From the Guidelines
The recommended treatment for warts in pregnant women is cryotherapy with liquid nitrogen or trichloroacetic acid (TCA) 80-90% applied by a healthcare provider, as these methods are considered safe and effective. The treatment approach should prioritize conservative methods first, with medical interventions used cautiously 1. Watchful waiting is often appropriate as many warts resolve spontaneously or after delivery. For symptomatic warts, physical removal methods are preferred, including cryotherapy with liquid nitrogen (freezing the wart), laser therapy, or surgical excision for larger lesions. If medication is necessary, salicylic acid preparations (over-the-counter strengths of 17% for common warts) can be used topically with careful application to avoid surrounding skin. Some key points to consider:
- Imiquimod and podophyllin should be avoided during pregnancy due to limited safety data 1.
- For extensive or resistant warts, consultation with a dermatologist or obstetrician is recommended.
- Treatment decisions should balance the need for intervention against potential risks to the pregnancy, with the understanding that warts often improve after delivery due to normalization of the immune system.
- Pregnant women should avoid scratching warts to prevent spreading and should maintain good hygiene practices. The most recent and highest quality study 1 supports the use of cryotherapy with liquid nitrogen or TCA 80-90% as the preferred treatment options for warts in pregnant women.
From the Research
Treatment Options for Warts in Pregnant Women
- The treatment of warts in pregnant women is crucial to relieve physical and psychological discomfort and prevent the spread of infection [ 2 ].
- Available medical and destructive therapeutic options for cutaneous warts include salicylic acid, silver nitrate, glutaraldehyde, cryotherapy, and imiquimod [ 2 ].
Recommended Treatments
- First-line therapy includes medical treatments such as salicylic acid, which is useful for treating a single wart or a few small common warts of short duration [ 2 ].
- Cryotherapy may be considered as second-line therapy if first-line treatments have failed or are contraindicated [ 2 ].
- For recurrent or difficult-to-treat lesions, third-line therapy includes alternative therapeutic options such as topical, intralesional, systemic, and physical destruction [ 2 ].
Efficacy of Treatments
- Salicylic acid and cryotherapy have been shown to be effective in treating cutaneous warts, with cure rates of 24% and 39%, respectively [ 3 ].
- Combination therapy of cryotherapy and salicylic acid has been found to be more effective than salicylic acid alone [ 4 ].
- Imiquimod 5% cream combined with a keratolytic lotion has been found to be equally effective as cryotherapy in treating cutaneous warts in children [ 5 ].
Considerations for Pregnant Women
- The safety and efficacy of treatments for warts in pregnant women have not been extensively studied [ 2 ].
- However, salicylic acid and cryotherapy are generally considered safe for use during pregnancy [ 6 ].
- Imiquimod has not been extensively studied in pregnant women, and its use should be approached with caution [ 5 ].