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The safest and most effective wart treatments: salicylic acid and cryotherapy

Viral warts or verrucae are caused by the human papilloma virus and are very common. They are usually spread by skin to skin contact and are most commonly seen on the hands and feet. Warts are not harmful and usually go away in time without any treatment. One-fifth of all warts disappear within six months, and two-thirds are gone within two years. However, if your wart is unsightly and painful, various treatments exist to treat it. Unfortunately, not all are effective.

Our dermatologists at SkinCare Physicians in the Boston area regularly field questions on wart treatments. Here are our recommendations.

Over-the-counter treatments

• Salicylic acid (SA) is available as a solution which can be painted on to warts, or as a medicated patch which can be applied to the wart. When used every day, it is definitely effective and has few side effects, but it may take several weeks to months of daily use to work. Ideally, salicylic acid should be applied after soaking the affected area in warm water for 5 minutes, gently removing any dead skin over the wart with a pumice stone or foot file, applying the solution and covering with a bandage. If used faithfully every day this treatment works well for most warts and is the most effective over-the-counter therapy.
• Duct tape has become popular as a simple treatment that is easy to apply; however, recent trials suggest that this treatment is not as effective as first thought.
• Freezing treatments sold over the counter do not reach the extremely cold temperature of liquid nitrogen and therefore are not as effective as the ones offered by your dermatologist.

Commonly used dermatology treatment: Cryotherapy

If warts do not respond to over-the-counter treatments, you may wish to see a dermatologist for cryotherapy. This technique freezes the wart using liquid nitrogen. The treatment is often painful, and can sometimes cause blistering and scarring. More aggressive cryotherapy appears to be more effective than gentle cryotherapy, but with an increased risk of side effects.

Other possible therapies

Our dermatologists at SkinCare Physicians are not generally recommending lasers for wart treatment. Studies have shown no difference in cure rates between warts treated with laser therapy compared to those treated by conventional therapies.

Other treatments are sometimes used to treat warts that have not responded to traditional therapies. These include:

• 5-fluorouracil
• dinitrochlorobenzene
• intralesional bleomycin,
• intralesional interferon
• photodynamic therapy
• intralesional candida antigen

However, these therapies do not appear to be safer or more effective than salicylic acid and cryotherapy.

Treating warts takes a lot of patience for most people and persistent warts remain a challenging condition to treat.  Only rarely does a wart go away with the first treatment. Our experience shows that the most effective and safest therapies remain the over-the-counter treatments with salicylic acid and cryotherapy performed by a dermatologist.

If you are still concerned about a wart, consult one of our dermatologists at SkinCare Physicians in Boston.