Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence
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Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence The aims of treating cutaneous warts are to relieve the patient’s physical and psychological discomfort, and prevent the spread of infection. First-line pharmacological therapies for a single wart or a few and/or small common warts of short duration include topical salicylic acid, silver nitrate or glutaraldehyde. Cryotherapy may be considered as second-line therapy. Other pharmacological options or physical destruction may be considered for recurrent or difficult-to-treat lesions.
Not all cutaneous warts are the same Cutaneous warts are common, usually benign, skin lesions caused by the human papillomavirus (HPV).[1] The clinical features of warts vary depending on the type of HPV involved and the site of infection.[2] Although they are generally asymptomatic, warts can sometimes be very painful and cause considerable discomfort. Warts are classified into different types depending on their clinical presentation and location (table I).
No treatment is 100% % effective Cutaneous warts may regress spontaneously, but they can persist for years, particularly in adults.[1] A wide variety of Table I. Clinical classification of cutaneous warts[1] Common warts (verruca vulgaris) Mainly located on the back of the hands and fingers, but may occur anywhere on the skin Usually asymptomatic, but can be painful in areas exposed to pressure A single wart may persist unchanged for months or years, though the infection may spread by autoinoculation from scratching or other types of skin traumas Filiform or digitate warts Commonly occur on the face and neck, often in clusters, with an irregular distribution
treatments are used for cutaneous warts, including prescription or over-the-counter medications (administered topically, intralesionally or systemically), physical destructive methods and other methods, but no treatment has yet been proven to be 100% effective in achieving complete remission. According to the available evidence from limited clinical trials, many of the commonly used treatments show similar rates of clinical clearance and recurrence. Of note, there is a lack of rigorous, blinded, randomized controlled trials (RCTs) investigating the efficacy these treatments. This article provides a brief summary of the clinical evidence for the treatment of various wart types, as reviewed by Dall’Oglio et al.[1]
Consider clinical evidence Based on the available clinical evidence, treatments for the various types of clinical wart may be classified as:[3] first line (useful to treat a single wart or a few and/or small warts of short duration [i.e. duration generally of
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