WART TREATMENT IN ISTANBUL

Diagnosis and Advanced Therapies for HPV-Related Skin and Genital Warts

Warts (verrucae) are one of the most common viral skin infections encountered in dermatology and gynecology clinics. They are benign growths caused by specific types of the human papillomavirus (HPV), affecting both the skin and mucous membranes.
In Istanbul, many patients seek treatment for common, plantar, or genital warts due to discomfort, aesthetic concerns, or fear of contagion. Modern medicine offers multiple safe and effective approaches for wart diagnosis and treatment — both non-surgical and surgical — with excellent cosmetic outcomes and minimal recurrence.

For information and appointments in Istanbul: +90 541 998 34 34

Understanding Warts and HPV Infection

Warts are the result of HPV infection in the basal layer of the epidermis. The virus stimulates keratinocyte proliferation, creating rough, raised lesions that can appear on the hands, feet, face, genital area, or mucosa.
While most warts are harmless, some persist or spread, particularly in humid climates and among people with minor skin trauma or weak immune systems.
In Istanbul, dermatology and gynecology clinics often encounter both cutaneous (skin) and anogenital (mucosal) wart types, each requiring specific management.

Types of Warts

Common warts (Verruca vulgaris): Hard, raised growths typically found on fingers, hands, or knees.
Plantar warts (Verruca plantaris): Occur on the soles of the feet; can be painful while walking.
Flat warts (Verruca plana): Smooth, slightly elevated, often on the face or legs.
Genital warts (Condylomata acuminata): Soft lesions affecting the vulva, penis, anus, or perineum; caused mostly by HPV types 6 and 11.
Subungual warts: Under or around fingernails, difficult to treat due to thick keratin.

The type and location of warts guide the physician in choosing the optimal therapy.

Diagnosis of Warts in Istanbul Clinics

In most cases, clinical examination is sufficient to diagnose warts. The typical rough surface, color, and anatomic location provide clear diagnostic clues.

Additional Diagnostic Methods

Dermoscopy: A non-invasive imaging tool that magnifies skin structures and helps differentiate warts from corns, calluses, or keratoacanthomas.
Acetic acid test: Used for genital warts; 3–5% acetic acid may turn lesions white, but specificity is limited.
HPV typing (PCR): Rarely necessary but useful for research or recurrent genital cases.
Biopsy: Reserved for atypical or non-responsive lesions to exclude squamous cell carcinoma.

Assessing Associated Conditions

For genital warts, evaluation may include:

Screening for other sexually transmitted infections (STIs).
Pap smear and colposcopy in women for cervical lesions.
HIV testing for patients with extensive, recalcitrant warts.
Early, accurate diagnosis allows personalized treatment and reduces recurrence.

Treatment Goals and General Principles

The main objectives in wart treatment are:

Eradicate visible lesions while preserving healthy tissue.
Relieve symptoms like itching, burning, or pain.
Prevent spread to other body sites or partners.
Reduce recurrence and improve cosmetic outcomes.

While no treatment completely removes latent HPV DNA, combination therapy and immune modulation can achieve long-term clearance.

Treatment plans in Istanbul are customized according to:

Wart type and size,
Location (hands, feet, genitals, mucosa),
Patient age and pain tolerance,
Pregnancy status,
Immunity level.

Non-Surgical and Topical Treatments

1. Salicylic Acid Preparations

Salicylic acid is one of the most widely used first-line treatments for cutaneous warts. It acts as a keratolytic agent, gradually peeling off infected skin.
In Istanbul, pharmacies and dermatology clinics offer various formulations — gels, plasters, or solutions (10–40%).
Daily application after soaking the wart in warm water and gentle paring accelerates healing. Treatment may last several weeks.
Minor irritation is expected and is usually well tolerated.

2. Imiquimod Cream

Imiquimod 5% stimulates the body’s immune response (via interferon-α and cytokines).
It is mainly used for genital and perianal warts in both men and women.
Application: three times per week at bedtime, left for 6–10 hours, washed off in the morning. Treatment may continue up to 16 weeks.
It may cause local redness or mild inflammation, indicating immune activity.
This agent is widely available in Istanbul and often prescribed by gynecologists for vulvar lesions.

3. Podofilox (Podophyllotoxin)

A cytotoxic agent that destroys infected tissue.
Applied twice daily for three consecutive days followed by four days off; repeat cycles up to four times.
Should not be used during pregnancy or on large areas (>10 cm²).
Used primarily for external genital warts under physician supervision.

4. Sinecatechins 15% Ointment

Derived from green tea extract, this natural immune-modulating cream is applied three times daily for up to 16 weeks.
It is particularly effective in genital and perianal warts, well-tolerated with minimal systemic absorption.
Clinics in Istanbul often recommend this therapy for patients seeking plant-based options.

5. Trichloroacetic Acid (TCA)

A chemical cauterization method performed by doctors.
The acid (80–90%) is applied directly to the wart surface, causing controlled tissue necrosis.
Used safely in pregnant women and on mucosal lesions.
Repeat sessions weekly until clearance.

