Why Won't My Warts Budge with Cryotherapy?

by Dr Wan Chee Kwang
November 4, 2023

For many individuals grappling with stubborn verruca, the quest for effective wart removal can be an arduous journey. Cryotherapy, a popular treatment method, is frequently sought as a solution. However, there are instances where cryotherapy appears to falter, particularly when dealing with plantar warts or those insidious growths around the nails. The pressing question is whether the warts have somehow developed an immunity to cryotherapy. In this comprehensive guide, we delve into the science behind cryotherapy and why it might not always work.

The Mechanism Behind Cryotherapy

To unravel the mysteries of why cryotherapy might fail, it's crucial to understand how this treatment operates. Cryotherapy hinges on freezing the wart tissue, aiming to induce cell damage and, ideally, the eventual demise of the wart. However, the process has inherent limitations, particularly concerning the treatment of deep-seated warts.

Cryotherapy functions primarily through conduction, where the freezing agent delivers cold energy to the wart tissue. While it can effectively freeze the superficial layers of the wart, it encounters challenges when trying to penetrate the deeper recesses of the wart's base. The key impediment lies in the wart tissue's hypervascularity, meaning it is abundantly supplied with blood vessels. The presence of warm blood flow in this tissue diminishes the cold's effectiveness, allowing the wart-infected tissue at the base to persist and even extend further.

This vascular nature of the wart tissue serves as a protective mechanism, a shield against the freezing temperatures. It essentially keeps the core of the wart insulated from the cold's full impact. This means that while the outer layers of the wart might respond to cryotherapy, the deeper and more crucial regions, where the wart's roots lie, often remain untouched.

large blisters on the hands after cryotherapy for wart removal
Bothersome blisters may occur after cryotherapy for wart removal. You can see that the extent of tissue damage can be much bigger than the wart itself

Drawbacks of Cryotherapy: The Science Explained

One of the primary reasons behind cryotherapy's limitations is its proclivity to damage surrounding healthy tissue. Sometimes, cryotherapy freezing is aggressively intensified in an attempt to freeze the protected core of the wart. Since the hypervascularity of the wart base protects it from the cold, the prolonged exposure to the freezing agent tends to spread outward instead. In its attempt to eliminate the wart, cryotherapy can inadvertently harm the neighbouring skin. This compromised skin becomes more susceptible to HPV infection, which can lead to the recurrence of warts. The resultant damage might also trigger the formation of scar tissue or skin thickening, creating a protective barrier that insulates the wart from further cryotherapy.

In the case of plantar warts, the problem is compounded by the relentless pressure from weight-bearing. This pressure can push the thickened mass of infected tissue even deeper into the skin, making the task of eradicating deep-seated warts an intricate and often challenging process. The physical and biological intricacies surrounding cryotherapy help shed light on why it may not always provide the desired outcome.

The degree of damage that cryotherapy inflicts on the surrounding healthy skin can vary based on the skill and experience of the healthcare provider administering the treatment. In some cases, the skin's reaction to cryotherapy may result in scarring or thickening, which, paradoxically, can provide a protective environment for the wart to thrive.

annular recurrence (ring wart) due to damage of surrounding tissue facilitating the spread of HPV
Annular recurrence/ring wart (C) due to cryotherapy damage to surrounding tissue facilitating the spread of HPV after treatment of a plantar wart (A)

Exploring Alternative Wart Treatment Options

Given the limitations of cryotherapy, it is imperative to explore more effective wart treatment methods. These alternative options take different approaches to address warts effectively.

1. Radiofrequency Ablation: Radiofrequency wart removal involves the use of a special machine that generates radiofrequency waves. Unlike cryotherapy, where the primary mode of action is cold, radiofrequency waves generate more ablation and less heat. This approach offers greater control and precision. It precisely vaporizes only the infected cells, reducing the risk of complications such as scarring or post-inflammatory hyperpigmentation (PIH). While it may require multiple sessions for larger warts, it is highly effective, particularly for complicated or cosmetically sensitive warts, such as those on the face.

2. Ablative and Vascular Lasers: Lasers have become a popular and highly effective choice for wart removal. Ablative lasers can effectively eliminate warts in 1-2 sessions, although deep-seated warts may lead to scarring. More advanced ablative lasers like ultrapulse CO2 offer a high degree of control over tissue damage. These lasers precisely vaporize only the infected cells, reducing the risk of complications such as scarring or post-inflammatory hyperpigmentation (PIH). Vascular lasers, on the other hand, target the blood vessels feeding the wart, causing it to shrink and eventually fall off. While having a lower risk of scarring, they may require multiple sessions and may not be as effective for deeply rooted warts.

3. Combination Laser Treatments: In cases where a single laser modality may have limitations, combination treatments using multiple lasers can overcome these challenges. These treatments aim to provide a comprehensive and effective approach to wart removal. By utilizing different lasers in combination, they can target various aspects of wart tissue, reducing the risks of recurrence and complications.

4. Immunotherapy: Immunotherapy offers an entirely different approach to wart removal. It harnesses the body's immune system to combat the virus-causing warts. Some specific types of wart removal injections, such as MMR (Measles, Mumps, Rubella) vaccine, candida antigen, PPD tuberculin, and vitamin D injections, have been studied for their immunotherapeutic potential. These injections stimulate the immune response, leading to the clearance of the virus and viral-infected cells. They are less invasive and are particularly beneficial for individuals with multiple warts, complex warts, or those seeking to minimize scarring risk and recovery time.

It's important to note that while each of these alternatives has its advantages, they may also have their drawbacks. Radiofrequency and laser treatments can sometimes lead to scarring, especially in cases of deeper or larger warts. Immunotherapy, while less invasive, may take longer and require multiple sessions. It may also have a relatively higher failure rate. The choice of treatment should be based on individual circumstances, wart characteristics, and the expertise of the healthcare provider.

In Conclusion: Your Path to Wart-Free Skin

Warts can be incredibly persistent and frustrating, especially when cryotherapy fails to provide the desired results. The key to effective wart removal lies in understanding the complexities of wart tissue and exploring the most suitable treatment options. In your journey to clear, healthy skin, it's essential to work closely with a knowledgeable dermatologist or doctor who can assess your unique situation and recommend the best course of action.

By understanding the science behind wart treatments and the alternatives available, you can take a proactive approach to finally rid yourself of those stubborn warts that have persisted for far too long. Don't let your warts hold you back any longer; the path to clear and healthy skin is within reach.

With precision treatments like radiofrequency, laser therapies, and immunotherapy, there are more possibilities than ever to tackle warts effectively. It's time to break free from the limitations of cryotherapy and embark on a path to wart-free skin. Explore these options and make an informed decision for a future free from persistent warts. If you have a wart that seems to resist cryotherapy, drop us a note today to schedule a consultation for an in-depth assessment!


  1. Truong, K., Joseph, J., Manago, B., & Wain, T. (2022). Destructive therapies for cutaneous warts: A review of the evidence. Australian journal of general practice51(10), 799–803. https://doi.org/10.31128/AJGP-01-22-6305
  2. Nofal A, Salah E, Nofal E, Yosef A. Intralesional antigen immunotherapy for the treatment of warts: current concepts and future prospects. Am J Clin Dermatol. 2013;14(4):253–260. doi: 10.1007/s40257-013-0018-8. [PubMed]

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