San Francisco Podiatry Video

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Tuesday, March 5, 2013

Should I drain a liquid nitrogen wart blister?


Question:

I got a blister when I recently tried the liquid nitrogen treatment to freeze a wart on my foot. It is tender and so I stopped running. Should I try to drain the blister so I can run?


Answer:

The idea with treating a wart with liquid nitrogen is in fact to cause a blister. The way this treatment works is that when liquid nitrogen freezes the skin fluid collects between the dermis and the underlying subcutaneous layer of the skin creating the blister. The blister separates the skin layers. Here is how it cures a wart...

The wart is a thick callus covering an encapsulated collection of viral wart particles, which is within then the living layer of skin called the dermis. By creating a blister beneath the dermis (under the wart) the wart essentially gets lifted off of the underlying skin as the blister swells up.

The fluid within the blister will resorb over the next several days. As the blister heals and flattens out, it forms a scab-like structure that doesn’t fully re-adhere to the tissue underneath. Eventually the dried up skin of the blister peels off, and the wart goes with it. If all goes according to plan, you are left with new healthy skin underneath. 

There are many different blistering agents that can be used to cure plantar warts. Here are three of the most common wart treatments that work by blistering:

Liquid Nitrogen - creates a blister with a carefully placed frostbite-type injury. 

Bleomyocin - is a chemical blistering agent injected directly into the wart.

Canthacur - is a topical chemical blistering agent applied to the surface of the wart.

As every runner knows, blisters on the feet can be irritating enough to force one to limit their run mileage or stop running altogether. So it is not surprising that a runner may consider popping a painful blister to lessen the discomfort, promote healing and get back to running. 

This may be a reasonable strategy with friction blisters sustained during a marathon or other long run. But not so with warts treatment blisters.

The problem with warts is that they are caused by a viral infection of the skin. If you poke a needle through the blister (and through the wart containing all of those viral particles) you just might seed the surrounding healthy, non-infected skin with the wart virus. In this way, by attempting to drain the blister under the wart, you may actually infect other areas of the foot and cause a new wart to start growing nearby. 

Then, after the original wart (and its associated treatment blister) have gone away, you may have a brand new nasty little wart rearing its ugly head. Then you have to repeat this process all over again.

Another issue is that the fluid inside the blister is sterile. As soon as you poke a hole the blister fluid can drain out, but bacteria can also get in. So when you pop a blister the risk of bacterial infection goes up. 

If you have a wart that is being treated by a podiatrist, and the blister is large enough to interfere with your activities, you should follow-up with the treating physician. After all the doctor is being paid to treat the wart, so let the doctor finish what he started. Let your podiatrist decide whether or not to drain the blister, and do the draining if needed. That is the safest way to remedy the blister AND make sure that there isn’t any risk of causing a bigger problem long-term.

Heal fast and get back to running! 

Dr. Christopher Segler is a podiatrist who focuses on the rapid treatment of running injuries. He is a runner himself and 10-time Ironman Triathlon finisher. You can learn more about warts, blisters and running injuries at AnkleCenter.com and DocOnTheRun.com  If you have a question about a running injury, you can reach him directly at 415-308-0833.




31 comments:

  1. This answered my question right away! Couldn't find anything else with good disruption as my questions. Thank you! Know I know with my daughter what not to do.

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  2. Thank you sooo much for this information! I didn't have a wart on my foot, but on the face!! I had it treated with liquid nitrogen and the nurse told me to pop the blister when it formed. I am so glad I didn't! I also followed through the nationwidechildren.org on information of warts as well and they said the same thing you wrote! It makes sense not too pop it. The scab just fell out, but my blister hasn't flatten yet. Will it soon? Thank you again! :)

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  3. brilliant explanation - Thanks - I searched the whole internet but just couldnt get a spot on answer like this.

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  4. YUP, thanks so much...we needed that!

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  5. If I don't pop the blister should I put a band aid so that it doesnt rub and get agravated with the sock.. Thanks

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  6. I've read a lot about blisters post-freezing and have spoken with my daughter's doctor and nurse, and no one provided as concise and reassuring an answer as this. Thank you.

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  7. I am with everyone else on this subject. Other websites danced around answering the questions regarding warts but you directly answered my concerns and explained the formation of a blister after freezing and how to handle the condition. Thank you for helping.

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  8. What great information. Thank you!

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  9. Just had the freezing done today. Very painful and hard to walk, don't think I'll do the blistering procedure again...thanks for the information.

