Plantar wart medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
No treatment in common use is 100% effective. The most comprehensive medical review found that no treatment method was more than 73% effective and using a placebo had a 27% average success rate.
Treatment
The American Family Physician recommends:
| First-line therapy | Over the counter salicylic acid |
| Second-line therapy | Cryosurgery, intralesional immunotherapy, or pulsed dye laser therapy |
| Third-line therapy | Bleomycin, surgical excision |
Podiatrists and dermatologists are considered specialists in the treatment of plantar warts, though most warts are treated by primary care physicians.
- Keratolytic Chemicals
- The treatment of warts by keratolysis involves the peeling away of dead surface skin cells with trichloroacetic acid or salicylic acid.
- Immunotherapy
- Intralesional injection of antigens (mumps, candida or trichophytin antigens USP) is a new wart treatment which may trigger a host immune response to the wart virus, resulting in wart resolution. Distant, non-injected warts may also disappear.
- Chemotherapy
- Topical application of dilute glutaraldehyde (a virucidal chemical, used for cold sterilization of surgical instruments) is an older effective wart treatment. More modern chemotherapy agents, like 5-fluoro-uracil, are also effective topically or injected intralesionally. Retinoids, systemically (eg. isotretinoin) or topically (tretinoin cream) may be effective.
- As warts are contagious, precautions should be taken to avoid spreading.
Other
- X-ray is an old method that is seldom recommended due to the long term adverse side effects of irradiation.
- Duct tape occlusion therapy: The wart is kept covered with duct tape for six days, then soaked and debrided with a pumice stone. The process is repeated for 6 to 8 weeks.
- Watchful waiting may be appropriate since many warts will eventually resolve due to the patient's own immune system. In many cases, the body will become naturally immune to the wart and verrucæ will turn black and effectively fall off, although it can be two years before this takes place.