In other episodes about warts, I’ve shared with you that treating warts is very difficult and frustrating. In response to my saying that the most common locations for warts are the fingers, feet and genitals, a viewer with many facial warts asked if facial warts play by the same rules and if they’re treated the same way. Today, I’ll discuss this topic...
Most facial warts are flat warts which tend to be very small… less than 2 mm… not like regular raised ones which are often 4 to 10 mm in width. In reality, flat warts aren’t really flat, but they’re so minimally raised that they look flat. And unlike regular warts, they have a fairly smooth surface. That same smooth surface makes them even more resistant to topical medical treatment because there’s less surface area for the active ingredients in creams to be absorbed than with regular warts.
We use the same ingredients in creams for flat facial warts as regular ones. Since they work by causing a little irritation, which causes an immunological reaction, which finally fights the warts, and since facial skin is more sensitive than finger and foot skin, for facial warts you need to use even lower strengths, which of course can be less effective. As a result of lower strengths and less absorption, topical treatments often fail. But the good news is that flat warts don’t have roots or tentacles that are usually responsible for both the recurrence of regular warts removed surgically and also for the scars from successful wart removal since you don’t have to go as deep. As a matter of fact, flat warts tend to literally sit on top of the skin so only rarely are there scars from removal or recurrences after removal.
I usually try topical therapy before surgical removal. For topicals we use exfoliants like retinoids, salicylic and glycolic acid, as well as special ingredients called immunomodulators to directly try to boost local immunity. When topicals fail, surgically I use a curved knife called a curette to literally peel or scrape the warts off, with or without local anesthesia depending on the number of warts and their size. Usually healing takes a week, but pinkness can last a month or two, easily covered by makeup in women.
Another problem with treating flat facial warts is that by the time you realize you have them, because they are so hard to see, you’ve usually spread them and have many more. Women spread them with makeup and skincare products. Men spread them with their razor. And everyone spreads them by touching and rubbing.
So facial flat warts, just like regular warts, are really tough to treat, and are just one more reason we say that warts have done more to ruin the reputation of dermatologists than almost any other disease.