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Warts

Types of warts

These include common warts, plane warts, filiform warts (fine elongated growths, usually on the face and neck), digitate warts (finger-like projections, usually on scalp), genital and plantar.

Treatment options for warts

• Salicylic acid (e.g. 5–20% in flexible collodion, apply daily or bd)

• Salicylic acid 16% + lactic acid 16% in collodion paint

• Formaldehyde 2–4% alone or in combination

• Cantharadin 0.5–1% in equal parts collodion (available in USA), applied with care and occluded for 12 h

• Podophyllotoxin 0.5% or imiquimod for anogenital warts—good on mucosal surfaces but does not penetrate normal keratin

• Cytotoxic agents (e.g. 5-fluorouracil)—very good for resistant warts such as plane warts and periungal warts

Carbon dioxide (−56.5°C) or liquid nitrogen (−195.8°C) destroys the host cell and stimulates an immune reaction.

Note: Excessive keratin must be pared before freezing. Results often disappointing.

Some plantar warts can be removed under LA with a sharp spoon curette. The problem is a tendency to scar so avoid over a pressure area such as the sole of the foot.

A high-frequency spark under LA is useful for small, filiform or digitate warts. A combination of curettage and electrodissection is suitable for large and persistent warts.

• Topical retinoic acid (e.g. tretinoin 0.1% cream, Retin-A) is effective on plane warts

• Systemic oral retinoid, acitretin (Neotigason) for recalcitrant warts

Specific wart treatment

The method chosen depends on the type of wart, its site and the patient's age.

Plantar warts

Genital warts: podophyllotoxin 0.5% paint

Filiform and digitate warts: liquid nitrogen or electrodesiccation

Plane warts: liquid nitrogen; salicylic acid 20% co (e.g. Wartkil); consider 5-fluorouracil cream or Retin-A

Common warts: a recommended method:

1. Soak the wart/s in warm soapy water.

2. Rub back the wart surface with a pumice stone.

3. Apply the paint (only to the wart; protect the surrounding skin with Vaseline). The paint: formalin 5%, salicylic acid 12%, acetone 25%, collodion to 100%.

Do this daily or every 2nd day. Carefully remove dead skin between applications or

• (adult) 16% salicylic acid, 16% lactic acid in collodion paint, apply once daily

• (children) 8% salicylic acid, 8% lactic acid in collodion

Periungal warts (fingernails): consider 5-fluorouracil or liquid nitrogen. Always use a paint rather than ointment or paste on fingers.

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