Warts (Verruca Vulgaris)- Treatment

Treatment

Common warts can go away without treatment, though the chances to spread to other areas increases and it may take an year or two to resolve on its own. The treatment option depends on the symptoms, what the patients prefers and the cost. Before starting the treatment it’s important to understand that recurrences are common with warts.

Topical

• Salicyclic acid for common warts can be applied over the wart, with each application it forms a thin layer over the wart hence this layer should be removed before the solution is applied again. Mostly there are available over the counter and may come in combination with lactic acid.

• Cryotherapy- most commonly used for common warts in adults and older children. The treatment needs to be repeated every week and it may form a blister (fluid filled lesion) and fall off leaving behind a dark spot in dark skinned individual.

• Tretinoin cream 0.05% – most commonly used for flat warts and recalcitrant (unmanageable)common warts. Should not be used during pregnancy.

• Podophyllotoxin 0.05% solution or gel and 0.15% cream can be used by patient. It should be applied twice daily, thrice a week for maximum four weeks.

• Imiquimod 5% cream- commonly used for genital and cutaneous warts, applied at bed time thrice a week for 4 months.

• Trichloroacetic acid 80-90% can be used to burn, cauterize the skin and mucosa. It is only done by physicians. It is an inexpensive and cost effective treatment.

Intralesional

• MMR vaccine 0.3-0.5ml injected into the single largest wart every 2 weeks (fornightly) for 5 times.

• BCG vaccine for genital and cutaneous warts 0.1-0.5ml into the largest wart every 2 weeks for 5 times.

• Interferon alpha 2B for genital warts can be used 1-2 million units 3days/week for 3 weeks.

• Tuberculin 2.5units into few warts every 2 weeks.

Surgical

• Electrodessication- It is preferred method of treatment for common warts, filiform and foot warts.

• Excision- In some cases the preferred treatment is complete removal under local anesthesia.

• Laser- Pulse dye laser/ Erbium YAG laser. CO2 Laser can be used to destroy the blood vessels that supply the warts therefore stopping the multiplication of the virus.

Systemic

• Retinoids- oral isotretinoin 1mg/kg/day can be given for 3 months

• Cimetidine-20-40mg/kg/day for 3-4 months.

• Ranitidine-20-40mg/kg/day for 3-4 months

Prevention

• Avoid touching the wart as it can spread to other sites too.

• Don’t try to manipulate/ remove the wart on our own.

• If the wart is in the beard region avoid shaving or using clipper so that it doesn’t spread to other areas.

• Don’t bite your fingernails or pick at hangnails as warts are more likely to develop where the skin is broken.

• Gardasil (HPV4)- this vaccine is FDA approved and can be used by young women between the age group of 9 years to 26 years. It prevents against HPV types 16 & 18. In addition, it prevents against HPV 6, 11, 16 and 18.

• Cervarix (HPV2) it is ideal for females between the age group of 10 years to 35 years and it acts against HPV 16 &18.