Every practicing DPM understands the enigmatic and unpredictable nature of warts and wart treatment. Frustration is not uncommon on the part of patients and clinicians.
As time goes on, we try more and more treatments, and those treatments join the ever-growing pile of “mediocre” treatments. It can be puzzling when one treatment we use clears one patient in a few weeks yet has no effect on another patient. In discussions with colleagues, it is also not uncommon to hear claims of favorite treatments that work “most of the time.”
In this blog, I would like to change course and ask you the following question: Does the presence of warts compel us to treat them? If yes, why? What factors into the decision to treat?
For myself, I believe the majority of warts resolve spontaneously on their own when they are ready. I have yet to witness the scenario I learned in podiatry school that leaving warts alone will result in them overtaking the entire skin envelope. Yes, there is certainly local spread and I have seen some impressive cases in the immunosuppressed but these are not the rule.
Therefore, unless warts are painful and affecting one’s activities of daily life, I increasingly recommend no treatment at all. What say you, colleagues?