From the Guidelines
For the treatment of warts, I strongly recommend starting with topical salicylic acid (SA) preparations, applied daily after removing the thick keratin layer, with occlusion if possible, for 3-4 months, as this approach has the strongest evidence supporting its effectiveness 1.
Treatment Options
When considering treatment for warts, several options are available, but their effectiveness and recommendation strength vary. The British Association of Dermatologists' guidelines for the management of cutaneous warts provide a comprehensive overview of these treatments, categorized by their strength of recommendation:
- Salicylic Acid (SA): Topical preparations of 15–26% SA are recommended for hand warts, applied daily with occlusion if possible, for 3–4 months 1.
- Cryotherapy: This involves freezing the wart for 15–30 seconds, repeated every 2–4 weeks for at least 3 months or six treatments, and is considered effective for treating warts 1.
Less Recommended Treatments
Other treatments have less strong recommendations or insufficient evidence to support their use as first-line treatments:
- Bleomycin, 5-Fluorouracil, Laser, Acupuncture, Cantharidin, Cidofovir, Formaldehyde, Glutaraldehyde, Hyperthermia, Imiquimod, Phenol, Photodynamic therapy, Podophyllin, Pyruvic acid, Retinoids, systemic, Surgery, Trichloroacetic acid, and Vitamin D analogues are options with varying levels of evidence and recommendation strength 1.
Preventing Spread
It's essential to prevent the spread of warts to other body areas or people by avoiding direct contact with the wart, keeping it covered when possible, and maintaining good hand hygiene. Given the variety of treatment options and the importance of preventing the spread of warts, consulting a healthcare provider is recommended for personalized advice and treatment, especially if over-the-counter treatments are not effective or if the warts are persistent or widespread 1.
From the FDA Drug Label
For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, The answer to the question about Wart is that Salicylic Acid 6% is used as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae (warts) 2.
- Key points:
- Salicylic Acid 6% is used for dermatologic use.
- It is used to remove excessive keratin in hyperkeratotic skin disorders.
- Verrucae (warts) is one of the skin disorders it is used for.
From the Research
Wart Treatment Options
- Imiquimod is an immune response modifier that has been used to treat various types of warts, including genital warts and cutaneous warts 3, 4, 5, 6, 7
- The efficacy of imiquimod in treating warts has been established in several studies, with complete clearance rates ranging from 27% to 89% in immunocompetent patients 3, 4, 5, 6, 7
Imiquimod Application and Dosage
- The optimal dosage regimen for imiquimod in treating genital warts is 5% cream applied overnight by the patient three times weekly until warts clear, for up to 16 weeks 3
- More frequent application of imiquimod (up to three times a day) did not improve clearance and was associated with an increase in local adverse events 4
- Imiquimod can be combined with other treatments, such as salicylic acid, to increase its effectiveness in treating cutaneous warts 5, 6
Comparison with Other Treatments
- Imiquimod 5% cream combined with salicylic acid was found to be equally effective as cryotherapy in treating cutaneous warts in children 6
- Imiquimod may be more effective than cryotherapy in treating plantar warts 6
Limitations and Future Studies
- The efficacy of imiquimod in treating cutaneous warts has not been well established, and further studies are needed to determine its effectiveness and optimal dosage regimen 7
- Studies on the use of imiquimod in immunosuppressed patients are limited, and more research is needed to determine its safety and efficacy in this population 7