From the Guidelines
The management of plantar warts should start with topical salicylic acid (15-40%) applied daily for 12 weeks, with prior soaking and debridement of dead skin, as this approach has been shown to be effective in reducing symptoms and transmission 1. The choice of treatment for plantar warts depends on the size, location, and patient factors.
- First-line treatment typically includes topical salicylic acid (15-40%) applied daily for 12 weeks, with prior soaking and debridement of dead skin.
- Cryotherapy with liquid nitrogen is another common option, applied every 2-3 weeks for up to 3-4 sessions.
- For resistant warts, stronger options include cantharidin (applied by clinicians), bleomycin injections (0.1-1 mg/mL intralesionally), or surgical excision.
- Immunotherapy approaches like imiquimod 5% cream (applied 3 times weekly) or intralesional Candida antigen injections may be effective for recalcitrant cases.
- Laser therapy and photodynamic therapy are specialized options for resistant warts. Patients should be advised that plantar warts can resolve spontaneously within 1-2 years, and treatment aims to reduce symptoms and transmission.
- Multiple treatments may be necessary as plantar warts are often resistant due to their location on pressure-bearing surfaces and the thick overlying callus that reduces medication penetration.
- Patients should avoid walking barefoot in public areas to prevent transmission and reinfection, as recommended by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. The British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 also suggest that combination treatments, such as salicylic acid and cryotherapy, can be undertaken for plantar warts, but care is needed with worse side-effects 1. In particular, for plantar warts, cure rates are lower at this site probably due to a thicker cornified layer and subsequent poorer penetration of treatments to the lower epidermis, as noted in the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. Therefore, topical salicylic acid (15-40%) applied daily for 12 weeks, with prior soaking and debridement of dead skin, is the recommended first-line treatment for plantar warts, with cryotherapy and other options available for resistant cases 1.
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 management of plantar warts includes the use of salicylic acid 6% as a topical aid in removing excessive keratin on plantar hyperkeratotic lesions, and it can be a useful adjunctive therapy for verrucae plantares 2.
- Key points:
- Salicylic acid 6% is used for the removal of excessive keratin
- It is used as an adjunctive therapy for plantar warts (verrucae plantares)
From the Research
Management of Plantar Warts
The management of plantar warts involves various treatment options, including:
- Topical treatments
- Cryotherapy
- Intralesional injections
- Laser therapy
- Immunotherapy
Topical Treatments
Topical treatments for plantar warts include:
- Salicylic acid: a common over-the-counter treatment, with cure rates ranging from 13.6% to 24% 3, 4
- Cantharidin-podophyllin-salicylic acid formulation: a topical proprietary formulation with high cure rates, up to 97.82% 5, 4
- Topical antivirals: with cure rates ranging from 72.45% 4
Cryotherapy
Cryotherapy is a widely used treatment for plantar warts, with cure rates ranging from 39% to 45.61% 3, 4, 6. However, studies suggest that cryotherapy may have lower cure rates compared to other treatments, such as antivirals and chemotherapy 6.
Intralesional Injections
Intralesional injections, such as autologous platelet-rich plasma (PRP) and bleomycin, have shown promising results in the treatment of plantar warts, with cure rates ranging from 68.14% to 83.37% 7, 4.
Other Treatments
Other treatments for plantar warts include:
- Laser therapy: with cure rates ranging from 79.36% 4
- Immunotherapy: with cure rates ranging from 68.14% 4
Comparison of Treatments
Studies have compared the efficacy of different treatments for plantar warts, with results suggesting that: