Skip to content
The Skin Doctor

Warts are benign viral (HPV) skin growths that can be stubborn, contagious and painful. The Skin Doctor offers tailored treatment — from salicylic acid and cryotherapy through to an advanced four-step laser plus photodynamic therapy protocol (Nd:YAG, complete Er:YAG ablation, fractional channels, ALA-PDT) for stubborn, recurrent, peri-ungual or multiple warts.

Viral skin infection

Warts

Warts are benign (non-cancerous) skin growths caused by human papillomavirus (HPV). They can be stubborn, spread to nearby skin, and in some locations — especially the soles of the feet or around the nails — become painful or difficult to clear. Many warts respond to simple home or in-clinic options; for stubborn, recurrent, thick or peri-ungual warts, energy-based treatments (Nd:YAG, ablative lasers, photodynamic therapy) have a growing evidence base.

Portrait of Dr Christopher Irwin

By Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA

Published 2026-06-06 · Updated 2026-06-28 · Editorial policy

For a diagnosis and tailored plan — including whether the advanced laser wart pathway is appropriate — book a review with Dr Chris. If you have multiple warts and want a comprehensive plan, a combined booking (20-minute medical + 40-minute dermal therapist) is available.

Key takeaways

  • Warts are harmless, but they are contagious and can spread on your skin or to others. 1,2,3
  • Many clear naturally over time, but that can take months to years — and some persist. 1,2,3
  • Standard treatments (salicylic acid, cryotherapy, cantharidin, immune creams) help many people, but recurrence is common. 1,2,3,4
  • For stubborn warts, energy-based treatments (Nd:YAG, ablative lasers, PDT) have a growing evidence base. 4,5,6,7
  • Notably, in one controlled study of plantar warts, HPV DNA was undetectable in every wart treated with Nd:YAG laser hyperthermia, but remained present in 96% of warts treated with cryotherapy. 4,12

What are warts?

Warts form when HPV infects the top layer of skin, usually entering through tiny breaks. The virus triggers extra growth of skin cells, creating a rough keratinous bump. 1,2,3

They occur in both children and adults — adults commonly present with persistent plantar (foot) warts, peri-ungual warts, or recurrent warts after partial treatment. 1,2,3

How warts spread (and how to stop spread)

HPV can spread by direct contact and via shared surfaces/items, especially in warm moist environments (pools, change rooms). The incubation period can be long, so exposure isn’t always obvious. 1,2,3

Simple prevention steps:

  • don’t pick or shave over warts
  • cover warts during sport/gym/pool use
  • don’t share nail clippers/razors/towels
  • wear footwear in communal wet areas 1,2,3

Types of warts

  • Common warts (hands/fingers)
  • Plantar warts / verrucas (soles) — often painful because pressure pushes them inward
  • Flat warts (face/legs/hands) — can occur in large numbers
  • Filiform warts (face) — finger-like growths
  • Peri-ungual warts (around nails) — can distort the nail and are often stubborn 1,2,3,4

When to get a wart checked

Book a review if:

  • the diagnosis is uncertain (not everything rough is a wart)
  • it bleeds repeatedly, ulcerates, or is rapidly changing
  • it’s on the face or genital region (sensitive areas)
  • it’s painful (especially plantar), spreading, or persistent
  • you are immunosuppressed, diabetic (feet), or have poor circulation 1,2,3

If you’re unsure what a lesion is, see Other Dermatological Conditions.

Our advanced 4-step laser and PDT wart protocol

For stubborn, recurrent, thick, peri-ungual, mosaic, or multiple warts, we offer an advanced multi-modality pathway that targets different “pillars” of wart persistence. 4,5,6,7

Why this matters: warts are often resistant because HPV-infected tissue can persist below the visible surface, and because partial treatment can leave a viable “base” behind. 1,2,3,4

Step 1 — Nd:YAG (1064 nm): reduce blood supply and weaken the wart

Nd:YAG targets haemoglobin within the wart’s vascular supply. Histologic studies describe devascularisation effects and dermo-epidermal separation after treatment. 4

Key virology point: in a controlled plantar wart study (25 patients per arm), HPV DNA was undetectable after Nd:YAG laser hyperthermia, compared with 96% of cryotherapy-treated warts in which it remained. 4,12

Step 2 — Complete Er:YAG ablation: remove wart tissue precisely

Ablative Er:YAG physically removes wart tissue with high precision. Across the energy-based device literature, ablative laser cohorts report high clearance rates, though the published studies vary widely in protocol, wart type and follow-up, so a single representative figure would be misleading. 4,6

Step 3 — Fractional Er:YAG “wells”: improve penetration into deeper wart structures

Fractional ablative laser creates micro-channels that bypass the barrier of the epidermis, improving topical delivery into deeper structures — the basis of laser-assisted drug delivery. 8,9,10

In our protocol, this step is used to help the photosensitiser reach deeper residual wart tissue before PDT.

