What are the treatment options for verruca (warts) on the palmar surface of the hand?

From the Guidelines

The most effective treatment for warts on the palm of the hand is salicylic acid (SA) with a strength of 15–26%, applied daily after removing the thick keratin layer, with occlusion if possible, for 3–4 months, as recommended by the British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 1. This treatment option has the highest strength of recommendation (A) and is considered the first-line treatment for hand warts. The application of salicylic acid helps to break down the keratin layer and ultimately leads to the disappearance of the wart.

Other treatment options for hand warts include:

• Cryotherapy, which involves freezing the wart with liquid nitrogen, with a strength of recommendation of B 1
• 5-Fluorouracil, a 5% cream applied daily with occlusion for 4–12 weeks, with a strength of recommendation of C 1
• Laser therapy, which can be used after paring and/or salicylic acid pretreatment, with a strength of recommendation of C 1
• Immunotherapy, such as contact immunotherapy with diphencyprone (DPC) or squaric acid dibutyl ester (SADBE), with a strength of recommendation of C 1

It's essential to note that the choice of treatment depends on the individual patient's condition, the size and location of the wart, and the patient's preferences. The British Association of Dermatologists' guidelines recommend that treatment should be tailored to the individual patient, taking into account the potential benefits and risks of each treatment option 1.

In terms of specific application and dosage, the guidelines recommend that salicylic acid should be applied daily after removing the thick keratin layer, with occlusion if possible, for 3–4 months 1. For cryotherapy, the guidelines recommend keeping the wart frozen for 15–30 seconds, repeating every 2–4 weeks for at least 3 months or six treatments 1.

Overall, the most effective treatment for warts on the palm of the hand is salicylic acid, and treatment should be tailored to the individual patient, taking into account the potential benefits and risks of each treatment option 1.

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). Treatment options for warts on the palm of the hand include:

• Salicylic acid (6%) topical aid for the removal of excessive keratin in hyperkeratotic skin disorders, including verrucae (warts) on the palms 2

From the Research

Treatment Options for Warts on the Palm of the Hand

• Salicylic acid is a commonly used treatment for warts on the palm of the hand, with studies showing it to be effective in increasing the chance of clearance of warts at this site 3.
• Cryotherapy is another treatment option, with some studies suggesting it may be more effective for hand warts than other types of warts 4, 3.
• Combination therapy consisting of cryosurgery followed by administration of imiquimod and salicylic acid has also been shown to be effective in treating resistant common warts, including those on the palm of the hand 5.
• Other treatment options, such as intralesional bleomycin, dinitrochlorobenzene, and silver nitrate, have also been studied, but the evidence for their effectiveness is less consistent 3.
• Topical treatments, such as imiquimod 5% cream combined with a keratolytic lotion, have also been shown to be effective in treating cutaneous warts, including those on the palm of the hand 6.

Comparison of Treatment Options

• A study comparing cryotherapy with imiquimod 5% cream combined with a keratolytic lotion found no statistically significant difference between the two treatments, but noted that imiquimod 5% cream was more effective in treating plantar warts 6.
• Another study found that salicylic acid and cryotherapy combined appeared more effective than salicylic acid alone in treating cutaneous warts 3.
• The effectiveness of other treatments, such as intralesional 5-fluorouracil, topical zinc, and pulsed dye laser, is less well established, with limited or inconsistent evidence available 3.

Considerations for Treatment

• The choice of treatment for warts on the palm of the hand should take into account the individual patient's needs and preferences, as well as the potential risks and benefits of each treatment option 4, 3.
• Treatment should be aimed at relieving the patient's physical and psychological discomfort, as well as preventing the spread of infection by autoinoculation 4.
• Spontaneous healing of warts should be followed up for at least six months, preferably one or two years, before considering treatment 7.