From the Guidelines
The success rate of salicylic acid for treating common warts is approximately 60-80% with proper use over 3-4 months, as it is 16 times more likely to clear warts compared to placebo, with a relative risk of 160 and a 95% confidence interval of 115-224 1.
Treatment Overview
The treatment of common warts with salicylic acid involves applying over-the-counter preparations, typically 17% for plantar warts and 12-17% for common warts, once daily after soaking and gently filing the wart to remove dead skin.
- Apply petroleum jelly to protect surrounding healthy skin
- Cover with a bandage
- Treatment requires consistency and patience, with most patients needing 6-12 weeks of daily application
Important Considerations
- If no improvement occurs after 12 weeks, or if warts are extensive, painful, or on the face or genitals, medical consultation is recommended
- Side effects are generally mild and include local skin irritation, but discontinue use if severe irritation develops
- This treatment is most effective for small to medium-sized warts and may be less effective for immunocompromised patients
Evidence-Based Recommendation
The British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 recommend salicylic acid as a first-line treatment for hand warts, with a strength of recommendation A 1.
- The guidelines suggest applying topical preparations of 15–26% salicylic acid daily after removing the thick keratin layer, with occlusion if possible, for 3–4 months.
From the FDA Drug Label
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. Once clearing is apparent, the occasional use of Salicylic Acid 6% will usually maintain the remission
The FDA drug label does not answer the question.
From the Research
Treatment of Common Warts with Salicylic Acid
- The rate of common wart infections treated with salicylic acid is not directly stated in the provided studies, but the effectiveness of salicylic acid in combination with other treatments is reported 2, 3, 4, 5, 6.
- A study from 2016 found that 81.1% of children treated with imiquimod 5% and salicylic acid were free from their warts after 3 months, compared to 67.3% of children treated with cryotherapy 2.
- Another study from 2002 reported that 9 out of 10 patients with recurrent warts were successfully treated with imiquimod 5% cream, which was applied under occlusion once daily for 4 weeks, but salicylic acid was not used in this study 3.
- A case report from 2022 presented a patient with multiple recalcitrant plantar warts who was treated with a cantharidin-podophyllin-salicylic acid formulation after failed treatments with cryotherapy and nitric-acid-zinc complex, and the warts were resolved after 3 sessions of the formulation 4.
- A randomized prospective study from 2012 compared the efficacy of cantharidin-podophylotoxin-salicylic acid with cryotherapy in the treatment of plantar warts and found that the topical 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 5.
- An anecdotal report from 2002 presented 3 cases of resistant common warts treated with cryotherapy followed by topical imiquimod and salicylic acid, with efficacy ranging from 50% to 100% after 6 to 9 weeks 6.