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Non-genital warts are benign cutaneous growths caused by infection with the human papillomavirus. Although warts can resolve spontaneously, patients might seek treatment due to discomfort or social ostracism. This review summarises high-quality studies investigating the efficacy of chemical and physical destructive wart therapies. We considered systematic reviews, randomised controlled trials RCTscohort studies and case series. We included studies that investigated chemical or physical destructive therapies.
Fifteen therapies were evaluated and included salicylic acid, cryotherapy, silver nitrate, phenol, cantharidin, glycolic acid, pyruvic acid, citric acid, formic acid, trichloroacetic acid, monochloroacetic acid, zinc, laser, surgery and electrocautery.
Very few treatment options have been studied through RCTs. To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment.
Important considerations when treating patients with warts include the location of the wart, the evidence supporting the proposed treatment and potential adverse effects of treatment. A break in the epidermal barrier of the skin allows entry of HPV and subsequent infection of basal epithelial cells. HPV replicates alongside the natural lifecycle of epithelial cells, and is eventually released from desquamated keratinocytes on the surface of warts, potentially infecting other sites via direct contact or through fomites.
Cutaneous warts generally self-resolve. Up to two-thirds of immunocompetent children experience spontaneous clearance of their cutaneous warts by two years of age. Patients might request treatment for their warts when they cause discomfort, functional impairment, social ostracism, are numerous, grow large or raise concerns regarding transmission.
Treatment for cutaneous warts can be painful, scar, cause pigmentary disturbances and might not be effective. No language restrictions were applied. Case reports were excluded. This includes not sharing personal items, wearing protective footwear in communal areas and not scratching warts. Checking the soles of feet regularly will help identify early lesions, which are easier to treat. Treatment options can be categorised into chemically destructive, physically destructive, antiproliferative or immunostimulatory.
Table 1 provides an overview of the evidence supporting treatment options in the management of cutaneous warts. Damaging or destroying the infected epithelium causes HPV cell death. The subsequent antigen exposure and presentation might also induce an immune response. Salicylic acid chemically debrides the wart of excess keratin and induces an inflammatory response.
A meta-analysis of six RCTs demonstrated that topical salicylic acid was more effective than placebo for cutaneous warts at all sites relative risk [RR]: 1.
Cryotherapy with liquid nitrogen causes direct cell damage and subsequent inflammatory response Figure 1B. A meta-analysis of three RCTs surprisingly found no evidence to suggest that cryotherapy was different to placebo in the treatment of cutaneous warts RR: 1. Plantar wart. Four sessions of fortnightly cryotherapy achieving complete remission.
Ring warts on the elbow after two sessions of cryotherapy. Silver nitrate is a chemical cauteriser. Participants experienced a mild-to-moderate burning sensation, itching and temporary discolouration of the skin. Phenol is a caustic agent. Pain and pigmentary changes were noted in the phenol group.
Cantharidin is a vesicant that causes acantholysis and subsequent destruction of epithelial cells Figure 2. A systematic review of cantharidin monotherapy for cutaneous warts found four studies evaluating topical cantharidin 0.
Figure 2. Before and B. Glycolic acid is an alpha-hydroxy acid with keratolytic properties. Pyruvic acid is an alpha-hydroxy acid with strong keratolytic properties. Citric acid has keratolytic and disinfecting properties. Formic acid acts similarly to formalin by dehydrating and finally destroying the infected tissue. A case series of adults with recalcitrant Verruca vulgaris treated with a proprietary product, in which the pen was applied on each wart for 30 seconds twice weekly for six weeks, reported that It should be noted that chemical burns have occurred from the application of topical acid-based products, including formic acid, salicylic acid, monochloroacetic acid and glutaraldehyde.
Most of these occur in the paediatric population. Trichloroacetic acid TCA is a caustic agent that destroys warts by chemical coagulation of proteins.
In an RCT investigating Verruca plana in children and adults, weekly applications of TCA were compared with weekly cryotherapy sessions over an eight-week period.
