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

Topical applications

• 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

• Podophyllotoxin 0.5% paint for external keratinised skin, 0.15% cream for the perianal area, introital area and under foreskin

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

• The immunomodulator imiquimod 5%

Cryotherapy

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.

Curettage

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.

Electrodesiccation

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

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

Plantar warts, 260

Genital warts: podophyllotoxin 0.5% paint 269

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

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