What are the treatment options for a wart?

From the Guidelines

Treatment for warts should prioritize cryotherapy with liquid nitrogen as the first-line option, given its effectiveness and relatively low risk of complications, as supported by the most recent guidelines 1. When considering treatment options for warts, it's essential to weigh the benefits and risks of each approach, focusing on minimizing morbidity, mortality, and improving quality of life. The treatment landscape includes both at-home remedies and medical interventions. For common warts, over-the-counter salicylic acid products are often recommended as a first-line treatment, applied daily for several weeks until the wart disappears. However, for more stubborn cases or specific patient populations, such as those with plantar, plane, facial, or immunosuppression-related warts, the approach may vary.

Treatment Options

• Cryotherapy with liquid nitrogen: This is a common medical treatment where a healthcare provider freezes the wart, typically requiring multiple sessions spaced 1-3 weeks apart, as recommended by guidelines 1.
• Salicylic acid: Over-the-counter salicylic acid products (like Compound W or Dr. Scholl's) are effective for common warts, applied daily for several weeks.
• Prescription-strength treatments: These may include stronger salicylic acid formulations, prescription retinoids, or immunotherapy agents like imiquimod cream for stubborn warts.
• Surgical options: Curettage (scraping off the wart), electrosurgery (burning the wart), or laser therapy can be considered for resistant cases.
• Duct tape occlusion therapy: A home remedy involving covering the wart with duct tape for 6 days, then soaking and gently abrading it before repeating the process.

Considerations

• Wart location: Treatment choice depends on the location of the wart, with different approaches recommended for plantar, plane, facial, and genital warts 1.
• Patient age: The tolerance for pain and the potential for spontaneous resolution influence treatment decisions, especially in children.
• Previous treatment responses: The choice of treatment may be guided by how the patient has responded to previous treatments.
• Immunosuppression: In immunosuppressed patients, treatment aims to reduce wart size and alleviate symptoms, as cure may not be achievable.

Given the variety of treatment options and the importance of tailoring the approach to the individual patient, cryotherapy with liquid nitrogen stands out as a broadly applicable and effective first-line treatment for warts, as indicated by the British Association of Dermatologists' guidelines from 2014 1. This method offers a balance of efficacy and safety, making it a preferred choice for many patients.

From the FDA Drug Label

Imiquimod Cream should be applied 3 times per week to external genital/perianal warts. Imiquimod Cream treatment should continue until there is total clearance of the genital/perianal warts or for a maximum of 16 weeks. A thin layer of Imiquimod Cream should be applied to the wart area and rubbed in until the cream is no longer visible.

The treatment options for a wart include applying Imiquimod Cream 3 times a week to the affected area until the wart is cleared or for a maximum of 16 weeks.

• Key points:
  • Apply a thin layer of Imiquimod Cream to the wart area
  • Rub in the cream until it is no longer visible
  • Apply the cream 3 times a week
  • Continue treatment until the wart is cleared or for a maximum of 16 weeks
  • Wash hands before and after applying the cream
  • Avoid applying the cream to broken or irritated skin
  • Avoid sexual contact while the cream is on the skin 2

From the Research

Treatment Options for Warts

• Medical treatments, such as salicylic acid, silver nitrate, and glutaraldehyde, are useful for treating a single wart or a few small common warts of short duration (less than 1 year) 3
• Cryotherapy may be considered as a second-line therapy if medical treatments have failed or are contraindicated 3
• For recurrent or difficult-to-treat lesions, third-line therapy includes alternative therapeutic options, such as topical, intralesional, systemic, and physical destruction, which are generally off-label and have limitations due to drawbacks or adverse effects 3

Specific Treatment Approaches

• Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion: a randomized study found no statistically significant difference between the two treatments, but imiquimod 5% cream was found to be equally effective and more effective than cryotherapy in plantar warts 4
• Cantharidin-podophylotoxin-salicylic acid versus cryotherapy: a randomized prospective study found that topical cantharidin-podophylotoxin-salicylic acid was more effective than cryotherapy in the treatment of plantar warts 5
• Combination therapy consisting of cryosurgery followed by administration of imiquimod and salicylic acid: anecdotal reports suggest that this approach can be 50% to 100% effective after 6 to 9 weeks 6

Management of Difficult-to-Treat Warts

• Traditional and new approaches, including novel investigational therapies, may be considered for difficult-to-treat warts, such as large, deep, numerous, and extensive warts, or treatment-resistant lesions with higher risk for side effects 7