The investigators observed total remission in Adverse events in the TCA group included itch, pain, erythema, erosions, bullae and hyperpigmentation. At the end of the six-week study, Monochloroacetic acid MCA is a caustic agent that destroys warts by chemical coagulation of proteins. Zinc oxide and nitric—zinc complex solution NZCS is a topically applied solution that induces a painless caustic effect. The investigators found complete resolution in CO 2 lasers emit infrared light at 10, nm and act to destroy the epidermis.
A recent small RCT comparing CO 2 laser with cryotherapy demonstrated no significant difference in the resolution of warts in both groups; remission rate was The erbium-doped yttrium aluminium garnet Er:YAG laser emits a wavelength of nm and causes direct ablation of the epidermis.
The neodymium-doped yttrium aluminium garnet Nd:YAG laser emits a wavelength of nm and destroys wart dermal blood vessels. Newer modalities of laser therapy, such as pulsed dye lasers PDLare more subtle and can destroy the dilated superficial capillaries, rather than the tissue itself, and reduce complications. The number of laser passes used depends on the depth of the lesion, but studies have reported using 2—4 passes per wart.
Very few of the treatment options discussed here have been tested by RCTs. Clinicians should consider the location and type of cutaneous wart, the evidence supporting the proposed treatment, potential adverse effects of treatment, as well as patient comorbidities when considering treatment options. Appropriate and effective treatments in primary care generally include salicylic acid and cryotherapy. Resistant cases may require referral for the more specialised options summarised in this article.
Did you know you can now log your CPD with a click of a button? Dermatology Warts. Destructive therapies for cutaneous warts: A review of the evidence.
Background and objectives Non-genital warts are benign cutaneous growths caused by infection with the human papillomavirus. Results Fifteen therapies were evaluated and included salicylic acid, cryotherapy, silver nitrate, phenol, cantharidin, glycolic acid, pyruvic acid, citric acid, formic acid, trichloroacetic acid, monochloroacetic acid, zinc, laser, surgery and electrocautery. Discussion To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment.
Results and discussion Non-pharmacological therapies To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment. Table 1. Provenance and peer review: Not commissioned, externally peer reviewed. Funding: None. Correspondence to: kelvin. Create Quick log. The prevalence of common skin conditions in Australian school students: 1. Common, plane and plantar viral warts.
Br J Dermatol ; 5 — Human papillomavirus molecular biology and pathogenesis. J Eur Acad Dermatol Venereol ;16 3 — Natural course of cutaneous warts among primary schoolchildren: A prospective cohort study. Ann Fam Med ;11 5 — Br J Dermatol ; 4 — Management of difficult-to-treat warts: Traditional and new approaches.
Am J Clin Dermatol ;22 3 — Plantar warts: Epidemiology, pathophysiology, and clinical management. J Am Osteopath Assoc ; 2 — Topical treatments for cutaneous warts. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: Randomized controlled trial.
CMAJ ; 15 — Int J Dermatol ;46 2 — International J Pharm Pract ;25 6 — Singapore Med J ;49 12 — Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: A systematic review. Am J Clin Dermatol ;19 6 — Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution. Dermatol Ther ;32 6 :e J Clin Aesthet Dermatol ;4 9 — Adv Biomed Res ;
❾-50%}Creams with salicylic acid podophyllin tretinoin and cantharidin.Destructive therapies for cutaneous warts: A review of the evidence
A recent small RCT comparing CO 2 laser with cryotherapy demonstrated no significant difference in the resolution of warts in both groups; remission rate was The erbium-doped yttrium aluminium garnet Er:YAG laser emits a wavelength of nm and causes direct ablation of the epidermis. The neodymium-doped yttrium aluminium garnet Nd:YAG laser emits a wavelength of nm and destroys wart dermal blood vessels.
Newer modalities of laser therapy, such as pulsed dye lasers PDL , are more subtle and can destroy the dilated superficial capillaries, rather than the tissue itself, and reduce complications. The number of laser passes used depends on the depth of the lesion, but studies have reported using 2—4 passes per wart.
