From the Guidelines
The most effective compounded topicals for warts include salicylic acid, cantharidin, and 5-fluorouracil, which work by either directly destroying wart tissue or stimulating the immune system to fight the underlying HPV infection. These treatments are supported by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. The guidelines recommend salicylic acid as the first-line treatment for warts, with a strength of recommendation A, due to its high efficacy and safety profile 1. Some key points to consider when using these treatments include:
- Salicylic acid (17-40%) is effective in treating warts by promoting exfoliation of epidermal cells and stimulating host immunity 1
- Cantharidin (0.7-1%) is a vesicant that creates blisters under the wart to lift it away, but its use is recommended with caution due to potential side effects 1
- 5-fluorouracil (5%) combined with salicylic acid interferes with DNA synthesis in rapidly dividing wart cells, making it an effective treatment option 1
- Other effective combinations include imiquimod (5%) with salicylic acid, tretinoin (0.05-0.1%) with 5-fluorouracil, and squaric acid dibutylester (SADBE, 0.2-2%) for recalcitrant warts 1 It is essential to note that treatment should continue until the wart is completely gone, and patients should avoid touching other body areas after application to prevent spreading the virus. Additionally, protective covering for surrounding skin is recommended to prevent irritation and other potential side effects. Overall, the choice of treatment depends on the individual patient's needs and the specific type of wart being treated, and patients should consult with a healthcare professional to determine the best course of treatment.
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). The most popular compounded topical for Warts is Salicylic Acid 6% 2.
- Key words: Salicylic Acid, Warts, Verrucae
- Main idea: Salicylic Acid 6% is used as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders, including verrucae (warts).
From the Research
Compounded Topicals for Warts
The most popular compounded topicals for warts include:
- Salicylic acid, which is a first-line therapy for treating single or few small common warts of short duration (less than 1 year) 3
- Imiquimod, an immune response modifier that has been used to treat cutaneous warts, with a combined rate of patients achieving complete response to therapy of 44% in non-controlled studies 4
- Cantharidin, a topical vesicant that has been shown to be effective and safe for the removal of warts, with clearance rates ranging from 15.4-100% 5, 6
- Podophyllotoxin and salicylic acid, which have been used in combination with cantharidin to demonstrate efficacy for plantar warts, with clearance rates ranging from 81-100% 6
Efficacy and Safety
The efficacy and safety of these compounded topicals have been evaluated in various studies, including:
- A randomized study that compared cryotherapy with imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children, which found that imiquimod 5% cream was equally effective and more effective than cryotherapy in plantar warts 7
- A systematic review that assessed the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts, which found that cantharidin demonstrated clearance of warts, particularly in combination with podophyllotoxin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety 6
Adverse Effects
The adverse effects of these compounded topicals include: