From the Guidelines
Fluorouracil combined with salicylic acid is a recommended treatment for plantar warts, with a strength of recommendation C, as per the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. The typical formulation contains 5% fluorouracil cream applied daily with occlusion for 4–12 weeks, as stated in the guidelines 1. This combination works through dual mechanisms: salicylic acid acts as a keratolytic agent that breaks down the outer layer of skin and helps remove the wart tissue, while fluorouracil is an antimetabolite that interferes with DNA synthesis in rapidly dividing cells, including those infected with human papillomavirus (HPV) that cause warts. Some key points to consider when using this treatment include:
- Apply the medication once daily to the affected area after soaking and gently filing the wart to remove dead skin
- Cover with a bandage overnight and continue treatment for 6-12 weeks or until the wart resolves
- Potential side effects include local skin irritation, redness, and pain, which are generally temporary
- Discontinue use if severe irritation occurs and consult a healthcare provider
- This treatment should be avoided during pregnancy and in patients with peripheral vascular disease or diabetes with poor circulation. According to a study published in the British Journal of Dermatology in 2014, topical 5-FU has been used with effect to treat both plane warts and common warts on the hands and feet, with a clearance rate of 95% in patients using 5-FU under occlusion compared with 10% in the control group 1. However, it is essential to note that the level of evidence for this treatment is 2+, and the strength of recommendation is C, indicating that while it is a viable option, it may not be the most effective treatment for all patients. In clinical practice, the decision to use fluorouracil combined with salicylic acid should be made on a case-by-case basis, taking into account the individual patient's needs and medical history.
From the FDA Drug Label
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. The use of salicylic acid on warts plantar is supported as an adjunctive therapy.
- Fluorouracil is not mentioned in the provided drug label. There is no information about the combination of Fluirouracil and salicylic acid on warts plantar in the provided drug label 2.
From the Research
Efficacy of Fluirouracil and Salicylic Acid on Warts Plantar
- The combination of 5-FU and SA is an effective and beneficial therapy for common and plantar warts, with a response rate of 63.0% vs. 11.0% for plantar warts 3.
- A study comparing the outcomes of three different methods of treating plantar warts in pediatric patients found that a combination of 5-fluorouracil (0.5%) and salicylic acid (10%) was effective, but had a longer mean treatment duration compared to a salicylic acid-lactic acid combination applied in multiple layers under occlusion 4.
- Salicylic acid and cryotherapy were found to be equally effective for clearance of plantar warts, with no evidence of a difference between the two treatments in terms of complete clearance of all plantar warts at 12 weeks 5.
- Another study found that cryotherapy was the most effective therapy for common warts, but for plantar warts, there was no clinically relevant difference in effectiveness between cryotherapy, topical application of salicylic acid, or a wait-and-see approach after 13 weeks 6.
- A randomized prospective study found that a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin, and 30% salicylic acid was more effective than cryotherapy in the treatment of plantar warts, with 14 patients completely cleared of their warts with topical treatment, compared to 5 patients with cryotherapy 7.
Comparison of Treatment Options
- The available evidence suggests that the combination of 5-FU and SA is a effective treatment option for plantar warts, with response rates comparable to or better than other treatment options such as cryotherapy and salicylic acid alone 3, 4, 7.
- However, the choice of treatment may depend on factors such as patient preference, treatment duration, and potential side effects, and further research is needed to fully compare the efficacy and safety of different treatment options for plantar warts 4, 5, 6.