Very few of the treatment options discussed here have been tested by RCTs. Clinicians should consider the location and type of cutaneous wart, the evidence supporting the proposed treatment, potential adverse effects of treatment, as well as patient comorbidities when considering treatment options. Appropriate and effective treatments in primary care generally include salicylic acid and cryotherapy.
Resistant cases may require referral for the more specialised options summarised in this article. Did you know you can now log your CPD with a click of a button? Dermatology Warts. Destructive therapies for cutaneous warts: A review of the evidence. Background and objectives Non-genital warts are benign cutaneous growths caused by infection with the human papillomavirus. Results Fifteen therapies were evaluated and included salicylic acid, cryotherapy, silver nitrate, phenol, cantharidin, glycolic acid, pyruvic acid, citric acid, formic acid, trichloroacetic acid, monochloroacetic acid, zinc, laser, surgery and electrocautery.
Discussion To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment. Results and discussion Non-pharmacological therapies To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment. Table 1. Provenance and peer review: Not commissioned, externally peer reviewed.
Funding: None. Correspondence to: kelvin. Create Quick log. The prevalence of common skin conditions in Australian school students: 1. Common, plane and plantar viral warts. Br J Dermatol ; 5 — Human papillomavirus molecular biology and pathogenesis.
J Eur Acad Dermatol Venereol ;16 3 — Natural course of cutaneous warts among primary schoolchildren: A prospective cohort study. Ann Fam Med ;11 5 — Br J Dermatol ; 4 — Management of difficult-to-treat warts: Traditional and new approaches.
Am J Clin Dermatol ;22 3 — Plantar warts: Epidemiology, pathophysiology, and clinical management. J Am Osteopath Assoc ; 2 — Topical treatments for cutaneous warts. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: Randomized controlled trial.
CMAJ ; 15 — Int J Dermatol ;46 2 — International J Pharm Pract ;25 6 — Singapore Med J ;49 12 — Efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts: A systematic review. Am J Clin Dermatol ;19 6 — Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution.
Dermatol Ther ;32 6 :e J Clin Aesthet Dermatol ;4 9 — Adv Biomed Res ; Indian J Derm ;52 2 — Treatment of common recalcitrant warts with topical formic acid.
Int J Dermatol ;57 2 :e3—e4. Treatment of warts with topical formic acid. Iran J Med Sci ;30 4 Cutan Ocul Toxicol ;34 2 — J Drugs Dermatol ;11 11 :e66— Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: A randomized controlled trial. J Invest Dermatol ; 5 — Use of topical nitric-zinc complex solution to treat palmoplantar and periungual warts in a pediatric population. Dermatol Ther Heidelb ;9 4 — Topical zinc oxide vs.
Int J Dermatol ;46 4 — Cryotherapy versus CO2 laser in the treatment of plantar warts: A randomized controlled trial. Dermatol Pract Concept ;8 3 — Laser treatment of nongenital verrucae: A systematic review. JAMA Dermatol ; 9 — Pulsed dye laser therapy in the treatment of warts: A review of the literature.
Dermatol Surg ;43 4 — Warts of the nail unit: Surgical and nonsurgical approaches. Cover with a piece of non-porous plastic adhesive tape, e. Instruct patient to keep the tape on for at least four hours up to 8 hours. Within 24 hours a blister forms which is often painful and inflamed. Have the patient return for observation in one to two weeks.
During this period the patient may or may not do periodic soaks as the doctor prefers. Remove necrotic tissue and treat as before if any viable wart tissue remains. Allow tissue to re-epithelialize before re-treatment. Method B with curettage : Proceed as in Method A except have patient return in one day for curettage. Local anesthesia may be necessary. The lesion normally heals completely within one to three weeks.
Have the patient return for observation in four weeks. Treatment is at 10 days to 2 week intervals. Delay treatment if inflamed. Both products are to be used under occlusion with a non-porous tape, e. Daily soaks are at the discretion of the physician.
It is recommended to use a mild anti-bacterial soap until tissue re-epithelializes. Warning Cantharone and Cantharone Plus are for physician use only. They should not be dispensed or prescribed for patient administration under any circumstances. My Order. Chemotechnique - Everything for Patch Testing.
