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.
Vitamin A and the retinoids
Topical retinoic acid (e.g. tretinoin 0.1% cream, Retin-A) is effective on plane warts
Systemic oral retinoid, acitretin (Neotigason) for recalcitrant warts
The method chosen depends on the type of wart, its site and the patient's age.
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:
Soak the wart/s in warm soapy water.
Rub back the wart surface with a pumice stone.
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.
Weight loss is an important symptom because it usually implies a serious underlying disorder, either organic or functional.