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Wart TreatmentAka: Wart Management

General Precautions
1. Avoid over-treatment
  1. May result in painful scar worse than wart!
2. Expect only 60-70% success with only 1 treatment
Management: Home General Measures
1. Debriding or paring down callus
  1. Use rasp or lava stone with care - stop if irritation
  2. Tools
    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. 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 (85% efficacy)
  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. More effective than Cryotherapy
    1. Focht (2002) Arch Pediatr Adolesc Med 156:971
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 :
  2. Occlusal (17% salicylic acid)
2. Second line Keratolytic Agents
  1. Cantharidin
  2. Imiquimod Cream (Aldara) 5%
  3. Retin A (Tretinoin) 0.05% cream applied qhs to warts
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
  2. Topical Fluorouracil
Management: Advanced Dermatologic Procedures
1. Pulse dye laser or CO2 Laser
2. Intralesional Bleomycin
References
1. Stulberg (2003) Am Fam Physician 67(6):1233

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.