Wart and milia removal in Calgary

Wart and milia removalat Rejuvenation Dermatology Calgary South.

Warts are a viral infection of the skin and are treated in clinic with cryotherapy, prescription topicals, immunotherapy and laser, chosen for the type, site and age of the patient. Milia are small keratin cysts and are removed by extraction in a single visit. Dr. Paul Kuzel, a board-certified dermatologist, confirms the diagnosis and performs the treatment.

Book a consultation Call (403) 286-6888

14Years of training FRCPCRoyal College certified VPAlberta Society of Dermatologists

What they are

A virus in the skin, and a trapped keratin cyst.

Warts and milia are grouped here because both are small, benign and commonly brought to a dermatologist for removal. They are otherwise unrelated, and they are treated differently.

WartsWarts are caused by human papillomavirus infecting the outer layer of the skin, which responds by thickening into a rough growth. The virus spreads by direct contact and through damp surfaces, and can spread on the same person by scratching or shaving. Warts persist because the virus sits below the reach of the immune system, and every treatment works by either destroying the infected tissue or provoking an immune response against it.

MiliaMilia are tiny white cysts, one to two millimetres across, formed when keratin becomes trapped just beneath the surface of the skin. They are common around the eyes, on the cheeks and nose, and in newborns. They are not acne, not contagious and not harmful, and they do not respond to squeezing or to acne treatment.

What each needsWarts need a treatment that reaches the virus, usually over several sessions, because the immune system must be recruited to prevent recurrence. Milia need a single, precise extraction of the cyst through a small opening in the skin, after which they do not return at that site.

The types

Types of wart, and where they present.

The type and site of a wart determine which treatment is appropriate. Plantar warts on the sole, for example, tolerate aggressive treatment that would scar the face.

Hands and fingers

Common warts

Rough, raised, dome-shaped growths, often with small black dots that are clotted capillaries. Most common on the backs of the hands, fingers and around the knees, and most common in children.

Respond to cryotherapy, cantharidin and topical salicylic acid
Often clear spontaneously in children within two years

Soles of the feet

Plantar warts

Warts on the sole, pushed inward by the pressure of walking, often painful and sometimes clustered into a mosaic. Frequently mistaken for corns or calluses, which they are distinguished from by their black dots and interruption of the skin lines.

The most resistant type; several sessions are usual
Treated with cryotherapy, cantharidin, immunotherapy or laser

Face, hands and legs

Flat warts

Small, smooth, flat-topped and slightly raised, often in large numbers, on the face, backs of the hands and shins. Spread by shaving. More common in children and young adults.

Treated with topical retinoids or immunotherapy rather than destruction, to avoid scarring

Around and under the nails

Periungual and filiform warts

Periungual warts grow around and under the nail, can distort nail growth, and are difficult to treat. Filiform warts are thread-like projections on the face, eyelids and neck.

Periungual warts require patience and often combination treatment
Filiform warts are removed in one visit by snip excision or cautery

Why a dermatologist

Diagnosis first, then the correct method for the site.

Most warts and milia are straightforward. The value of a dermatologist is in recognising the ones that are not, and in choosing a treatment that removes the lesion without leaving a mark that is worse than the lesion was.

Confirming the diagnosisSeborrhoeic keratoses, corns, molluscum, and occasionally squamous cell carcinoma or amelanotic melanoma are mistaken for warts. A lesion that bleeds, grows quickly, or fails to respond to standard treatment is biopsied rather than frozen again.

The full range of methodsBeyond cryotherapy, the clinic offers cantharidin, intralesional immunotherapy, prescription topicals, electrocautery and laser. Warts that have resisted months of over-the-counter treatment usually respond to a method that was not available at the pharmacy.

Site-appropriate treatmentThe face, eyelids, fingertips and nail folds scar easily and are treated conservatively. The sole tolerates aggressive treatment. Children are treated with painless methods first. Selecting by site is what prevents a permanent mark.

CoverageAssessment of warts is medical dermatology, generally covered by Alberta Health Care with a referral. Treatment of warts and removal of milia are considered cosmetic under Alberta's fee schedule and are quoted at the consultation. Treatment of painful plantar warts or warts in immunocompromised patients may be covered; the team advises when you book.

Treatment

Methods, selected by type, site and age.

No single wart treatment works for everyone, and most resistant warts are cleared by combining methods. Milia are handled separately, in one visit.

First line

Cryotherapy

Liquid nitrogen applied to the wart for a few seconds freezes the infected tissue, which blisters and sheds over one to two weeks. Repeated every two to four weeks until clear, typically three to six sessions. Effective for common and plantar warts in adults.

Brief stinging during and after; a blister the next day is expected
Used cautiously near nails and on the face

Children and sensitive sites

Cantharidin

A painless topical blistering agent applied in clinic and washed off at home after a set time. A blister forms under the wart and lifts it away. Preferred for children and for warts where cryotherapy would be too painful.

No discomfort at the time of application
Repeated at three-week intervals as needed

Resistant warts

Immunotherapy

An injection of a small amount of Candida antigen into the wart provokes an immune response against the virus, which can clear the treated wart and untreated warts elsewhere. Used for multiple, recurrent or long-standing warts.

Three to five injections, three weeks apart
Particularly useful for plantar and periungual warts

Home and adjunct

Prescription topicals

High-strength salicylic acid, topical retinoids for flat warts, and immune-modifying creams, used between clinic sessions to speed clearance. Paring of thick plantar warts in clinic improves penetration.

Selected cases

Laser and electrocautery

Pulsed dye laser targets the blood supply of resistant warts. CO₂ laser ablation and electrocautery remove the wart tissue directly and are reserved for warts that have failed other methods, because they carry a higher risk of scarring.