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  10. Yes...it can indeed be painful. But the blister is the goal when you have a wart...so hopefully you will have success with the wart removal after your liquid nitrogen blister treatment as an attempt to cure you plantar wart.

    Best of luck and heal fast!

    Dr. Christopher Segler
    www.DocOnTheRun.com

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  11. I appreciate this post so much!! I had a tiny wart on my finger, this blister is driving me crazy. Knowing exactly what's going on in my body helps me try to ignore it and be patient.

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    Replies
    1. Thank you for reading and for your comment!. I am glad you found the info useful.

      Dr. Segler

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  12. Great article! Drained mine last night when the pain woke me though. I wished the treatment came with even half of what you just said. I didn't even know the blister was supposed to happen. I thought I might have been too aggressive with my freezing. Thank

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  13. Thank you for your kind comment. I'm glad to hear that you found the article helpful.

    Heal fast!
    Dr. Segler
    www.DocOnTheRun.com

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  14. Great article. My son just had 2 warts frozen on his hand unexpectedly today at a doctors visit. He works tomorrow and we're worried they may pop since their on the palm of his hand. My question is...can we bandage up his hand to keep it protected or will wrapping it up keep too much moisture on his hands and help them to pop? BTW, he already has super sweaty palms. :( Any help would be greatful. Thanks

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  15. My son's blister is on his hand and it has been 2 weeks since the nitrogen treatment and it hasn't hardened at all. Still very soft. Should he pop it now?

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  16. Hello J-red,

    I am sorry, but I only treat feet. For hand advice you would need to follow-up with your son's dermatologist.

    Thank you,
    Dr. Christoper Segler

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  17. How long do they usually take to go away?

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  18. My daughter had a wart on the bottom of her foot. Had it frozen and now she can't walk, and it hurts all the time. The blister is very big and tender. How long do you think it will take to go down and stop causing her pain? She is 9 years old.

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  19. I just had the same procedure. It took a full nine days, but the blister has finally "resorbed" and flatted out. (It didn't pop -- just got smaller and smaller.)

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  20. Thank you for posting this information. I was going to pop my wart blister until I came across this article.

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    Replies
    1. Thanks for reading and for the comment. Glad you found it the article helpful!

      You can also find more helpful info on similar topics on the Doc On The Run Podcast: https://www.docontherun.com/doc-on-the-run-podcast/

      Thanks!

      Dr. Segler

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  21. Hello Dr.
    I recently did the liquid nitrogen freezing this past Tuesday. My wart on my pinky blistered up and looks to be progressing as your article describes. However I have slight redness/pinkness surrounding the wart and I'm a little concerned. It doesn't really hurt a whole lot just a little tender where it is red. If it were to get infected Is there anything I should do to help it heal?

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  22. Any redness, particularly in association with an increase in pain could be a sign of infection so you should definitely call the doctor who did the procedure right away.

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  23. Fantastic article, straight to the point. I had three warts and two of them are blistered but one isn't really, this particular wart is large and has been there substantially longer than the other two. I have scheduled another appointment to redo the liquid nitrogen however just out of curiosity does this mean that the larger wart will definitely require another treatment?

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    Replies
    1. Thank you for your comment and I'm glad you enjoyed the article!

      In some cases works require a second treatment that this is not always true. It just depends upon whether or not any fluid has accumulated underneath a large wart, which might enable to separate from the underlying tissue. In some cases you may have a sufficient response even if they're just not appear to be a large blister developing.

      Best of luck! And heal fats!

      Dr Segler
      Doc On The Run
      www.DocOnTheRun.com



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  24. My daughter is 10 and had a wart bottom of her foot the dr used the stuff to freeze it off ..now the blister is larger . It has been a day since doing this when will it go down and its turing blueish looking is this normal. She cant walk on it but is not in alot of pain. Her dr want to pierce it on monday which is in 2 days .should I not let her do this.
    Thank you.

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  25. Hello Susie,

    Thank you for your comment. You should always follow your local doctor's advice, as you doctor always has the most information.

    Wishing her a fast recovery.

    Dr Segler

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  26. I have freezed a few warts on my foot but the ones underneath doesent form a blister only the one on the soft er skin on the side of my foot, will this lead to them not healing or do i have to keep freezing untill a blister appears?

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  27. OML - this was so helpful. Wow- you just rescued me from making a big mistake after day 3 days of hobbling! 4 on the upper pad of foot - swollen...... and tight but endurance I can do. Husband hates my whining

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