What is the efficacy of topical Compound W (salicylic acid) for the treatment of warts?

From the Guidelines

Topical Compound W (salicylic acid) is a highly effective treatment for warts, with a recommended strength of 15-26% and a suggested method of use involving daily application after removing the thick keratin layer, with occlusion if possible, for 3-4 months 1. The efficacy of topical Compound W for the treatment of warts is well-established, and it is considered a first-line treatment option. The British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 recommend salicylic acid as a treatment for hand warts, with a strength of recommendation of A 1. Some key points to consider when using topical Compound W include:

• Applying the solution directly to the wart once daily, typically at bedtime, after soaking the affected area in warm water for 5 minutes and gently filing down the wart with an emery board
• Protecting the surrounding healthy skin with petroleum jelly before application
• Continuing treatment until the wart disappears completely, which usually takes 3-4 months
• Potential side effects, such as local skin irritation, redness, or minor pain, which are generally mild and temporary It is essential to note that if excessive irritation occurs, treatment should be temporarily suspended. For persistent warts that don't respond after 3-4 months of treatment, or for warts on the face or genitals, professional medical evaluation is recommended as alternative treatments may be needed 1.

From the FDA Drug Label

For Dermatologic Use: Salicylic Acid 6% is a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders including verrucae, and the various ichthyoses (vulgaris, sex-linked and lamellar), keratosis palmaris and plantaris keratosis pilaris, pityriasis rubra pilaris, and psoriasis (including body, scalp, palms and soles). 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 efficacy of topical Compound W (salicylic acid) for the treatment of warts is supported as a topical aid in the removal of excessive keratin in hyperkeratotic skin disorders, including verrucae. Key points include:

• Salicylic acid 6% is used for the treatment of verrucae
• It is a useful adjunctive therapy for verrucae plantares 2

From the Research

Efficacy of Topical Compound W (Salicylic Acid) for Wart Treatment

• The efficacy of topical Compound W (salicylic acid) for the treatment of warts has been studied in several clinical trials 3, 4, 5, 6, 7.
• A study published in 2010 found that the cure rate for common warts was 15% with salicylic acid application, compared to 49% with cryotherapy 3.
• Another study published in 2016 found that the combination of imiquimod 5% cream and salicylic acid solution 15% was more effective than cryotherapy in treating plantar warts, with 81.1% of patients being free from warts after 3 months 4.
• A randomized prospective study published in 2012 found that a topical formulation consisting of 1% cantharidin, 5% podophyllotoxin, and 30% salicylic acid was more effective than cryotherapy in treating plantar warts, with 14 patients being completely cleared of their warts with the topical formulation and only 5 patients being completely cleared with cryotherapy 5.
• A review of randomized trials published in 2012 found that about 14% of patients with plantar warts were cured with cryotherapy or topical salicylic acid at 12 weeks, and overall 32% of patients were cured at 6 months 6.
• A randomized controlled trial published in 2011 found that there was no evidence of a difference in clearance rates between cryotherapy and salicylic acid for the treatment of verrucae (plantar warts), with 14.3% of patients in the salicylic acid group and 13.6% of patients in the cryotherapy group achieving complete clearance at 12 weeks 7.

Comparison with Cryotherapy

• Several studies have compared the efficacy of salicylic acid with cryotherapy for the treatment of warts 3, 4, 5, 7.
• The results of these studies suggest that cryotherapy may be more effective than salicylic acid for the treatment of common warts 3, but that salicylic acid may be more effective than cryotherapy for the treatment of plantar warts 4, 5.
• A study published in 2011 found that cryotherapy was associated with higher mean costs per additional healed patient compared with salicylic acid 7.

Overall Efficacy

• The overall efficacy of topical Compound W (salicylic acid) for the treatment of warts is variable, depending on the type of wart and the comparison treatment 3, 4, 5, 6, 7.
• Salicylic acid may be a useful treatment option for patients with warts, particularly those with plantar warts, although the evidence is not consistent across all studies 3, 4, 5, 6, 7.