Step 4 — Apply ALA and perform photodynamic therapy (PDT)

PDT uses a photosensitiser (such as ALA) plus light to generate reactive oxygen species that destroy infected keratinocytes. Systematic reviews report meaningful clearance in recalcitrant warts. In a controlled plantar wart study, 75% of ALA-PDT–treated warts (48 of 64) had resolved two months after the last session, compared with 22.8% (13 of 57) of vehicle-treated control warts. 4,7,11

Why we combine these steps

Each step targets a different vulnerability:

  • Blood supply + HPV burden (Nd:YAG)
  • Complete physical clearance (Er:YAG ablation)
  • Depth and delivery (fractional wells / laser-assisted drug delivery)
  • Microscopic residual infected cells + recurrence reduction (ALA-PDT) 4,6,7,8,9,10

In our clinical experience, this combination is extremely effective for appropriately selected patients, particularly when standard methods have failed.

For a broader overview of our laser devices and how each modality works, see the Laser & Light Treatments hub.

Evidence behind each step (plain English)

  • Nd:YAG: systematic reviews report efficacy, and a controlled study found HPV DNA cleared after Nd:YAG laser hyperthermia but persisting in 96% of cryotherapy-treated warts. 4,12
  • Er:YAG ablation: the same evidence base includes Er:YAG wart cohorts with high clearance outcomes in multiple wart subtypes. 4,6
  • ALA-PDT: systematic reviews show clearance ranges across sites and protocols, and a controlled plantar wart study found substantially higher clearance with ALA-PDT than with vehicle treatment (75% vs 22.8% of warts at two months). 4,7,11
  • Fractional channels: laser-assisted drug delivery reviews support that ablative fractional lasers create channels that enhance penetration of topicals (including ALA-based approaches used in PDT). 8,9,10

Other wart treatment options (we tailor to you)

We don’t “over-laser” everyone. Many warts respond to simpler options, especially early.

Home and pharmacy options

  • Salicylic acid (wart paints/plasters): first-line when used consistently for weeks to months. 1,2,3
  • Duct tape occlusion: low risk, mixed evidence; sometimes used as an adjunct. 2,3

In-clinic options

  • Cryotherapy (liquid nitrogen): common; can cause hypo or hyperpigmentation, often needs multiple sessions; can be painful. 1,2,3,4
  • Cantharidin: useful for selected sites/patients; typically well tolerated at application. 2,3,4
  • Curettage/electrosurgery: selected cases; effective but scar risk depends on location. 2,3,4
  • Topical immune / prescription options (selected cases):
  • Immunotherapy (selected stubborn cases): contact immunotherapy and antigen approaches in appropriate settings. 2,3,4

Aftercare and prevention

  • Follow dressing and aftercare instructions to reduce infection and pigment change risk.
  • Avoid picking/shaving over the area.
  • Use footwear in communal wet areas. 1,2,3

Book

For a diagnosis and a tailored plan — including whether the advanced laser wart pathway is right for you — book a review with Dr Chris at Ivanhoe or Diamond Creek. If you have multiple warts and want a comprehensive plan, ask about the combined booking (20-minute medical + 40-minute dermal therapist).

You can also read about our laser wart treatment, or compare the prescription creams Aldara (imiquimod) and Efudix (5-fluorouracil).

Clinics — Ivanhoe (Unit 1/1065 Heidelberg Road, Ivanhoe VIC 3079) and Diamond Creek (Shop 12/67 Main Hurstbridge Road, Diamond Creek VIC 3089).

Symptoms

Causes & contributors

Diagnosis

Most warts are diagnosed clinically. Not everything rough is a wart — some lesions can mimic warts and some warts can mimic other lesions, so doctor-led review is important when the diagnosis is uncertain, especially on the face or genital region. Dermoscopy helps identify the characteristic thrombosed capillary pattern. Biopsy is occasionally needed if a lesion is bleeding, ulcerating or atypical.

