From the Guidelines
To treat a periungual wart, the most effective treatment is salicylic acid (SA) with a strength of 15–26%, applied daily after removing the thick keratin layer, with occlusion if possible, for 3–4 months 1. When treating periungual warts, it's essential to consider the location and sensitivity of the skin around the nail. The British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 recommend salicylic acid as the first-line treatment for hand warts, including periungual warts 1.
Some key points to consider when treating periungual warts include:
- Applying salicylic acid daily after removing the thick keratin layer and occluding the area if possible
- Continuing treatment for 3–4 months
- Considering alternative treatments, such as cryotherapy, if salicylic acid is not effective
- Being cautious when using home treatments around the nail, as the skin is sensitive
- Avoiding cutting or picking at the wart, which can spread the virus
Other treatment options, such as cryotherapy, bleomycin, and 5-fluorouracil, may be considered if salicylic acid is not effective 1. However, salicylic acid remains the most recommended treatment due to its high strength of recommendation (A) and effectiveness in treating periungual warts. It's crucial to consult a healthcare provider before starting any treatment, especially if the wart is persistent or resistant to over-the-counter treatments.
From the Research
Treatment Options for Periungual Warts
- Imiquimod 5% cream has been shown to be effective in treating periungual and subungual warts, with a complete resolution rate of 80% in one study 2.
- Photodynamic therapy combined with liquid nitrogen cryotherapy and curettage is another treatment option for recalcitrant periungual and subungual warts, with successful treatment reported in one case study 3.
- Local hyperthermia has also been used to treat periungual warts, with two cases reported to be successfully cured using this method 4.
Comparison of Treatment Options
- Imiquimod 5% cream has been compared to other treatment options, such as liquid nitrogen cryotherapy and CO2 laser, and has been shown to have fewer side effects and a higher clinical response rate 2.
- The optimal dosage regimen for imiquimod 5% cream is three times a week, as more frequent application did not improve clearance and was associated with an increase in local adverse events 5.
Special Considerations
- Human immunodeficiency virus (HIV)-positive patients with anogenital warts may benefit from treatment with imiquimod 5% cream, with a total clearance rate of 32% reported in one study 6.
- Imiquimod 5% cream has been shown to be safe and effective in HIV-positive patients with successful highly active antiretroviral therapy (HAART) treatment 6.