What are the recommended topical treatments for warts?

From the Guidelines

Topical salicylic acid is the most recommended treatment for warts, with a strength of recommendation A, and should be applied daily after removing the thick keratin layer, with occlusion if possible, for 3-4 months 1. The treatment of warts typically involves topical applications, with the goal of removing the infected tissue or stimulating the immune system to fight the virus.

• Salicylic acid (SA) is the most commonly used topical treatment, available over-the-counter in concentrations of 15-26% SA, and is applied daily after removing the thick keratin layer, with occlusion if possible, for 3-4 months 1.
• Other topical treatments include imiquimod cream 5% (Aldara), which stimulates the immune system to fight the virus, and is typically applied three times weekly for up to 16 weeks 1.
• 5-Fluorouracil cream targets rapidly dividing cells and can be used for resistant warts, applied daily under occlusion for 4-12 weeks 1.
• It is essential to protect the surrounding healthy skin from irritation by covering it during treatment. These treatments work by either directly destroying wart tissue, stimulating local immune response, or interfering with viral replication of the human papillomavirus that causes warts.
• The choice of treatment should be guided by the preference of the patient, the available resources, and the experience of the healthcare provider 1.
• It is crucial to follow the recommended treatment regimen and to seek medical attention if the warts persist or recur after treatment.
• The most recent and highest quality study recommends salicylic acid as the first-line treatment for warts, due to its high efficacy and safety profile 1.

From the FDA Drug Label

Dosing is 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.

The recommended topical treatment for warts is Imiquimod Cream, applied 3 times per week to external genital/perianal warts, for a maximum of 16 weeks or until total clearance of the warts 2.

• The treatment area should be washed with mild soap and water 6-10 hours following Imiquimod Cream application.
• Local skin reactions such as erythema, erosion, excoriation/flaking, and edema are common at the site of application or surrounding areas.

From the Research

Topical Treatments for Warts

The following are some recommended topical treatments for warts:

• 5% 5-Fluorouracil cream: This treatment has been shown to be effective in treating common warts in children 3 and plantar warts in adults 4.
• 70% Salicylic acid: This treatment can be used in combination with cryotherapy to increase destruction of the wart 5.
• Topical zinc oxide: This treatment has been shown to be efficacious, painless, and safe for wart treatment 6.
• 5% Potassium hydroxide solution: This treatment has been compared to a 5-fluorouracil and salicylic acid combination in the treatment of anogenital warts, with similar efficacy 7.
• 0.5% 5-Fluorouracil and 10% Salicylic acid combination: This treatment has been shown to be effective in treating anogenital warts 7.

Key Findings

• Topical 5% 5-fluorouracil cream has been shown to have a high success rate in treating warts, with 88% of treated warts improving after 6 weeks of treatment 3.
• The combination of cryotherapy and 70% salicylic acid has been shown to have a high success rate in treating plantar warts, with an 89.2% rate of eradication of verrucae in 86.2% of patients 5.
• Topical zinc oxide has been shown to be an efficacious and safe treatment for warts, with 50% of patients showing complete cure 6.
• The 5% potassium hydroxide solution and the 5-fluorouracil and salicylic acid combination have been shown to be effective in treating anogenital warts, with similar efficacy 7.