CO₂ laser lesion removal

One visit

Milia extraction

The skin over each milium is opened with a sterile needle or fine blade and the keratin cyst is expressed. The procedure takes seconds per lesion, requires no anaesthetic, and heals without a mark within a few days. Persistent or numerous milia may be treated with a topical retinoid to prevent new ones forming.

Milia removal

Your visit

Assessment and treatment in the same appointment.

Most warts and all milia are treated at the first visit. Warts then need follow-up sessions at two to four week intervals until clear.

AssessmentThe lesion is examined, with dermoscopy where needed, and the diagnosis confirmed. Anything atypical is biopsied.

MethodTreatment is chosen for the type of wart, its site, the patient's age, and what has been tried before.

TreatmentPerformed the same day. Cryotherapy, cantharidin or an injection takes minutes. Milia are extracted immediately.

AftercareWritten instructions for the blister or wound, and any home treatment to use between visits.

Follow-upWarts are reviewed every two to four weeks and retreated until clear. The method is changed if there is no response after three sessions.

Aftercare

What to expect after treatment.

Each method produces a predictable reaction. Knowing what is normal, and what is not, avoids unnecessary concern.

Normal recovery

After cryotherapy: stinging for an hour, a blister within a day, which dries and sheds over one to two weeks
After cantharidin: a blister at 24 to 48 hours, sometimes tender, which resolves within a week
After immunotherapy: redness and itch at the site for a few days, occasionally mild flu-like symptoms
After milia extraction: a pinpoint mark that heals within two to three days
Leave blisters intact where possible; if one breaks, clean and cover it
Continue any prescribed home treatment between visits
Contact the clinic for spreading redness, pus or increasing pain after 48 hours

Referrals and booking

Assessment of warts is generally covered by Alberta Health Care with a referral from your family physician, faxed to (403) 225-2914. Wart treatment and milia removal are usually cosmetic under Alberta's fee schedule and are quoted at consultation. Call (403) 286-6888 and the team will confirm what applies.

Children are welcome. Painless methods are used first.

What to expect

Expected outcomes.

Most common warts clear within three to six treatment sessions. Plantar and periungual warts take longer, and a proportion require combination treatment or immunotherapy. Because the virus can persist in surrounding skin, a small number recur after apparent clearance and are treated again. In children, many warts resolve spontaneously, which is weighed against treatment when the wart is not troublesome.

Milia are removed completely in one visit and do not recur at the same site. New milia can form elsewhere, particularly in patients who use heavy creams around the eyes, and a topical retinoid reduces this.

Treatment is chosen to avoid scarring. Cryotherapy can leave a pale mark on darker skin, which is discussed beforehand and is one reason other methods are preferred on the face.

3 to 6Sessions for a typical wart 2 to 4Weeks between sessions 1Visit to remove milia

Questions

Questions about warts and milia, answered.

Is wart treatment covered by Alberta Health Care?

Assessment is generally covered with a referral. Treatment of warts is classed as cosmetic under Alberta's fee schedule in most circumstances and is quoted at consultation. Painful plantar warts and warts in patients with weakened immune systems may be treated under coverage; the team confirms this when you book.

Do I need a referral?

For a covered assessment, a referral from a physician is the normal route, and it can be faxed to (403) 225-2914. Cosmetic wart treatment and milia removal can be booked directly. If you do not have a family doctor, call (403) 286-6888 and the team will advise.

Does cryotherapy hurt?

It stings sharply for a few seconds during the freeze and aches for up to an hour afterwards. Most adults tolerate it without anaesthetic. For children, and for sensitive sites, cantharidin is used instead because it is painless at the time of application.

Why did the wart come back after treatment?

The virus lives in the skin around the visible wart, and treatment that destroys the wart may leave infected cells behind. Recurrence is common with any single method, which is why treatment is repeated until fully clear and why immunotherapy, which trains the immune system to recognise the virus, is used for warts that keep returning.

Are warts contagious?

Yes, by direct contact and through damp surfaces such as pool decks and shared showers. They can also spread on the same person by scratching, picking or shaving over them. Covering warts, avoiding sharing towels and wearing footwear in communal wet areas reduces transmission.

Should a child's warts be treated?

Not always. Many warts in children resolve on their own within two years, and treatment is reserved for warts that are painful, spreading, in a location that causes embarrassment, or that the child wants removed. When treatment is chosen, painless methods such as cantharidin are used first.

What are milia, and can I remove them myself?

Milia are small keratin cysts just beneath the skin surface. They cannot be squeezed out like a blackhead because the keratin is sealed beneath intact skin, and attempts at home usually cause bruising, infection or scarring. Extraction in clinic opens the skin precisely and removes the cyst in seconds.

Why do I keep getting milia?

Milia are more common with heavy occlusive creams, particularly around the eyes, with sun damage, and after skin injury or blistering. Changing to lighter products and using a topical retinoid reduces new milia. Existing ones still need extraction.

Can a wart be something else?

Yes. Seborrhoeic keratoses, corns, molluscum and, rarely, skin cancers are mistaken for warts. A lesion that bleeds, grows quickly, changes colour or does not respond to treatment is biopsied. This is the principal reason to have persistent lesions assessed by a dermatologist rather than treated indefinitely at home.

Who performs the treatment?

Dr. Paul Kuzel, MD FRCPC, a board-certified dermatologist and the founder and Medical Director of Rejuvenation Dermatology Calgary South. He sees patients in English and Czech.

If you want to go deeper.

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Book an assessment.

Book a consultation with Dr. Kuzel, or ask your family physician for a referral. Children welcome.