From the Guidelines
Plantar warts should be treated with salicylic acid (15–40%) topical paints or ointments, or cryotherapy, fortnightly for 3–4 months, as these methods have been shown to be effective in managing the condition, despite lower cure rates at this site due to the thicker cornified layer 1. When treating plantar warts, it is essential to consider the location and potential for scarring.
- Paring, if used to remove excess skin from warts before treatment, should avoid damaging surrounding skin because of the risk of spreading infection 1.
- Combination treatments, such as salicylic acid and cryotherapy, can be undertaken, but care is needed with worse side-effects 1.
- Other treatments, including dithranol, 5-FU, formaldehyde, glutaraldehyde, hyperthermia, laser, PDT, podophyllotoxin, and topical immunotherapy, may also be considered 1. It is crucial to weigh the potential benefits and risks of each treatment option, considering the individual patient's needs and circumstances.
- Treatment should aim to reduce the size and symptoms of the warts, while minimizing the risk of scarring and spreading the infection 1.
- Patients should be advised to keep their feet dry and wear shoes in public showers to prevent the spread of the infection 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 ... plantaris keratosis 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 salicylic acid is used to remove excessive keratin on plantar hyperkeratotic lesions and is useful for verrucae plantares (plantar warts) 2.
From the Research
Plantar Warts Treatment Options
- Various treatments are available for plantar warts, including topical treatments, cryotherapy, and other methods 3, 4, 5, 6, 7
- Topical treatments such as cantharidin-podophyllotoxin-salicylic acid (CPS) have shown high cure rates for plantar warts, with one study reporting a cure rate of 97.82% 5
- Cryotherapy is also a commonly used treatment for plantar warts, but its cure rates are generally lower than those of CPS, with a reported cure rate of 45.61% 5
Efficacy of Cryotherapy
- A systematic review and meta-analysis found that cryotherapy has lower cure rates than other treatments for plantar warts, with an odds ratio of 0.31 and substantial heterogeneity 6
- Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to physical treatment and antiviral, chemotherapy, and retinoid groups 6
Comparison of Treatment Options
- A study comparing topical CPS and cryotherapy found that CPS was more effective, with 14 out of 26 patients completely cleared of their warts, compared to 5 out of 12 patients treated with cryotherapy 3
- Another study found that CPS was a safe and effective treatment for recalcitrant plantar warts, with 77% of patients experiencing complete resolution of their warts 4
Treatment Recommendations
- The choice of treatment for plantar warts depends on various factors, including the size and location of the wart, as well as the patient's medical history and preferences 7
- First-line therapy for plantar warts may include medical treatments such as salicylic acid, while cryotherapy may be considered as second-line therapy 7