Poisonous, may be fatal if ingested. For external use only. Acuderm - Medical Devices. Cantharone Search. Features: Simple office procedure, no special instrument required A selective procedure not randomly destructive Painless application Produces a uniform blistering action Leaves no permanent scars.
Salicylic acid is a keratolytic. The chemical name is 2-hydroxybenzoic acid. Podophyllin is a caustic. Cantharidin is a vesicant. The chemical name is hexahydro-3a, 7a-dimethyl-4b, 7b-epoxyisobenzofuran-1, 3-dione. Painless application and the absence of instruments makes it a simple wart treatment procedure.
Some pain may occur later. The action of salicylic acid is thought to be due to its keratolytic activity in removing wart virus infected epithelial cells, podophyllin has caustic properties causing destruction of tissue and cantharidin has vesicant properties which are thought to exfoliate the wart tumor. The exact mechanism of each of these agents is not known. For large mosaic warts, treat a portion of the wart at a time. Allow to dry for a few minutes. Cover with a piece of non-porous plastic adhesive tape, e.
Instruct patient to keep the tape on for at least four hours up to 8 hours. Within 24 hours a blister forms which is often painful and inflamed.
Have the patient return for observation in one to two weeks. During this period the patient may or may not do periodic soaks as the doctor prefers. Remove necrotic tissue and treat as before if any viable wart tissue remains.
Allow tissue to re-epithelialize before re-treatment. Method B with curettage : Proceed as in Method A except have patient return in one day for curettage. Local anesthesia may be necessary. The lesion normally heals completely within one to three weeks. Have the patient return for observation in four weeks. Treatment is at 10 days to 2 week intervals. Delay treatment if inflamed. Both products are to be used under occlusion with a non-porous tape, e.
Daily soaks are at the discretion of the physician. It is recommended to use a mild anti-bacterial soap until tissue re-epithelializes. Warning Cantharone and Cantharone Plus are for physician use only. They should not be dispensed or prescribed for patient administration under any circumstances.
My Order. Chemotechnique - Everything for Patch Testing. Chemotechnique - Metal Allergy Products. Dormer - Cantharone Wart Removers. George Tiemann - Reusable Instruments. Sales Terms Terms of use Privacy Policy. Email Us.
One non-randomized study and two evidence-based guidelines were identified regarding topical cantharidin/ salicylic acid/ podophyllin for the. Easy-to-read patient leaflet for Cantharidin, Podophyllin Resin, and Salicylic Acid. Includes indications, proper use, special instructions. Keywords: cantharidin podophyllin salicylic acid solution, clearance rate, Topical 5% 5‐fluorouracil cream in the treatment of plantar warts: A. Description: CANTHARONE® PLUS is a topical liquid containing 30% salicylic acid, 2% podophyllin BP, 1% cantharidin in a film-forming vehicle containing One non-randomized study and two evidence-based guidelines were identified regarding topical cantharidin/ salicylic acid/ podophyllin for the. J Eur Acad Dermatol Venereol ;16 3 — Common, plane and plantar viral warts. Dormer - Cantharone Wart Removers. Evidence to support efficacy. The chemical name is 2-hydroxybenzoic acid. Management of cutaneous warts of the hand.This would be used for the students who travel more than usual limits. A Girl L'Oreal Lafe's Le Tan Lee Stafford Linden Leaves Lip Smacker Lynx Mae Manicare ManukaVantage Maybelline MCoBeauty Me Extremely Merino Milani Mita ModelCo Mustela N - Q Natio Between Instinct Neostrata Neutrogena Nexcare Nicka K New York Nivea Nude by Nature Oasis Beauty OGX Oil Garden Olay Life OPI Palmer's Palmolive Same Goat Plunkett's Neck Quicknits QV Skincare R - Z Real Seconds Redken Regaine Revitanail Revlon Rimmel Indus Ruby Kisses Schwarzkopf Sebamed Shea Luggage Simple Skincare Simply Essential SinfulColors SpaScriptions St.
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