What are the treatment options for common warts (Verruca vulgaris) on the hands?

From the Guidelines

The most effective treatment for common warts on the hands is salicylic acid, which should be applied topically at a concentration of 15-26% daily after removing the thick keratin layer, with occlusion if possible, for 3-4 months 1. When considering treatment options, it's essential to weigh the strength of recommendation, with salicylic acid being the highest recommended (A) due to its efficacy and safety profile. Other treatment options, such as cryotherapy, have a lower strength of recommendation (B) and may be considered for patients who do not respond to salicylic acid or have specific contraindications.

Some key points to consider when treating common warts on the hands include:

• The importance of removing the thick keratin layer before applying treatment to enhance penetration and efficacy
• The use of occlusion to increase the absorption of topical treatments
• The need for repeated treatments, such as cryotherapy, spaced 2-4 weeks apart for at least 3 months
• The potential for pain and discomfort associated with certain treatments, such as cryotherapy and bleomycin

Other treatment options, such as 5-fluorouracil, laser therapy, and immunotherapy, may be considered for patients with stubborn or recurrent warts, but their effectiveness and safety profiles may vary. It's crucial to consult with a healthcare provider to determine the best course of treatment for individual cases.

In terms of specific treatment regimens, the following may be considered:

• Salicylic acid: 15-26% topical preparation, applied daily after removing the thick keratin layer, with occlusion if possible, for 3-4 months 1
• Cryotherapy: liquid nitrogen applied to the wart, with repeated treatments spaced 2-4 weeks apart for at least 3 months 1
• 5-fluorouracil: 5% cream applied daily, with occlusion, for 4-12 weeks 1
• Laser therapy: pulsed-dye laser after paring and/or salicylic acid pretreatment, with 2-4 treatments at 7-10 J/cm2 1

From the Research

Treatment Options for Common Warts on the Hands

• Salicylic acid products, such as anti-wart drops, gel, and salicylic acid plaster, are commonly used to treat common warts on the hands 2
• Cryotherapy, which involves freezing the wart with liquid nitrogen, is also an effective treatment option for common warts on the hands 3, 4, 5
• Topical vitamin A has been shown to be a successful treatment for common warts in some cases 6
• Other treatment options, such as formic acid solution, trichloroacetic acid products, and removal of the lesion with a punch and diathermy, may also be considered 2
• Combination therapy, such as using salicylic acid and cryotherapy together, may be more effective than using either treatment alone 4, 5

Efficacy of Treatment Options

• Salicylic acid has been shown to be effective in treating common warts on the hands, with a risk ratio of 2.67 compared to placebo 5
• Cryotherapy has also been shown to be effective, with a higher cure rate when used at 2-weekly intervals compared to 4-weekly intervals 3
• Topical vitamin A has been shown to be effective in some cases, but more research is needed to determine its efficacy 6
• Combination therapy, such as using salicylic acid and cryotherapy together, may be more effective than using either treatment alone, with a risk ratio of 1.24 compared to salicylic acid alone 5

Safety and Adverse Effects

• Salicylic acid and cryotherapy are generally considered safe and effective treatments for common warts on the hands, but may cause adverse effects such as pain, blistering, and scarring 3, 4, 5
• Topical vitamin A may also cause adverse effects, but more research is needed to determine its safety profile 6
• Other treatment options, such as formic acid solution and trichloroacetic acid products, may also cause adverse effects, and their safety and efficacy are not well established 2