From the Guidelines
Plantar warts can be effectively treated with salicylic acid (SA) as the first-line treatment, with a recommended concentration of 15-40% applied daily after soaking and gently filing the wart, covering it with a bandage for 24-48 hours, and continuing this regimen for up to 12 weeks 1. The treatment of plantar warts involves several options, including:
- Salicylic acid (SA) topical paints or ointments, with a cure rate of 15% for all sites combined, and 33% for plantar warts specifically 1
- Cryotherapy, which can be applied fortnightly for 3-4 months, with a cure rate of 49% for all sites combined, and 30% for plantar warts specifically 1
- Other treatments, such as dithranol, 5-FU, formaldehyde, glutaraldehyde, hyperthermia, laser, PDT, podophyllotoxin, and topical immunotherapy, may also be considered, but their effectiveness for plantar warts is limited 1 It is essential to note that the cure rates for plantar warts are generally lower compared to other types of warts, likely due to the thicker cornified layer and poorer penetration of treatments to the lower epidermis 1 While treating the wart, it is crucial to avoid walking barefoot in public areas, keep feet clean and dry, and don't pick at the wart to prevent spreading the virus 1 These treatments work by either destroying the infected tissue directly or stimulating your immune system to fight the human papillomavirus (HPV) that causes warts, and patience is important as complete resolution may take several weeks to months 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, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). For Podiatric Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin on dorsal and plantar hyperkeratotic lesions. Topical preparations of 6% salicylic acid have been reported to be useful adjunctive therapy for verrucae plantares.
Salicylic acid can be used as a topical aid in the treatment of plantar warts (verrucae plantares). The drug label suggests that it is useful as an adjunctive therapy for this condition 2.
- Key points:
- Salicylic acid 6% is used for the removal of excessive keratin in hyperkeratotic skin disorders.
- It is used for the treatment of verrucae plantares as an adjunctive therapy.
From the Research
Treatment Options for Plantar Warts
- Cryotherapy: a method that uses liquid nitrogen to freeze the wart, with cure rates ranging from 14% to 45.61% 3, 4, 5, 6
- Salicylic acid: a topical treatment that can be applied daily, with cure rates ranging from 13.6% to 14% 3, 7, 5, 6
- Cantharidin-podophyllotoxin-salicylic acid (CPS) formulation: a topical treatment with a reported cure rate of 97.82% 4, 6
- Laser treatment: a method that uses a laser to target the wart, with a reported cure rate of 79.36% 6
- Topical antivirals: a treatment that targets the virus that causes the wart, with a reported cure rate of 72.45% 6
- Intralesional bleomycin: a treatment that involves injecting a medication into the wart, with a reported cure rate of 83.37% 6
- Intralesional immunotherapy: a treatment that involves injecting a substance into the wart to stimulate the immune system, with a reported cure rate of 68.14% 6
Comparison of Treatment Effectiveness
- A study found that salicylic acid and cryotherapy were equally effective for clearance of plantar warts 3
- Another study found that topical CPS was more effective than cryotherapy in the treatment of plantar warts 4
- A cost-effectiveness analysis found that cryotherapy was more costly and no more effective than salicylic acid 7
- A randomized controlled trial found that cryotherapy was the most effective therapy for common warts, but found no clinically relevant difference in effectiveness between cryotherapy, topical application of salicylic acid, or a wait-and-see approach for plantar warts 5
- A systematic review found that first-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts, while other treatments such as CPS formulation, immunotherapy, and intralesional bleomycin have higher cure rates 6