6. Other Topicals

Retinoic acid (tretinoin): For flat facial warts.
5-Fluorouracil: Occasionally used for resistant plantar warts.
Cimetidine or zinc supplements: Limited evidence but sometimes used as adjuncts to enhance immunity.

Office-Based and Surgical Treatments in Istanbul

When topical therapies fail or warts are large, thick, or painful, physician-administered procedures are preferred.

1. Cryotherapy

Freezing the wart with liquid nitrogen remains one of the most effective and widely used techniques in Istanbul clinics.
It causes cell destruction through freezing and thawing cycles.
Typically performed every 2–3 weeks for several sessions.
Side effects: temporary pain, blistering, or light pigmentation changes.
Success rate: 70–90% after multiple sessions.

2. Electrocautery / Electrosurgery

Electric current is used to burn wart tissue.
Offers immediate results and is suitable for stubborn warts.
Requires local anesthesia; minor scarring may occur.
Post-treatment wound care is essential to avoid infection.

3. Laser Therapy

CO₂ laser or pulsed dye laser effectively vaporizes wart tissue, ideal for extensive genital or resistant plantar warts.
Laser treatment in Istanbul is available in advanced dermatology centers with strict safety protocols.
Advantages: precision, minimal bleeding, excellent cosmetic outcome.
Drawback: higher cost, possible recurrence if HPV persists in nearby tissue.

4. Surgical Excision or Curettage

Physical removal under local anesthesia.
Recommended for single, large, or keratinized warts.
Healing usually within 1–2 weeks.
Sometimes combined with cauterization to reduce recurrence.

5. Photodynamic Therapy (PDT)

Involves applying a photosensitizing agent (e.g., aminolevulinic acid) followed by specific light exposure.
Useful for multiple, flat, or recalcitrant warts, including genital types.
Available in selected Istanbul dermatology centers.

6. Immunotherapy (Advanced Option)

Newer immunotherapeutic methods use intralesional injections (e.g., Candida antigen or MMR vaccine) to stimulate systemic clearance.
Recent Turkish and international studies show promising results for patients with chronic or recurrent warts.

Managing Genital Warts in Istanbul Gynecology Clinics

Genital warts (condyloma acuminata) are among the most common sexually transmitted infections in Turkey.
They may appear weeks or months after HPV exposure.
Treatment aims to remove visible lesions, relieve discomfort, and reduce transmission risk — though the virus may persist subclinically.

Available treatments for genital warts in Istanbul include:

Imiquimod, Podofilox, Sinecatechins (patient-applied)
Cryotherapy, Electrocautery, TCA, Laser (clinician-applied)
Surgical excision for large clusters

Important Counseling Points

Treatment removes visible lesions, not latent HPV.
Condom use reduces but does not fully prevent transmission.
HPV vaccination (Gardasil 9) is recommended for both sexes.
In women, Pap smear and HPV DNA testing should continue as routine screening.

Special Considerations

During Pregnancy

Avoid Podofilox, Podophyllin, and Imiquimod.
Preferred options: Cryotherapy or Trichloroacetic acid (TCA).
Delivery method: Cesarean section only if large obstructive warts are present.

In Immunocompromised Patients

Warts may be multiple and resistant.
Combination therapy, including immunomodulators, is often necessary.
Regular follow-up in specialized clinics in Istanbul is recommended.

In Children

Most common: flat or common warts.
Prefer conservative options like salicylic acid or cryotherapy.
Avoid aggressive surgical methods to prevent scarring.

Prognosis and Recurrence

Recurrence rates range between 20–40%, depending on immune status, HPV type, and treatment adherence.
Even after complete removal, microscopic virus particles may remain in adjacent tissue.
Maintaining a strong immune system, avoiding trauma, and following preventive hygiene greatly improve long-term outcomes.

Prevention and Patient Education

Avoid direct contact with warts (self or others).
Do not share razors, towels, or footwear.
Keep skin dry and intact; cover cuts or abrasions.
Practice safe sex; use condoms with new partners.
Consider HPV vaccination for prevention of both genital warts and HPV-related cancers.
Maintain regular dermatologic or gynecologic check-ups in Istanbul clinics for early detection.

Evidence-Based Summary

Warts result from localized HPV infection; spontaneous regression occurs in some, others require therapy.
First-line treatments: salicylic acid for cutaneous warts, imiquimod or cryotherapy for genital types.
Refractory cases: electrocautery, CO₂ laser, photodynamic therapy, or surgical removal.
Recurrence: common, but reduced through immune modulation and vaccination.
Multimodal therapy — combining destructive and immune-boosting treatments — yields the highest clearance rates.

Comprehensive Wart Care in Istanbul

Istanbul hosts numerous dermatology, venereology, and gynecology centers providing state-of-the-art wart management.
From simple salicylic acid therapy to advanced CO₂ laser surgery, patients receive individualized care in sterile, confidential environments.
English, Arabic, Russian, and Turkish-speaking specialists are available for international patients.
Modern protocols align with UpToDate, CDC, and European (IUSTI) guidelines to ensure safe, effective, and evidence-based results.

For examination, diagnosis, and personalized wart treatment in Istanbul: +90 541 998 34 34

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