From the Guidelines
To remove a plantar wart from a pediatric toe, the most effective treatment is salicylic acid (15–40%) topical paints or ointments, as recommended by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1.
Treatment Options
- Salicylic acid treatments can be applied daily for several weeks, with the foot soaked in warm water for 5-10 minutes before application and gently filed down with an emery board.
- Cryotherapy, fortnightly for 3–4 months, can also be considered, especially for persistent warts.
- Other treatments, such as dithranol, 5-FU, formaldehyde, glutaraldehyde, hyperthermia, laser, PDT, podophyllotoxin, and topical immunotherapy, may be considered, but their effectiveness and safety in pediatric patients should be carefully evaluated.
Important Considerations
- Paring, if used to remove excess skin from warts before treatment, should avoid damaging surrounding skin because of the risk of spreading infection 1.
- Painful treatments should be avoided in young children if possible, as warts in children are often relatively short-lived and are likely to clear within a year or two 1.
- Throughout treatment, ensure the child doesn't touch or scratch the wart to prevent spreading, and have them wear clean socks daily.
When to Seek Medical Advice
- If the wart causes pain, changes appearance, or doesn't improve after 2-3 months of home treatment, seek medical advice from a pediatrician or a dermatologist.
- The pediatrician may recommend alternative treatments, such as cantharidin application or minor surgical removal, depending on the severity and persistence of the wart.
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. To remove a plantar wart from a pediatric toe, salicylic acid 6% can be used as a topical aid. The treatment may involve applying the medication to the affected area to help remove excessive keratin. However, it is essential to note that salicylic acid is reported to be a useful adjunctive therapy, implying that it may be used in conjunction with other treatments. 2
From the Research
Treatment Options for Plantar Warts in Pediatric Toes
- Cryotherapy: a method that uses liquid nitrogen to freeze the wart, with a cure rate of 45.61% 3 and 67.3% 4
- Salicylic acid: a topical treatment that can be used to remove the wart, with a cure rate of 13.6% 3
- Imiquimod 5% cream: a topical treatment that can be used in combination with salicylic acid to increase its penetration through the epithelium, with a cure rate of 81.1% 4
- Cantharidin-podophyllotoxin-salicylic acid (CPS) formulation: a topical treatment that has been shown to be more effective than cryotherapy, with a cure rate of 97.82% 3 and 100% in some cases 5
Comparison of Treatment Options
- Imiquimod 5% cream combined with salicylic acid was found to be equally effective and more effective than cryotherapy in plantar warts 4
- CPS formulation was found to be more effective than cryotherapy in the treatment of plantar warts 5
- Salicylic acid was found to be more cost-effective than cryotherapy, with no additional benefit in terms of proportion of patients healed 6
Specialized Treatments
- Laser treatment: a treatment that uses a laser to remove the wart, with a cure rate of 79.36% 3
- Topical antivirals: a treatment that uses antiviral medications to treat the wart, with a cure rate of 72.45% 3
- Intralesional bleomycin: a treatment that uses an injection of bleomycin to treat the wart, with a cure rate of 83.37% 3
- Intralesional immunotherapy: a treatment that uses an injection of immunotherapy to treat the wart, with a cure rate of 68.14% 3