From the Guidelines
Treatment of large verrucae pedis should prioritize salicylic acid preparations (15-26%) applied daily for 3-4 months, as recommended by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. This approach is supported by the guidelines, which suggest that salicylic acid is a first-line treatment for hand warts, and by extension, can be applied to large verrucae pedis. The treatment should be applied daily after removing the thick keratin layer, with occlusion if possible.
Some key points to consider when treating large verrucae pedis include:
- The strength of recommendation for salicylic acid is A, indicating a high level of evidence and consensus among experts 1
- Cryotherapy with liquid nitrogen is also an effective treatment, but may require multiple treatments every 2-4 weeks 1
- Combination therapy using both salicylic acid and cryotherapy may yield better results than either alone
- Surgical options, such as curettage with electrodesiccation, laser therapy, or surgical excision, may be considered for particularly large or stubborn warts, but may result in scarring and potentially cause pain with walking 1
It is essential to consider the patient's age, pain tolerance, and previous treatment response when selecting a treatment option. Regardless of the method chosen, patience is required, as complete resolution may take months, and the goal is to eliminate the wart while minimizing scarring and discomfort.
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.
Treatment protocols for large verrucae pedis may include the use of salicylic acid 6% as a topical aid in the removal of excessive keratin. The treatment is considered an adjunctive therapy, implying it may be used in conjunction with other treatments. Key points to consider:
- Salicylic acid 6% is used for the removal of excessive keratin in hyperkeratotic skin disorders, including verrucae.
- It is specifically mentioned as useful for verrucae plantares, which includes verrucae pedis.
- The exact protocol for large verrucae pedis is not detailed, but topical application of salicylic acid 6% is indicated 2.
From the Research
Treatment Options for Large Verrucae Pedis
- Cryotherapy using liquid nitrogen: This method involves freezing the wart using liquid nitrogen, and it has been shown to be effective in treating verrucae pedis 3, 4, 5.
- Salicylic acid treatment: This involves applying salicylic acid to the wart, and it has been shown to be effective in treating verrucae pedis 3, 4, 6, 5.
- Combined cryotherapy and salicylic acid treatment: This method involves combining cryotherapy with salicylic acid treatment, and it has been shown to be effective in treating verrucae pedis 6.
- Pulsed dye laser therapy: This method involves using a laser to treat the wart, and it has been shown to be effective in treating verrucae pedis 7.
- Pulsed dye laser therapy with salicylic acid: This method involves combining pulsed dye laser therapy with salicylic acid treatment, and it has been shown to be effective in treating verrucae pedis 7.
Efficacy of Treatment Options
- Cryotherapy has been shown to be effective in treating verrucae pedis, with cure rates ranging from 13.6% to 49% 3, 4, 5.
- Salicylic acid treatment has been shown to be effective in treating verrucae pedis, with cure rates ranging from 14.3% to 24% 3, 4, 5.
- Combined cryotherapy and salicylic acid treatment has been shown to be effective in treating verrucae pedis, with a cure rate of 89.2% 6.
- Pulsed dye laser therapy has been shown to be effective in treating verrucae pedis, with a complete clearance rate of 66.4% after five sessions 7.
- Pulsed dye laser therapy with salicylic acid has been shown to be effective in treating verrucae pedis, with a complete clearance rate of 54.6% after two sessions 7.
Comparison of Treatment Options
- There is no evidence of a difference in clearance rates between cryotherapy and salicylic acid treatment 3, 4.
- Cryotherapy has been shown to be more effective than salicylic acid treatment in treating common warts, but not plantar warts 5.
- Combined cryotherapy and salicylic acid treatment has been shown to be more effective than cryotherapy alone in treating verrucae pedis 6.
- Pulsed dye laser therapy with salicylic acid has been shown to be more effective than pulsed dye laser therapy alone in treating verrucae pedis, with a shorter number of sessions required for complete clearance 7.