Are Proton Pump Inhibitors (PPIs) effective for treating warts?

Proton Pump Inhibitors Are Not Effective for Treating Warts

Proton pump inhibitors (PPIs) have no established efficacy for the treatment of warts and should not be used for this purpose. 1

Approved Treatments for Warts

The CDC guidelines for wart treatment recommend several evidence-based options:

• First-line physical treatments:

  • Cryotherapy with liquid nitrogen (63-88% efficacy) 1
  • Trichloroacetic acid (TCA) 80%-90% (comparable efficacy to cryotherapy) 1
  • Electrodesiccation or electrocautery (35-94% efficacy, requires local anesthesia) 1

• Patient-applied treatments:

  • 0.5% podofilox solution (45-88% efficacy, self-applied) 1
  • Podophyllin 10%-25% in compound tincture of benzoin (32-79% efficacy, provider-applied) 1

Why PPIs Are Not Indicated for Warts

PPIs are acid-suppressing medications with specific approved indications:

• Gastroesophageal reflux disease (GERD) 1, 2
• Eosinophilic esophagitis 1
• Peptic ulcer disease 1, 2
• Gastroprotection for NSAID/aspirin users 1, 2
• Prevention of GI bleeding in high-risk patients 1, 2
• Management of Zollinger-Ellison syndrome 1, 3

PPIs work by inhibiting the proton pump (H+/K+ ATPase) in gastric parietal cells, which blocks acid production 3, 4. This mechanism has no physiological basis for treating warts, which are caused by human papillomavirus (HPV) infection of the skin or mucous membranes 1.

Potential Harms of Inappropriate PPI Use

Using PPIs for unapproved indications like warts raises several concerns:

• Unnecessary medication exposure with potential adverse effects 5, 6
• Risk of inappropriate long-term use and difficulty discontinuing due to rebound acid hypersecretion 5, 7
• Potential adverse effects associated with PPI use, including:
  • Increased risk of gastrointestinal infections 6
  • Nutrient deficiencies (vitamin B12, magnesium, calcium) 6
  • Potential kidney injury 6
  • Drug interactions 4

Conclusion

For wart treatment, clinicians should follow evidence-based guidelines and use established therapies with proven efficacy 1. PPIs have no role in wart treatment and should only be prescribed for their approved indications 2, 7. Using medications for unapproved indications without scientific evidence increases the risk of adverse effects and contributes to medication overuse 5, 6.