Verruca treatment

What is verruca treatment, and how does it work?

A verruca (plantar wart) is a wart on the sole of your foot, caused by the human papillomavirus, or HPV¹. It sheds the virus, which can spread to other spots on your foot or to other people¹. Most verrucae disappear without treatment or scarring, usually within six months to two years². Treatment isn't usually needed unless a verruca is very painful or spreading².

When you do treat one, the aim is mostly to destroy or soften the infected tissue so it falls away. That means acid-based paints and gels (keratolytic agents), or cryotherapy, which freezes the wart with liquid nitrogen³⁴. No treatment works for everyone, and plantar warts often come back³⁵.

How well does verruca treatment work?

It works modestly, and results vary. Salicylic acid and freezing are the treatments with the most support⁶⁷. For plantar warts, freezing, salicylic acid and simply waiting gave similar results after 13 weeks⁸.

Age seems to matter. Plantar warts in children often clear, in about half of cases, whatever the treatment. In teenagers and adults they are stubborn, and only about 5% cleared⁸. Even the most successful treatments cure at best about 50–70% of warts at 3 months, and about 30% go away on their own in that time⁹.

Newer options, such as injections into the wart and combination acid paints, report higher cure rates. Those figures come from small or varied studies, so don't assume they beat standard care³¹⁰¹¹. Expect treatment to take months, and ask your clinician why they recommend a particular option for your verruca.

Is verruca treatment right for me?

For an uncomplicated verruca, a simple, well-tolerated over-the-counter treatment is the usual first step⁹¹². The right choice depends on your age, the possible side effects, where the verruca is, and how many there are and how big¹³. Ask a pharmacist, podiatrist or GP which product suits you, and ask for written instructions.

Freezing is harder to use in children because of pain and blisters¹⁴. If you're buying for a child, tell the pharmacist their age.

It isn't clear how treatment performs if you have impaired healing, a weakened immune system, are on kidney dialysis, or can't tolerate cold (such as Raynaud's syndrome)¹⁵. If you're pregnant, ask a health professional before treating.

What happens during verruca treatment?

Salicylic acid at home. Remove the dead skin first with an emery board or pumice stone, then apply the acid daily. Keep going for at least 3 months, and often longer if the wart has only shrunk⁹. Soaking the wart in warm water for 5–10 minutes beforehand, and covering it with waterproof plaster or duct tape afterwards, may make it work better⁹. Ask your clinician to show you how to apply it, and follow the product instructions.

Freezing (cryotherapy). A clinician freezes the verruca with liquid nitrogen. This causes a blister that lifts the virus away from the healthy skin¹⁶. It can be very painful and may need a few treatments¹⁶. Sessions are usually repeated every two to three weeks until the wart clears⁸¹⁷. Freezing is likely to help when salicylic acid hasn't worked⁴.

What are the risks and side effects?

Freezing can be painful and cause blisters¹⁶. Scarring, or lighter or darker patches of skin, can also happen afterwards¹⁴.

Acid-based products can burn the skin, so follow the instructions carefully. If the area becomes painful, stop for about a week until it settles¹⁶.

Before you start any treatment, tell your clinician if you're immunosuppressed or have neuropathy (nerve damage) or impaired healing. Starting with simple, well-tolerated treatments is usually the safest approach¹².

How does verruca treatment compare with other options?

Freezing and salicylic acid appear broadly similar: most trials comparing them found no clear difference⁹. Freezing is done in a clinic and can hurt, while acid is something you apply yourself over months.

Doing nothing is a good first option for many verrucae, because they often clear on their own⁹. If a verruca isn't troublesome or painful, leaving it alone is a reasonable choice¹⁶.

Newer treatments report higher average cure rates, but those figures come from different studies and aren't head-to-head comparisons¹⁰. Before choosing, talk with your clinician about how painful, how slow and how available each option is.