How precisely are warts removed? It’s my understanding that when the virus is killed the wart is effectively dead. I’ve heard some claims that it’s actually the body’s own immune system that kills the wart, and any treatment is only to stimulate the immune reaction. This seems hard to believe as wouldn’t doctors have a more direct method of triggering the immune reaction than using lasers or liquid nitrogen (which are painful and usually result in some healthy tissue killed)?
This doctor on YouTube suggest that the body’s immune response is what kills the wart after liquid nitrogen application:
This article discusses it but seems to lack a conclusion
Our body's immune response often eliminates warts. The immune system attacks and destroys most virus infections. However, as this immune system functions primarily in the dermis, the layer of skin just beneath the epidermis where the wart grows, it may take some time before it discovers the infection and mounts a response that will shed the wart virus and the wart.
Some wart treatments destroy the virus-infected cells. Such treatments include freezing warts with liquid nitrogen (cryosurgery) or burning them with electric current (electrodesiccation) or lasers. Unfortunately, if your body hasn't built up immunity to the virus, then any leftover viruses can start another infection and the wart will recur.
In some instances, freezing the wart or irritating it with a salicylic acid treatment (found in over-the-counter products such as Compound W) releases the virus from the cell and jump-starts the body's immune response. It begins to react to the virus. Each treatment may act like a booster shot for your immune system. This is why freezing a wart several times may rid the body of the wart even though freezing it once did not.
The Wikipedia article also contains relevant information but is inconclusive: https://en.wikipedia.org/wiki/Plantar_wart#Relative_effectiveness
A 2010 study compared the efficacy of cyotherapy versus topical salicylic acid in the treatment both of cutaneous and plantar warts. This study was a randomized controlled trial comparing the effectiveness of the aforementioned treatments with the "wait and see approach" over a treatment period of 13 weeks. As this study distinguishes between cutaneous and plantar warts and had a reasonably large sample size of 250 participants, it may be more relevant here than the 2006 review. The conclusions were:
- contrary to earlier evidence, this study supports the use of cryotherapy over salicylic acid with cure rates of 49% verses 15% for common cutaneous warts
- More importantly (re. plantar warts), the study showed no clinically relevant difference between cyrotherapy, salicylic acid, and "wait and see".
This last point implies that in the case of plantar warts it was likely the patients own immune system responsible for resolution and not the specific treatment.
Question: is the human’s natural response what ultimately kills the wart or does freezing it actually kill it? I’m mainly interested in plantar warts.