What is the recommended cream treatment for warts?

From the Guidelines

The recommended cream treatment for warts is imiquimod 5% cream, which should be applied once daily at bedtime, three times a week for up to 16 weeks, as it stimulates the immune system to fight the human papillomavirus (HPV) causing the wart. This treatment option is based on the guidelines provided by the Centers for Disease Control and Prevention, as outlined in the study 1.

Key Considerations for Treatment

• Imiquimod cream is a topically active immune enhancer that stimulates production of interferon and other cytokines, making it an effective treatment for warts.
• The treatment area should be washed with soap and water 6–10 hours after the application of imiquimod cream.
• Local inflammatory reactions, including redness, irritation, induration, ulceration/erosions, and vesicles, are common with the use of imiquimod, and hypopigmentation has also been described.
• Imiquimod might weaken condoms and vaginal diaphragms, and its safety during pregnancy has not been established.

Alternative Treatment Options

• Other cream treatments, such as podofilox and sinecatechin ointment, are also available, but imiquimod 5% cream is the recommended treatment based on the provided guidelines.
• Podofilox solution should be applied with a cotton swab, or podofilox gel with a finger, to visible genital warts twice a day for 3 days, followed by 4 days of no therapy, as outlined in the study 1.
• Sinecatechin ointment should be applied three times daily using a finger to ensure coverage with a thin layer of ointment until complete clearance of warts, but its safety and efficacy have not been established in certain populations, such as HIV-infected persons or pregnant women.

Important Safety Information

• The safety of imiquimod during pregnancy has not been established, and it is not recommended for use in pregnant women.
• Imiquimod might weaken condoms and vaginal diaphragms, and patients should be advised to use alternative forms of contraception during treatment.
• Local inflammatory reactions are common with the use of imiquimod, and patients should be monitored for signs of irritation or other adverse effects.

From the FDA Drug Label

Imiquimod Cream should be applied 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 cream treatment for warts is Imiquimod Cream, applied 3 times a week, 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, and edema, are common at the site of application.
• Patients should avoid sexual contact while Imiquimod Cream is on the skin, and the cream should not be applied internally 2.

From the Research

Cream Treatment for Warts

• Imiquimod 5% cream is a recommended treatment for warts, particularly for recalcitrant cutaneous warts in immunosuppressed individuals 3.
• The efficacy of imiquimod in treating cutaneous warts has been established in several studies, with a combined rate of complete response to therapy of 44% in immunocompetent patients 4.
• Imiquimod 5% cream has been shown to be effective in treating non-genital warts, with 9 out of 10 patients achieving complete clearance of warts after 4 weeks of treatment 5.
• A randomized study comparing cryotherapy with imiquimod 5% cream combined with a keratolytic lotion found that imiquimod was equally effective and more effective than cryotherapy in plantar warts 6.
• Patient-applied imiquimod 5% cream has been rated favourably by patients, with 82% reporting a decrease in wart size and 61% perceiving complete clearance of warts within the 16-week treatment period 7.

Key Findings

• Imiquimod 5% cream is a potential treatment option for cutaneous warts, particularly for recalcitrant cases.
• The treatment has been shown to be effective in both immunocompetent and immunosuppressed individuals.
• Imiquimod 5% cream can be used in combination with other therapies, such as keratolytic lotions, to enhance its effectiveness.
• Patient satisfaction with imiquimod 5% cream is high, with most patients reporting a decrease in wart size and complete clearance of warts within a reasonable treatment period.

Treatment Considerations

• Imiquimod 5% cream should be applied under occlusion, once daily, for a recommended treatment period of 4-16 weeks.
• Local skin reactions may occur, but are usually mild and transient.
• The treatment may not be suitable for all patients, particularly those with certain medical conditions or taking certain medications.
• Further studies are needed to determine the optimal treatment regimen and combination with other therapies for cutaneous warts 4.