How to treat plantar warts?

From the Guidelines

Plantar warts can be effectively treated with a combination of salicylic acid and cryotherapy, with a clearance rate of 86% reported in some studies 1. To treat plantar warts, the following methods can be used:

• Over-the-counter salicylic acid products, such as Compound W or Dr. Scholl's, applied daily for several weeks after soaking and filing down the wart
• Cryotherapy, which involves freezing the wart with liquid nitrogen every 2-3 weeks, with a cure rate of 49% reported in one study 1
• Prescription-strength treatments, such as cantharidin, or surgical removal for stubborn warts
• Home remedies, including duct tape occlusion and apple cider vinegar soaks, which can help stimulate the immune system to fight the human papillomavirus (HPV) causing the wart It's essential to note that cure rates for plantar warts are lower than for warts at other sites, probably due to the thicker cornified layer and poorer penetration of treatments to the lower epidermis 1. When using cryotherapy, it's crucial to avoid damaging surrounding skin, as this can spread the infection 1. In addition to these treatments, it's recommended to:
• Avoid walking barefoot to prevent spreading the virus
• Keep the wart covered during swimming
• Use paring to remove excess skin from warts before treatment, if necessary, while avoiding damage to surrounding skin 1 Most plantar warts eventually resolve with consistent treatment, though it may take weeks to months for complete clearance.

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 preferable method of use is to apply Salicylic Acid 6% thoroughly to the affected area and to cover the treated area at night after washing and before retiring.

To treat plantar warts, apply salicylic acid 6% thoroughly to the affected area and cover it at night after washing and before retiring 22. The skin should be hydrated for at least five minutes prior to application. The medication is washed off in the morning.

• Apply the medication as directed to avoid increased local intolerance and systemic adverse effects.
• If excessive drying and/or irritation is observed, a bland cream or lotion may be applied.
• Once clearing is apparent, the occasional use of salicylic acid 6% will usually maintain the remission.

From the Research

Treatment Options for Plantar Warts

• Topical treatments:
  • Cantharidin-podophyllotoxin-salicylic acid (CPS) formulation has been shown to be effective in treating plantar warts, with a cure rate of 62.5% 3 and 97.82% in some studies 4.
  • Salicylic acid has a lower cure rate of 13.6% 4.
• Cryotherapy:
  • Has been found to have lower cure rates than other treatments, with an odds ratio of 0.31 5 and a cure rate of 45.61% 4.
  • Intralesional versus spray-on cryotherapy appears to be more effective 5.
• Other treatments:
  • Laser treatment has a cure rate of 79.36% 4.
  • Topical antivirals have a cure rate of 72.45% 4.
  • Intralesional bleomycin has a cure rate of 83.37% 4.
  • Intralesional immunotherapy has a cure rate of 68.14% 4.

Comparison of Treatment Options

• A study comparing CPS formulation and cryotherapy found that CPS formulation was more effective, with 14 out of 26 patients completely cleared of their warts, compared to 5 out of 12 patients treated with cryotherapy 6.
• A systematic review found that cryotherapy had lower cure rates than other treatments, including antivirals and chemotherapy 5.
• Another systematic review found that first-choice treatments for common warts, such as cryotherapy and salicylic acid, have low cure rates for plantar warts, while other treatments like CPA formulation, immunotherapy, and intralesional bleomycin have higher cure rates 4.