From the Guidelines
The most effective compounded topical treatments for warts in the USA include salicylic acid, 5-fluorouracil, and imiquimod combinations, which have been shown to be effective in treating warts with minimal side effects. When considering treatment options for warts, it's essential to prioritize morbidity, mortality, and quality of life as outcomes. According to the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1, salicylic acid is a highly recommended treatment for hand warts, with a strength of recommendation of A. Some key points to consider when treating warts with compounded topicals include:
- Salicylic acid with lactic acid combinations (typically 15-40% salicylic acid with 10-20% lactic acid) can be effective in gradually exfoliating the wart tissue
- 5-fluorouracil (5-FU) combined with salicylic acid can target rapidly dividing cells while also exfoliating the wart
- Imiquimod 5% combined with tretinoin 0.05% can provide immune-modulating effects alongside cell turnover enhancement
- Cantharidin-podophyllin-salicylic acid (CPS) combinations can provide multiple mechanisms of action for resistant warts
- Squaric acid dibutylester (SADBE) at 0.2-2% concentrations can be used for its contact sensitization properties These compounded medications are typically applied daily or several times weekly for 4-12 weeks, with the affected area protected from contact with healthy skin. It's crucial to consult with a healthcare professional to determine the best course of treatment for individual cases of warts.
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, NDC 72934- 9036-9 CANTHARIDIN 1% / PODOPHYLLUM RESIN USP 5% / SALICYLIC ACID USP 30%. Liquid 15 gm The popular compounded topicals for warts in the USA include:
- Salicylic acid: used as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae 2
- Cantharidin: compounded with podophyllum resin and salicylic acid, used as a topical treatment 3
From the Research
Popular Compounded Topicals for Warts in the USA
- Salicylic acid is a commonly used topical treatment for warts, with studies showing its efficacy in treating cutaneous warts 4, 5, 6.
- A combination of cantharidin, podophyllotoxin, and salicylic acid (CPS) has been shown to be effective in treating plantar warts, with a higher cure rate compared to cryotherapy 7.
- Other topical treatments, such as dinitrochlorobenzene, have been shown to be effective in treating refractory warts, but may have adverse effects 6.
- A combination of 5-fluorouracil and salicylic acid has been used to treat anogenital warts, with similar efficacy to a 5% potassium hydroxide solution 8.
- Cryotherapy is also a commonly used treatment for warts, but its efficacy compared to topical treatments is still debated, with some studies showing no significant difference in effectiveness 5, 6.
Commonly Used Topical Treatments
- Salicylic acid: 10-30% concentration 4, 5, 6
- Cantharidin-podophyllotoxin-salicylic acid (CPS): 1% cantharidin, 5% podophyllotoxin, 30% salicylic acid 7
- Dinitrochlorobenzene: 1-2% concentration 6
- 5-fluorouracil and salicylic acid: 0.5% 5-fluorouracil, 10% salicylic acid 8