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Management of Warts

• No treatment has a very high success rate – average 60-70% at 3 months
• Spontaneous clearance at 3 months occurs in 30%
  - so not treating a valid management option if acceptable to the patient
• Salicylic acid preparations (see section  13.7 ) slowly destroy the virus-infected epidermis. Excess keratin should be pared or filed prior to application. Do not use on face due to risk of irritation/scarring.
• Cryotherapy (liquid nitrogen) causes destruction of the epidermis.Cotton bud and cryospray are thought to be equally effective for clearing warts, cryospray is quick and convenient, but potentially more destructive.  Cotton buds are probably a more appropriate application method for children and face - these should be dipped in liquid nitrogen once only due to the risk of viral transmission. Freeze time will vary depending on age of patient, individual response to cold injury, size of wart and site of treatment.
  Optimal time between treatments is uncertain - probably 2-3 weeks.
  Warn patient of pain and possible blistering.
  Caution over tendons and if poor circulation.
  It is not recommended to treat children under 7 years of age.

See cryotherapy guidelines on Dermatology website. A training pack is now available.

• Aerosol cryotherapy devices are not as effective as liquid nitrogen cryotherapy.

• An immune reaction is usually necessary for clearance – so immunosuppressed patients may never clear.

• Plantar warts must be distinguished from corns/callosities. This is easily done by paring away the keratin - warts have bleeding points, corns which have a central plug and callosities do not bleed.

• Anogenital warts should be referred to the genito-urinary or paediatric department.

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