From the Guidelines
The most effective treatment for warts on the side of a fingernail is cryotherapy with liquid nitrogen, applied every 1-2 weeks until the wart resolves, as recommended by the 2010 guidelines 1. This treatment approach is prioritized due to its high efficacy and relatively low risk of complications. Cryotherapy works by destroying the wart cells through thermal-induced cytolysis, and its application should be performed by a trained healthcare provider to minimize the risk of over- or under-treatment.
Some key considerations for the treatment of periungual warts include:
- Avoiding the surrounding healthy skin to prevent damage and promote healing
- Using protective measures, such as petroleum jelly, to prevent the treatment from affecting the surrounding skin
- Considering alternative treatments, such as salicylic acid or imiquimod cream, for patients who are not good candidates for cryotherapy or have persistent warts
- Emphasizing the importance of proper hygiene and avoiding picking or biting the area to prevent the spread of the human papillomavirus (HPV)
It is essential to note that the treatment of periungual warts can be challenging due to their location near the nail fold, where the skin is thicker, and the wart can grow under the nail. Therefore, a combination of at-home treatments and professional interventions may be necessary to achieve optimal results. Additionally, the safety of certain treatments, such as podofilox and imiquimod, during pregnancy has not been established, and their use should be approached with caution 1.
From the Research
Treatment Options for Warts on the Side of a Fingernail
- Salicylic acid has been shown to be effective in treating warts, although it is slow to work and requires frequent application for up to 12 weeks 2
- Cryotherapy with liquid nitrogen is a favorable option for many patients, with cure rates of 50 to 70 percent after three or four treatments 2
- For recalcitrant warts, Candida or mumps skin antigen can be injected into the wart every three to four weeks for up to three treatments 2
- Photodynamic therapy with aminolevulinic acid has been shown to be effective in treating recalcitrant warts 2
Specific Considerations for Warts on the Side of a Fingernail
- Periungual warts are usually due to HPV-1,2, and 4, and development is favored by maceration and trauma, especially nail biting 3
- Medical treatments for periungual warts include keratolytic agents, virucidal agents, and immunomodulators, with keratolytic agents being the best first-line approach 3
- Surgical treatments for periungual warts include cryotherapy, surgical excision, electrosurgery, infrared coagulation, localized heating with a radio-frequency heat generator, and laser therapy 3
Comparison of Treatment Options
- Cryotherapy has been shown to be more effective than salicylic acid for common warts, but not for plantar warts 4
- Combination therapy with cryotherapy and salicylic acid may be more effective than either treatment alone 5
- Novel approaches, such as new topical treatments and immunotherapies, are being investigated for the treatment of difficult-to-treat warts 6