Treatment of Verruca Vulgaris (Common Warts) with Cryotherapy in an 18-Year-Old Male
By: Dr. Caroline Vaughn
Patient Presentation
An 18-year-old male presented as a new patient to our dermatology clinic in Katy, Texas, with multiple irregular skin lesions on his right hand and right elbow. The lesions had been present for several months and were moderately symptomatic, with intermittent itching and inflammation. He presented today for cryotherapy treatment.
Clinical Examination
A focused examination of the right forearm and hand revealed multiple verrucous papules consistent with verruca vulgaris (common warts). The lesions were distributed on the right elbow, right anterior distal thigh, right knee, right thenar eminence, and right radial palm.
The patient appeared well-developed and well-nourished, in no acute distress, and was alert and oriented. Dermatoscopic evaluation confirmed characteristic features of viral warts, including thrombosed capillaries and irregular surface texture.
Diagnosis
Verruca Vulgaris (B07.8)
Associated findings included mild pruritus and cutaneous inflammation at the affected sites.
Treatment Plan and Counseling
The diagnosis and treatment options were reviewed in detail. The patient was informed that resolution of viral warts may require three to four sessions of cryotherapy. Alternative treatment options such as topical salicylic acid, retinoids, Imiquimod (Aldara), Candida antigen injections, or Cantharidin were discussed for future consideration if cryotherapy proves insufficient.
Procedure: Liquid Nitrogen Cryotherapy
A total of 8 lesions were treated using liquid nitrogen, located on:
Right elbow
Right anterior distal thigh
Right knee
Right thenar eminence
The procedure was performed after informed consent, discussing potential risks including blistering, scarring, pigmentary changes, recurrence, incomplete removal, and infection. The patient tolerated the procedure well.
Post-Treatment Instructions:
Expect mild redness, swelling, or blistering for a few days.
Avoid picking or scratching the treated areas.
Apply a gentle moisturizer or petroleum jelly as needed.
Contact the office if lesions spread or become painful.
The patient was scheduled to follow up in one month for reassessment and potential retreatment.
Discussion
Verruca vulgaris is a benign but contagious viral infection caused by the human papillomavirus (HPV). It is commonly seen in teenagers and young adults, particularly on the hands, knees, and elbows due to frequent microtrauma and skin contact.
At Village Dermatology in Katy and Houston, Texas, cryotherapy remains a first-line, effective, and well-tolerated treatment for common warts. By freezing the lesion and destroying virally infected keratinocytes, cryotherapy can lead to clearance over several sessions while minimizing scarring.
Alternative treatments such as Candida antigen immunotherapy can be considered for resistant cases, leveraging the body’s immune response to clear both treated and distant warts.
Conclusion
This case highlights the successful initial management of verruca vulgaris using liquid nitrogen cryotherapy in an adolescent male. With consistent follow-up and adherence to post-treatment care, the patient’s prognosis for full resolution is excellent.
