What are the treatment options for warts?

From the Guidelines

Treatment options for warts include cryotherapy with liquid nitrogen, podophyllin resin, trichloroacetic acid (TCA), and surgical removal, with the choice of treatment depending on wart location, patient age, and previous treatment responses. The most recent and highest quality study, 1, recommends cryotherapy with liquid nitrogen or cryoprobe, repeated every 1-2 weeks, as a provider-administered treatment option. Other treatment options include podophyllin resin 10%-25% in a compound tincture of benzoin, trichloroacetic acid (TCA) or bichloroacetic acid (BCA) 80%-90%, and surgical removal by tangential scissor excision, tangential shave excision, curettage, or electrosurgery.

Some key points to consider when choosing a treatment option include:

• The location and size of the wart
• The patient's age and overall health
• The patient's previous treatment responses
• The potential side effects and risks associated with each treatment option

For example, cryotherapy with liquid nitrogen can cause pain, necrosis, and blistering, while podophyllin resin can cause local irritation and has not been established as safe during pregnancy. Trichloroacetic acid (TCA) can cause local irritation and has not been established as safe during pregnancy, and surgical removal can cause scarring and requires substantial clinical training and equipment.

It's also important to note that some warts may resolve spontaneously within 1-2 years without treatment, and the treatment choice should be guided by the preference of the patient, the available resources, and the experience of the healthcare provider, as stated in 1. Additionally, the use of locally developed and monitored treatment algorithms has been associated with improved clinical outcomes, as mentioned in 1.

In terms of patient-applied therapies, podofilox and imiquimod are options, with podofilox being an antimitotic drug that destroys warts and imiquimod being a topically active immune enhancer that stimulates production of interferon and other cytokines, as described in 1. Sinecatechin ointment is also an option, but its safety and efficacy have not been established in certain populations, such as HIV-infected persons, immunocompromised persons, or persons with clinical genital herpes, as noted in 1.

Overall, the treatment of warts should be individualized and based on the specific characteristics of the patient and the wart, with the goal of minimizing morbidity, mortality, and improving quality of life.

From the FDA Drug Label

It is recommended that patients wash their hands before and after applying Imiquimod Cream. 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. Apply twice daily morning and evening (every 12 hours), for 3 consecutive days, then withhold use for 4 consecutive days This one week cycle of treatment may be repeated up to four times until there is no visible wart tissue.

The treatment options for warts include:

• Imiquimod Cream: applied 3 times per week to external genital/perianal warts for up to 16 weeks 2
• Podofilox Topical Solution: applied twice daily for 3 consecutive days, then withheld for 4 consecutive days, and repeated for up to 4 weeks 3 Key considerations:
• Treatment should be limited to less than 10 cm2 of wart tissue
• Patients should wash their hands before and after applying the treatment
• Local skin reactions are common, and a rest period may be taken if required by the patient's discomfort or severity of the reaction 2 3

From the Research

Treatment Options for Warts

• Cryotherapy with liquid nitrogen: This method is widely used for the treatment of cutaneous warts in primary care, and evidence suggests it is effective, especially for common warts 4, 5.
• Topical salicylic acid application: This treatment is also effective, although cure rates may be lower compared to cryotherapy, especially for common warts 4, 6.
• Trichloroacetic acid (TCA) 90%: This treatment has been shown to be less effective than cryotherapy for common warts, but with fewer side effects 5.
• Imiquimod 5% cream: This treatment can be used safely in children with warts and is equally effective as cryotherapy, especially for plantar warts 7.
• Combination therapy: Using cryotherapy followed by topical imiquimod and salicylic acid has been shown to be effective for resistant common warts 8.

Effectiveness of Treatment Options

• Cryotherapy has been shown to have cure rates of 39% to 49% for common warts, and 24% to 39% for plantar warts 4, 5.
• Topical salicylic acid application has cure rates of 15% to 24% for common warts, and 16% to 24% for plantar warts 4, 6.
• Imiquimod 5% cream has been shown to have cure rates of 67% to 81% for common warts, and is equally effective as cryotherapy for plantar warts 7.

Side Effects and Safety

• Cryotherapy can have side effects such as pain, blistering, and scarring, but is generally safe and effective 4, 5.
• Topical salicylic acid application can have side effects such as skin irritation and allergic reactions, but is generally safe and effective 4, 6.
• Imiquimod 5% cream can have side effects such as skin irritation and allergic reactions, but is generally safe and effective, especially for children 7.