From the Guidelines
Treatment of very large verrucae pedis typically requires a combination of approaches, including salicylic acid preparations, cryotherapy, and surgical options, to effectively manage the condition and improve quality of life. The most recent and highest quality study, 1, recommends the use of salicylic acid (15–40%) topical paints or ointments, as well as cryotherapy, fortnightly for 3–4 months, for the treatment of plantar warts.
Key Considerations
- Salicylic acid preparations (15-40%) applied daily for several weeks with regular debridement of dead tissue can be an effective first-line treatment.
- Cryotherapy with liquid nitrogen can be performed every 2-3 weeks, though multiple sessions are usually required.
- Surgical options, such as curettage with electrodesiccation, laser therapy (CO2 or pulsed dye), or formal excision, may be necessary for particularly large or resistant warts.
- Immunotherapy, with intralesional injections of Candida or mumps antigens, can stimulate the immune system to fight the HPV infection.
- Maintaining good foot hygiene and keeping the area dry can help prevent spread and recurrence.
Treatment Options
- Combination therapy, such as debridement followed by salicylic acid and cryotherapy, can be the most successful approach for very large warts.
- Other treatments, including dithranol, 5-FU, formaldehyde, glutaraldehyde, hyperthermia, laser, PDT, podophyllotoxin, and topical immunotherapy, may be considered, but their effectiveness and safety profiles vary.
- Patients should be advised that treatment may take months, and recurrence is possible, as all treatments address the lesion rather than the underlying HPV infection, as noted in 1.
Important Considerations
- Paring, if used to remove excess skin from warts before treatment, should avoid damaging surrounding skin because of the risk of spreading infection, as highlighted in 1.
- The choice of treatment should be individualized based on the size, location, and number of warts, as well as the patient's overall health and preferences.
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 treatment protocol for very large verrucae pedis using salicylic acid (TOP) involves using it as a topical aid in the removal of excessive keratin. The drug label 2 suggests that salicylic acid 6% can be used for the treatment of verrucae, including verrucae plantares. However, the label does not provide specific guidance on the treatment of very large lesions.
- The main idea is to use salicylic acid 6% as an adjunctive therapy for verrucae plantares.
- Key points to consider when treating very large verrucae pedis include the need for careful consideration of the treatment approach, as the label does not provide explicit guidance on this specific condition.
From the Research
Treatment Options for Verrucae Pedis
- Cryotherapy using liquid nitrogen is a common treatment for verrucae pedis, with a study showing a cure rate of 39% at 13 weeks 3
- Topical salicylic acid application is another treatment option, with a study showing a cure rate of 24% at 13 weeks 3
- A combination of cryotherapy and salicylic acid treatment has been shown to be effective, with a study demonstrating an 89.2% rate of eradication of verrucae in 86.2% of patients 4
Comparison of Treatment Effectiveness
- A randomized controlled trial comparing cryotherapy and salicylic acid treatment found no significant difference in clearance rates between the two treatments 5
- Another study found that cryotherapy was more effective than salicylic acid treatment for common warts, but not for plantar warts 3
Considerations for Treatment
- The size and location of the verruca, as well as the patient's age and medical history, should be taken into account when selecting a treatment option
- Destructive techniques, such as cryotherapy, should be used with caution to avoid damaging the surrounding tissue
- Treatment should be individualized based on patient characteristics and the specific characteristics of the verruca 6
Treatment Protocols for Large Verrucae Pedis
- There is limited research specifically addressing treatment protocols for very large verrucae pedis
- However, a study on the treatment of subungual and periungual verrucae suggests that treatment should be individualized based on patient characteristics and the size and location of the verruca 6