From the Guidelines
Persistent viral warts that return after cryotherapy should be treated with salicylic acid preparations (15-40% strength applied daily) as the first line of treatment, as recommended by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. This approach is based on the highest quality and most recent evidence available. The guidelines suggest that salicylic acid preparations have a strength of recommendation of A, indicating a high level of evidence and a strong recommendation for their use in treating hand warts.
Some key points to consider when treating persistent viral warts include:
- Combining treatments, such as cryotherapy with other options like imiquimod 5% cream or podophyllotoxin solution, may be necessary for optimal results.
- For stubborn warts, oral cimetidine (30-40 mg/kg/day divided into 3 doses for 2-3 months) may help boost immune response, particularly in children.
- Intralesional immunotherapy with Candida antigen injections can also be effective for resistant cases.
- Improving immune response is crucial since HPV thrives when immunity is compromised, and ensuring adequate sleep, managing stress, and maintaining good nutrition are essential.
- Avoiding picking or scratching warts, covering them during treatment, and continuing treatment consistently even after the wart appears gone can help prevent spreading the virus and ensure complete eradication of the virus.
It is essential to note that the treatment of persistent viral warts should be individualized, and the choice of treatment should be based on the specific characteristics of the warts, the patient's overall health, and the potential risks and benefits of each treatment option, as outlined in the guidelines 1.
From the Research
Persistent Viral Warts Coming Back After Cryotherapy
- Cryotherapy is a standard treatment for viral warts, but its efficacy can vary depending on the freezing time and interval between sessions 2, 3, 4.
- A study found that a 10-s sustained freeze is more effective than the traditional freeze method, but it carries a greater morbidity in terms of pain and blistering 2.
- Another study compared two cryotherapy protocols and found that a single cycle of 10 seconds of freezing at 2-weekly intervals achieved a higher cure rate than a single cycle of 20 seconds of freezing at 4-week intervals 3.
- The recurrence rate of hand-foot viral warts after cryotherapy can be reduced by using a 2-week interval between sessions instead of a 3-week interval 4.
- For persistent cutaneous warts that have failed to respond to cryotherapy, imiquimod 5% cream may be a beneficial treatment option, especially for immunosuppressed individuals 5.
- Treatment of cutaneous warts should be aimed at relieving physical and psychological discomfort and preventing the spread of infection, and the choice of treatment should be based on evidence-based medicine studies 6.