What ointment is recommended for treating plantar warts?

Recommended Ointment for Plantar Warts

Start with salicylic acid 15-40% topical ointment or paint as first-line treatment for plantar warts, applied daily after paring down the wart, and continue for at least 3 months before considering treatment failure. 1, 2

First-Line Treatment: Salicylic Acid

• Salicylic acid (15-40%) is the recommended first-line topical treatment based on British Association of Dermatologists guidelines, due to its strong safety profile, accessibility, and evidence-based efficacy. 3, 1

• The FDA specifically approves salicylic acid 6% as a topical aid for removal of excessive keratin in plantar warts (verrucae plantares). 4

• Salicylic acid works by promoting exfoliation of epidermal cells and stimulating host immunity against the human papillomavirus causing the wart. 1, 2

Critical Application Technique

• Always pare or debride the wart before each application to remove the thick keratin layer that blocks treatment penetration—this step is essential for efficacy. 1, 5, 2

• Apply the medication thoroughly to the affected area daily, preferably at night after washing and before retiring. 4

• Hydrate the skin for at least 5 minutes prior to application (wet packs or baths enhance the effect). 4

• Consider occlusion (covering the treated area overnight) to improve efficacy. 1

• Wash off the medication in the morning; if excessive drying or irritation occurs, apply a bland cream or lotion. 4

• Avoid damaging surrounding normal skin during paring, as this can spread the HPV infection to adjacent areas. 5, 2

Important Caveats About Plantar Warts

• Plantar warts have inherently lower cure rates (14-33%) compared to warts at other body sites due to the thick cornified layer of plantar skin preventing adequate treatment penetration. 5, 2

• Treatment duration must be adequate—continue for at least 3-4 months before declaring treatment failure. 1, 5, 2

• Patient compliance is often poor due to surrounding skin irritation and the prolonged treatment course required. 5, 2

• Salicylic acid can cause chemical burns and should not be used in areas of poor healing. 1

• Spontaneous resolution occurs in approximately 30% of cases within 6 months, though waiting may not be acceptable if the wart causes pain or functional impairment. 5, 2

Second-Line Treatment Options

If no improvement after 3 months of salicylic acid:

• Switch to cryotherapy with liquid nitrogen applied every 2 weeks for 3-4 months (achieves approximately 30% cure rates for plantar warts). 1, 5, 2

• Consider combination therapy (salicylic acid plus cryotherapy), though this increases side effects. 1, 5

• A recent 2025 study found no substantial difference in effectiveness between 50% salicylic acid, liquid nitrogen, 5-FU, or imiquimod as second-line treatments, with all showing modest results (3.5-20% complete remission at 90 days). 6

Alternative Topical Options for Resistant Cases

For warts that fail both salicylic acid and cryotherapy:

• Cantharidin-podophyllotoxin-salicylic acid (CPS) combination (1% cantharidin, 5% podophyllotoxin, 30% salicylic acid) shows high efficacy, with one study reporting 95.8% complete clearance and another showing superiority over cryotherapy. 7, 8

• Formaldehyde 3-4% solution as a daily 15-20 minute soak. 1, 5, 2

• Glutaraldehyde 10% solution applied topically. 1, 5, 2

• 5-Fluorouracil (5-FU) for recalcitrant lesions. 1, 5, 2

Special Populations

Children

• Salicylic acid 15-40% is the preferred first-line treatment for children with plantar warts. 1

• Warts in children often resolve spontaneously within 1-2 years. 1

• Limit the treatment area to avoid excessive systemic absorption and monitor for signs of salicylate toxicity (tinnitus, nausea, vomiting, hyperventilation, confusion). 1

• Avoid use during varicella infection or influenza-like illnesses due to Reye syndrome risk. 1