From the Guidelines
The most effective treatment for Verruca vulgaris involves a combination of salicylic acid preparations and cryotherapy with liquid nitrogen, as these methods have been shown to be effective in destroying the infected epithelium and promoting spontaneous regression of the warts. According to the most recent and highest quality study available 1, most cases of common warts will eventually spontaneously regress, with 30% regressing within 6 months and approximately 60% within 2 years. Treatment modalities are usually geared toward chemical or physical destruction of the infected epithelium and include techniques such as freezing with liquid nitrogen, application of salicylic acid-based products or tretinoin (retinoic acid) cream, surgical (paring) or laser removal, and use of topical immunomodulating agents.
Some key points to consider when treating Verruca vulgaris include:
- The use of over-the-counter salicylic acid preparations (15-40% concentration) applied daily for several weeks, with gentle debridement of dead tissue between applications
- Cryotherapy with liquid nitrogen, typically administered by a healthcare provider every 2-3 weeks until the wart resolves
- Prescription treatments for resistant warts, including stronger salicylic acid formulations, topical retinoids, or immunomodulators like imiquimod 5% cream applied 3 times weekly for up to 16 weeks
- Surgical options, such as curettage, electrosurgery, or laser therapy, for particularly stubborn warts
It's worth noting that the more destructive methods may lead to pain, which may inhibit athletic activity, as reported in the study 1. Additionally, cantharidin combined with podophyllotoxin-salicylic acid has been used in adults and reported to be effective but associated with pain and blistering. However, the study 1 provides guidance on alternative treatment options, including podophyllin resin, trichloroacetic acid, and surgical removal, which can be considered based on the individual patient's needs and preferences. Overall, the goal of treatment is to promote the spontaneous regression of the warts while minimizing pain and discomfort, as emphasized in the study 1.
From the FDA Drug Label
For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). Topical preparations of 6% salicylic acid have been reported to be useful adjunctive therapy for verrucae plantares.
The treatment for Verruca vulgaris is salicylic acid (6%) topical aid, which can be used to remove excessive keratin in hyperkeratotic skin disorders, including verrucae 2.
- Key points:
- Salicylic acid is used for dermatologic and podiatric use
- It is a topical aid in the removal of excessive keratin
- Useful adjunctive therapy for verrucae plantares
From the Research
Treatment Options for Verruca Vulgaris
- Cryotherapy: a method that involves the use of liquid nitrogen to freeze the wart, causing it to eventually fall off 3, 4, 5, 6
- Salicylic acid: a topical treatment that can be applied directly to the wart to help dissolve the keratin protein that makes up the wart 3, 4, 5, 6
- Cantharidin-podophylotoxin-salicylic acid (CPS): a topical proprietary formulation that has been shown to be effective in treating plantar warts 6
- Traditional medicine: various substances and methods of plant, animal, and mineral origin, as well as magic practices, are used as home remedies for warts 7
Efficacy of Treatment Options
- Cryotherapy has been shown to be effective in treating common warts, with a cure rate of 39% after 13 weeks 5
- Salicylic acid has been shown to be less effective than cryotherapy in treating common warts, with a cure rate of 24% after 13 weeks 5
- CPS has been shown to be more effective than cryotherapy in treating plantar warts, with a complete clearance rate of 58% compared to 41.7% for cryotherapy 6
- The efficacy of traditional medicine in treating warts is not well established, and more research is needed to determine its effectiveness 7
Comparison of Treatment Options
- A randomized controlled trial found no significant difference in clearance rates between cryotherapy and salicylic acid after 12 weeks 4
- Another study found that cryotherapy was more effective than salicylic acid in treating common warts, but not plantar warts 5
- A prospective study found that CPS was more effective than cryotherapy in treating plantar warts 6