Dermatology Book


Wart Treatment

Aka: Wart Treatment, Wart Management
  1. Precautions
    1. Avoid over-treatment
      1. May result in painful scar worse than wart!
    2. Expect only 60-70% success with only 1 treatment
  2. Management: Home General Measures
    1. Debriding or paring down callus
      1. Soak wart in warm water for 5 minutes before paring
      2. Use rasp or lava stone with care - stop if irritation
      3. Tools (avoid reusing the same tool to pare warts)
        1. Emery board
        2. Lava stone or pumice stone
        3. Avoid Blades!
    2. Hands
      1. Warm water soaks (50-70% efficacy)
        1. Temperature: 45 C = 113 F
        2. Use candy Thermometer to avoid burns
      2. Fifteen to thirty minutes per time as tolerated
      3. Repeat 2-3 times per week for 2 months
      4. Avoid in Peripheral Neuropathy or vascular disease
      5. Follow by Occlusal or other Keratolytic Agents
    3. Occlusion with Duct Tape
      1. Apply small piece of duct tape to each wart
      2. Leave duct tape in place for 6 days
      3. At 6 days, remove duct tape
        1. Soak for 15 minutes in warm water
        2. Debride as described below
        3. Leave tape off overnight
      4. Reapply duct tape for 6 days and repeat cycle
      5. May be more effective than Cryotherapy
        1. Focht (2002) Arch Pediatr Adolesc Med 156:971-4 [PubMed]
      6. More recent review, found no benefit to duct tape in Wart Treatment
        1. Kwok (2012) Cochrane Database Syst Rev (9): CD001781 [PubMed]
  3. Management: Home Application
    1. First Line: Salicylic Acid
      1. Salicylic Acid 17% (OTC)
        1. Apply daily to wart
        2. As effective as Cryotherapy
        3. Kuykendall-Ivy (2003) Cutis 213-22 [PubMed]
      2. Occlusal (17% salicylic acid)
      3. Salicylic acid 40% discs, pads, strips or sticks (e.g. Dr. Scholl's clear Away)
        1. Indicated for thick skin (Common Warts and Plantar Warts)
        2. More irritating, but more effective than the 17% preparations
    2. Second line Keratolytic Agents
      1. Imiquimod Cream (Aldara) 5%
      2. Retin A (Tretinoin) 0.05% cream applied qhs to warts
  4. Management: Clinic Procedures
    1. First line therapy
      1. Cryotherapy (50% efficacy)
    2. Second line therapy
      1. Wart Immune Therapy
        1. Intralesional Candida Injection
        2. Squaric Acid Wart Therapy
        3. Cimetidine wart therapy
          1. No more effective than Placebo
    3. Other measures that have been used
      1. Electrodessication and Curettage (higher risk for scarring)
      2. Topical 5-Fluorouracil 5% cream (Efudex)
      3. Cantharidin
  5. Management: Advanced Dermatologic Procedures
    1. Photodynamic Therapy with Aminolevulinic Acid (Levulan Kerastick)
    2. Pulse dye laser or CO2 Laser
    3. Intralesional Bleomycin
  6. References
    1. (2019) Presc Lett 26(6)
    2. Stulberg (2003) Am Fam Physician 67(6):1233-44 [PubMed]

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