II. Precautions

  1. Avoid over-treatment
    1. May result in painful scar worse than wart!
  2. Expect only 60-70% success with only 1 treatment

III. 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. 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]

IV. 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)
  2. Second line Keratolytic Agents
    1. Cantharidin
    2. Imiquimod Cream (Aldara) 5%
    3. Retin A (Tretinoin) 0.05% cream applied qhs to warts

V. 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 Fluorouracil

VI. Management: Advanced Dermatologic Procedures

  1. Photodynamic Therapy with Aminolevulinic Acid (Levulan Kerastick)
  2. Pulse dye laser or CO2 Laser
  3. Intralesional Bleomycin

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