Treatment options

Salicylic acid (wart paints/plasters)

First-line home option when used consistently for weeks to months. Often effective for simple hand or foot warts.

Cryotherapy (liquid nitrogen)

Common in-clinic option. Can cause hypo- or hyperpigmentation, often needs multiple sessions, and can be painful — especially on the feet.

Cantharidin

A topical blistering agent applied in clinic. Useful for selected sites and patients. Typically painless at application; later blistering produces controlled separation of the lesion.

Curettage / electrosurgery

Selected cases. Effective but scar risk depends on location.

Prescription topicals (selected cases)

Options may include imiquimod (Aldara) for immune modulation, topical 5-fluorouracil (Efudix) for selected flat-wart protocols, and retinoids (often for flat warts).

Advanced 4-step laser + PDT protocol →

For stubborn, recurrent, thick, peri-ungual, mosaic or multiple warts — Nd:YAG (1064 nm) to reduce vascular supply, complete Er:YAG ablation, fractional Er:YAG "wells" to enhance delivery, then ALA + photodynamic therapy. Each step targets a different vulnerability — blood supply and HPV burden, complete physical clearance, depth and delivery, and microscopic residual infected cells.

Immunotherapy

Contact immunotherapy and antigen approaches for selected stubborn cases.

When to see a doctor

Book a review if the diagnosis is uncertain (not everything rough is a wart), if a lesion bleeds repeatedly, ulcerates or is rapidly changing, if a wart is on the face or genital region, if it is painful (especially plantar), spreading or persistent, or if you are immunosuppressed, diabetic (feet) or have poor circulation.

Frequently asked questions

  • Who is a good candidate for your laser + PDT wart protocol?
    It is often a good fit for stubborn, recurrent, thick, peri-ungual, mosaic or multiple warts — especially when cryotherapy or topical treatments have not worked, or when warts are painful or affecting function.
  • How many sessions will I need?
    It depends on wart type, thickness, and location. Some clear quickly; stubborn plantar and peri-ungual warts often need staged care. The aim of our protocol is fewer partial results and a stronger emphasis on completeness. 4,5,6,7
  • What is the downtime?
    Most treatments create a healing phase (crusting or a superficial wound). We tailor dressings and activity advice based on location (hands vs feet) and your work or sport needs.

References

  1. Al Aboud AM, Nigam PK. Wart. StatPearls. Treasure Island (FL) — StatPearls Publishing (2023).
  2. DermNet NZ. Viral warts (verrucae).
  3. Cleveland Clinic. Warts (last updated 2024).
  4. Le M, Conte S, Hsu JTS, Li MK. Energy-based devices for the treatment of cutaneous verrucae — a systematic review. Dermatol Surg (2024).
  5. Australasian College of Dermatologists. Warts (last updated 2025).
  6. Iranmanesh B, Khalili M, Zartab H, Amiri R, Aflatoonian M. Laser therapy in cutaneous and genital warts — a review article. Dermatol Ther (2021).
  7. Maranda EL, Lim VM, Nguyen AH, Nouri K. Laser and light therapy for facial warts — a systematic review. J Eur Acad Dermatol Venereol (2016).
  8. Waibel JS, Wulkan AJ, Shumaker PR. Update of ablative fractional lasers to enhance cutaneous topical drug delivery. Dermatol Surg (2017).
  9. Thunshelle C, Yin R, Kerscher M, Hamblin MR. Current advances in 5-aminolevulinic acid mediated photodynamic therapy. Photodiagnosis Photodyn Ther (2016).
  10. Lee WR, Shen SC, Wang KH, et al. Fractional laser as a tool to enhance the skin permeation of 5-aminolevulinic acid with minimal disruption. J Control Release (2010).
  11. Fabbrocini G, Di Costanzo MP, Riccardo AM, et al. Photodynamic therapy with topical delta-aminolaevulinic acid for the treatment of plantar warts. J Photochem Photobiol B (2001);61(1-2):30-4.
  12. El-Tonsy MH, Anbar TE, El-Domyati M, Barakat M. Density of viral particles in pre and post Nd:YAG laser hyperthermia therapy and cryotherapy in plantar warts. Int J Dermatol (1999);38(5):393-8.

Related

Related conditions

Related treatments

Medically reviewed by Dr Christopher Irwin, MBChB, FRACGP, MMed (Skin Cancer), FACAM, MSCCA · Published 2026-06-06 · Updated 2026-06-28 · Editorial policy