From the Guidelines
Compounded medications for warts should be considered after failed over-the-counter treatments or for warts in sensitive locations, with common formulations including salicylic acid, 5-fluorouracil, and cantharidin, applied directly to the wart once or twice daily for several weeks. When considering treatment options for warts, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the most recent guidelines, cryotherapy with liquid nitrogen or cryoprobe is a recommended treatment option for warts, with applications repeated every 1–2 weeks 1. However, for cases where cryotherapy is not effective or feasible, compounded medications can be a viable alternative.
Some common compounded formulations for warts include:
- Salicylic acid (10-40%) combined with lactic acid for enhanced keratolytic effects
- 5-fluorouracil (0.5-5%) to inhibit DNA synthesis in rapidly dividing wart cells, often combined with tretinoin (0.05-0.1%) to increase penetration
- Cantharidin (0.7-1%) compounds, which cause blister formation under the wart
- Imiquimod (5%) may be combined with other agents to stimulate the immune response against the human papillomavirus causing the wart
These compounded medications are typically applied directly to the wart once or twice daily for several weeks, with the affected area covered by a bandage after application. The skin around the wart should be protected with petroleum jelly to prevent irritation of healthy tissue. Treatment should continue until the wart resolves, which may take 4-12 weeks depending on the size and location. It's worth noting that the safety of some treatments, such as podofilox and imiquimod, during pregnancy has not been established 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). Topical preparations of 6% salicylic acid have been reported to be useful adjunctive therapy for verrucae plantares.
The salicylic acid drug label directly supports the use of compounded medications for warts, specifically for the removal of excessive keratin in hyperkeratotic skin disorders including verrucae.
- The label mentions that salicylic acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae.
- It also states that topical preparations of 6% salicylic acid have been reported to be useful adjunctive therapy for verrucae plantares 2.
From the Research
Compounded Medications for Warts
- Compounded medications, such as salicylic acid, podophyllin, and cantharidin, are used to treat warts 3, 4, 5, 6.
- A study published in 1984 found that a topical preparation containing salicylic acid, podophyllin, and cantharidin was effective in treating plantar warts in children, with a success rate of 81% 5.
- Another study published in 2018 found that topical cantharidin was effective in treating warts, with clearance rates ranging from 15.4% to 100% 6.
- The combination of cantharidin with podophyllotoxin and salicylic acid has been shown to be effective in treating plantar warts, with clearance rates ranging from 81% to 100% 6.
Efficacy and Safety of Compounded Medications
- The efficacy and safety of compounded medications for warts have been evaluated in several studies 3, 4, 5, 6.
- A systematic review published in 2018 found that topical cantharidin was effective in treating molluscum contagiosum and warts, with significant clearance rates and good tolerability and safety 6.
- However, adverse effects such as pain, blistering, and hyper-/hypopigmentation have been reported with cantharidin treatment 4, 6.
Treatment Considerations
- The decision to treat warts should be individualized to the patient and their family, taking into account the severity of symptoms, extent and duration of disease, and ability to tolerate and comply with treatment recommendations 7.
- Realistic expectations regarding the potential for treatment failure and recurrence should be discussed with the patient and their family prior to initiating therapy 7.