraDermics, which is focused on fighting warts. Cryotherapy has been a mainstay for decades and decades and decades, Grant-Kels explained in a 2021 review paper published by Clinics in Dermatology—even she received it when she had a plantar wart as a child in the 1950s. The idea is that blasting a wart with beyond-freezing cold liquid destroys the cells and maybe even helps rally the immune system to come fight off the wart virus itself. (The exact mechanism by which it works is up for debate.) But according to a different 2021 review paper published in Dermatologic Therapy, this is only effective at banishing warts in about half of people, which is why it is often used in conjunction with other methods. It also can make walking painful.
Though there have been new developments in wart treatments since the 1950s, none has usurped cryotherapy as a first-line defense. Radusky has sung the praises of a machine that uses microwave energy on your foot to rid it of the wart, but he explained that he hadn’t bought one for his own office because it’s pricey and its treatments aren’t typically covered by insurance. The main innovation in home therapies for warts seem to be happening in box design. Dr. Scholl’s now has a version of salicylic patches that provides cushioning, to make the experience of attempting to treat a wart more pleasant, which it generally is not. “Any dermatologist hates when a patient comes in with plantar warts,” says Grant-Kels. “You have no easy way to make them better, and you end up hurting them.”
It all raises some pressing questions: Why are warts so hard to get rid of? Is anyone trying to make it easier? (In fact: Yes!) And finally: Do we even need to be treating warts at all?
Warts are little growths caused by a human papillomavirus that has entered the body through a “microtrauma” in the skin. It recruits little blood vessels to supply it with nutrients; the test to determine if a growth is a wart is to nick off a little bit of it and see if there are telltale dots. Warts also cloak themselves off from the body’s immune system. There are treatments entirely focused on getting your body to wake up to the fact that something bad is happening on your foot so that it can get to fighting it off. (Interestingly, this is what over-the-counter salicylic acid does: irritate the skin so that the immune system will swoop in.) This might be more effective than trying to remove it mechanically, because if a little bit of the virus is left behind, it may simply grow back. An additional wrinkle with warts that happen to be on the bottom of the foot: A callus can further protect them.
The best methods—the least frustrating and most advanced—might be those that skip over the callus entirely. There have been case reports that getting the HPV vaccine, if one has not yet had it, can jump-start the immune system into attacking the wart. (Warts are caused by a different kind of HPV; it is weird that this can work.)
Another needle-based method involves injections of yeast; the immune system attacks the yeast and, in turn, the wart. “The big issue with this therapy is that it’s incredibly painful,” says Reid Waldman, a dermatologist and co-founder of VeraDermics, noting that the needles are difficult for treating warts on children in particular. “It’s one of the worst things that I do.” (Other dermatologists I spoke to were less concerned about the pain from immunotherapy; it is a reported side effect, but a numbing agent can help.)
VeraDermics’ first product in development is a wart patch. Its promise, according to Waldman, is that it can impart immunotherapy into warts painlessly—through microneedles, which puncture the skin so gently they can barely be felt—and then dissolve. This kind of technology is currently found on the shelves of Sephora, delivering everything from moisturizer to zit treatments into skin; vaccine patches for measles and the coronavirus are in development. But importantly, the wart patches could be used at home: You could visit the doctor once, get a prescription, and then do a few rounds of treatment without future visits.
Waldman is currently preparing to try his wart patches out on people. If everything goes well, they may be available in a few years. Even in a best-case scenario, it is unlikely they will work for everyone. Currently, injected immunotherapy is effective about 70 percent of the time—for whatever reason, some people just do not mount an immune response to the protein, Wald explained. While he’s personally optimistic that the patches can do better than traditional immunotherapy, he also knows the patches will probably not offer a panacea.
Basically everyone I spoke to assured me that with enough effort (and copays) you can banish even the most stubborn of warts, and with the methods already available on the market, the internet is littered with people who coexist with their warts in despair. “I tell patients, ‘OK, you’ve had this wart for 10 years. You need to give me at least a year to work on it,’ ” says Ronda Farah, an assistant professor of dermatology at the University of Minnesota. Ten years! Personally, I have sidelined my own plantar wart treatment—one sits inoffensively on the inside of the pad of my foot—while I train for a marathon, having been warned by my doctor that the pain of both freezing and injecting the area (his plan of attack) could interfere with ambulating.
Why not just live with the wart? I put this to almost every person I spoke to, and while I cannot mount a wholly convincing argument that we as a society should just let the warts live, it’s also clear that, for all the trouble that it is to get rid of them, the payoff may not be all that significant. When it comes to letting warts be, “well, there’s no harm, but if it’s on a weight-bearing area, it will become painful to walk,” says Grant-Kels, adding that there is a risk that “you can give it to the people you love the most.” Perhaps a wart that is not painful for you will spawn a wart that is painful for someone else. “Don’t rub your warty foot on someone’s face,” advises Shoshana Marmon, a dermatologist based in New York.
As for patients who are truly resistant to the rigamarole of treatments, and comfortable playing host to a virus, “I tell those patients to go for it,” says Radusky. Eventually, he says, even if it takes years, your immune system will find it on its own: “One of my wiser attendings in training told me that no wart stays on the body forever.” Maybe the warts survive a battle or two; they never win the war.