Dr. William Ting, Board-Certified Dermatologist
at California Dermatology Care
2262 Camino Ramon, San Ramon, CA 94583
500 Alfred Nobel Drive, Suite #185, Hercules, CA 94547
Tel: 925-328-0255
Email: staff@CalDermCare.com

Advanced Care with a Personal Touch




Wart, Conventional Therapy and Advanced Laser Therapy using GenesisPlus
Advanced Laser Therapy for Warts using Cutera GenesisPlus (see before and after treatment photo below)


Deep plantar wart (A=3 days after laser tx, B=after 1 wk, C=after 2 wks)

What are warts?

Warts are non-cancerous skin growths caused by human papillomavirus (HPV) viral infection in the top layer of the skin. Warts can be distinguished from callus as they tend to interrupt natural skin lines and have small dark dots representing thrombosed capillaries. Warts are usually skin-colored, often painful to touch,  feel rough to the touch, but they can be dark, flat and smooth. Warts can grow anywhere on the body including eyelids, genitalia, hands and feet. There are several different kinds of warts including common warts, flat warts and plantar warts on feet.

Common warts
can present in anyone but are more commonly seen in kids, hands in people often engaged in wetwork, and individuals who are immunosuppressed. Common locations are back of hands and fingers particularly around the nails (periungual area). They are usually seen in places where skin barrier has been compromised, where the skin has been scraped.

Plantar Warts
are simply common warts on the feet and designated as such purely for their location on the feet. Among all of the warts, plantar warts are by far most resistant to treatment given thick callus overlying these warts and that plantar warts get pushed deeper underneath the skin as they are located in weight bearing area. These are typically quite painful, feeling like a piece of rock in the shoe.

Mosaic Warts
are warts that grow in clusters or ring configuration, most commonly due to aftermath of liquid nitrogen cryotherapy as the virus particles get scattered around the periphery of the cryotherapy treated area. These otherwise recalcitrant warts typically respond quite well to laser wart therapy.

Flat warts
can be equally resistant to conventional treatment and are flat-topped, smaller, and smoother than other warts. These are more  commonly seen on the face or legs of adult women where contaminated cosmetic products and shaving may play some roles respectively. They tend to grow in large numbers, even in excess of 100 at any one time. These tend to respond better to prescription-strength antiviral creams such as topical retinoid, imiquimod, 5-fluorouracil (5-FU) or combination of these.

Transmission of Warts
Wart virus thrives on skin of a person and are typically transferred from one person to another. There can be significant incubation period (even several months) between initial exposure such as workout session in a gym or contaminated shower stall. As soon as one gets exposed to the wart (HPV) virus, there is a tug of war between one's immune system and the wart virus. One should refrain from picking at a wart as Dr. Ting has witnessed several cases of spreading of warts to the nostril from frequent picking. Physical presence of a wart manifests local immune system in affected area to have temporarily succumbed to the wart vius. 

Treatment of Warts
While common warts may be treated at home with daily application of duct tape, salicylic acid gel, solution, or plaster, Dr. Ting believes in a multimodal approach in treating resistant warts. including physical destruction (paring, liquid nitrogen), prescription-strength topical antiviral cream (e.g. topical retinoid, imiquimod, 5-FU or combination of these), and boosting one's immune system to fend off the viral replication such as oral zinc supplementation and DPCP immunotherapy. Every last wart needs to be treated as it has the potential to serve as a seed for further viral spread and that occasionally, the HPV within a wart can be carcinogenic, particularly in sun-exposed areas. There have been several reports of squamous cell carcinoma arising from pre-existing warts.

How Does Cutera Genesis Plus Laser Treat Warts?
GenesisPlus Laser is an advanced optimized Nd:Yag laser targeting tiny blood vessels of warts. Each laser exerts its effect via physical interaction of its wavelength and targeting chromophore. The target chromophore for the wart is the vascular component. By obliterating tiny blood vessels within a wart, advanced laser wart therapy by GenesisPlus can dramatically speed up destruction of the most resistant warts.

Insurance coverage of wart therapy 
Most PPO and HMO insurance carriers and Medicare will pay for wart treatment utilizing conventional methods such as paring, cryotherapy, and prescription-strength antiviral creams as recommended by Dr. Ting. Unfortunately, use of laser wart therapy by licensed healthcare provider is typically not covered though out-of-pocket expense can often be reimbursed by Flexible Spending Account (FSA) o Health Savings Account (HSA) if available.