From the Guidelines
Treatment for plantar warts should prioritize a combination of salicylic acid and cryotherapy, as this approach has been shown to have a high clearance rate of 86% in a retrospective analysis 1.
Overview of Treatment Options
Treatment options for plantar warts include both over-the-counter and prescription medications, as well as procedural interventions. For mild cases, over-the-counter salicylic acid products (like Compound W or Dr. Scholl's) applied daily for several weeks can gradually remove the wart by dissolving the infected tissue. These typically contain 17-40% salicylic acid and should be applied after soaking the foot and filing down the wart.
Cryotherapy and Combination Therapies
Cryotherapy with liquid nitrogen is another common treatment performed in medical offices, requiring multiple sessions spaced 1-3 weeks apart to freeze and destroy the wart tissue. The application of salicylic acid 30% prior to pulsed-dye laser (PDL) therapy has also been shown to decrease the number of laser treatments needed 1.
Additional Treatment Considerations
For resistant warts, prescription options include stronger salicylic acid formulations, topical retinoids, or immunotherapy agents like imiquimod 5% cream applied 3 times weekly. Cantharidin, a blistering agent applied by healthcare providers, can also be effective. Surgical options for persistent warts include curettage, electrosurgery, or laser therapy 1.
Key Considerations for Treatment
Plantar warts are caused by human papillomavirus (HPV) entering through breaks in the skin, and treatment aims to remove infected tissue while stimulating an immune response. Most treatments require persistence, as complete resolution may take weeks to months. It's also important to note that paring, if used to remove excess skin from warts before treatment, should avoid damaging surrounding skin because of the risk of spreading infection 1.
Summary of Recommendations
In summary, the most effective treatment approach for plantar warts is a combination of salicylic acid and cryotherapy, with consideration for additional treatments such as immunotherapy agents or surgical options for persistent cases.
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.
Treatment options for plantar warts include:
- Topical preparations of 6% salicylic acid as an adjunctive therapy 2 Key points:
- Salicylic acid 6% is used for the removal of excessive keratin on plantar hyperkeratotic lesions.
From the Research
Treatment Options for Plantar Warts
The following are treatment options for plantar warts:
- Topical formulation of cantharidin, podophyllotoxin, and salicylic acid: This combination treatment has been shown to be safe and effective in the treatment of simple and mosaic plantar warts, with a complete eradication rate of 95.8% after 6 months of follow-up 3.
- Cryotherapy: This method involves the use of liquid nitrogen to freeze the wart, and has been shown to be equally effective as salicylic acid in the treatment of plantar warts, with a complete clearance rate of 14% at 12 weeks 4.
- Salicylic acid: This is a common treatment for plantar warts, and has been shown to be effective in clearing warts, with a complete clearance rate of 14% at 12 weeks 4.
- Cantharidin-podophylotoxin-salicylic acid versus cryotherapy: A randomized prospective study found that topical cantharidin-podophylotoxin-salicylic acid was more effective than cryotherapy in the treatment of plantar warts, with a complete clearance rate of 53.8% compared to 41.7% for cryotherapy 5.
- Liquid nitrogen and salicylic/lactic acid paint: A study found that combination therapy with liquid nitrogen and salicylic/lactic acid paint was effective in treating common hand warts, but not simple plantar warts 6.
Comparison of Treatment Options
The effectiveness of different treatment options for plantar warts can vary, and the choice of treatment may depend on the individual patient and the severity of the wart. Some studies have compared the effectiveness of different treatment options, including:
- Cantharidin-podophylotoxin-salicylic acid versus cryotherapy: Topical cantharidin-podophylotoxin-salicylic acid was found to be more effective than cryotherapy in the treatment of plantar warts 5.
- Salicylic acid versus cryotherapy: Salicylic acid and cryotherapy were found to be equally effective in the treatment of plantar warts, with a complete clearance rate of 14% at 12 weeks 4.