Published on 18/03/2015 by admin
Filed under Dermatology
Last modified 22/04/2025
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Hilmi F. Recica and Imtiaz Ahmed
Evidence Levels: A Double-blind study B Clinical trial ≥ 20 subjects C Clinical trial < 20 subjects D Series ≥ 5 subjects E Anecdotal case reports
Warts are a common disease caused by infection with various strains of the human papilloma virus (HPV). They appear on different sites of the body and in various forms including common, flat, filiform, periungual, plantar, mosaic, and genital warts. Children most commonly present with common or periungual warts on hands and feet, whereas adults often present with common warts on the back of hands or filiform warts on the face and neck. Genital warts are discussed in another chapter.
Most warts resolve spontaneously with time. However, patients and children’s parents often ask for treatment because of pain, social stigma or concern over infectivity. In some cases warts cause ridicule, distorted self-image, impaired dexterity, worry over loss of employment, or a health and safety issue. Immunosuppressed patients may have extensive and resistant warts.
Most patients will treat themselves with over the counter preparations containing keratolytics before presenting to the dermatologist. Salicylic acid has the best evidence base and is the most commonly used therapy. It can be applied in various concentrations with or without occlusion. However, it requires frequent application and it may cause irritation of the surrounding skin. Cryotherapy with dimethyl ether and propane applicator, silver nitrate pencils and occlusive ‘duct tape’ are also available over the counter.
When a dermatologist sees patients with warts, the diagnosis and the possibility of spontaneous resolution and watchful waiting should be explained. The patient should be educated on how to apply topical preparations accurately. Keeping the warts well pared down with the use of a file or pumice stone after soaking is especially important for plantar warts. Young and healthy individuals with short duration of infection have the highest clearance rate. Cryotherapy with liquid nitrogen is one of the commonest treatments used by the dermatologist. Liquid nitrogen is applied with a cryo spray or a cotton bud. The wart should be frozen outwards from the centre to include a 2 mm rim of normal skin, and the freeze maintained for 5 seconds. Cryotherapy is best repeated at 2- to 3-week intervals. Hyperkeratotic warts should be pared before cryotherapy and plantar warts treated by two freeze–thaw cycles. This treatment is painful and not always well tolerated by young children. The treated warts are sore and may blister. In pigmented skin, post-treatment hypopigmentation and hyperpigmentation can be a problem. Cryotherapy with liquid nitrogen can be combined with other topical preparations. Cryotherapy with carbon dioxide snow or dimethyl ether applicators does not produce temperatures as low as liquid nitrogen and is less effective.
If cryotherapy is not successful then various other options are available including immunotherapy with diphencyprone (DCP), squaric acid, and intralesional mumps or Candida antigen. Intralesional bleomycin may be injected into the wart or the solution applied to the wart and then repeatedly pricked through with a lancet. Laser ablation, hyperthermia, curettage and cautery or even surgical excision of troublesome and resistant warts can be attempted but the risk of scarring and recurrence of the warts in the scar can be a problem. The pulsed dye laser (PDL), thought to target the rich capillary network in warts, can be effective. Photodynamic therapy (PDT) is another option; however, pain during and after ALA (aminolevulinic acid)-PDT is well recognized. Other treatments used occasionally include 5-fluorouracil, zinc, levamisole, cimetidine, topical and oral retinoids, and imiquimod.
Bunney MH, Nolan MW, Williams DA. Br J Dermatol 1976; 94: 667–79.
This paper looked into 11 trials with over 1800 patients. In a randomized blind trial involving 389 patients, salicylic acid with lactic acid paint was as effective as cryotherapy with liquid nitrogen. The salicylic acid with lactic acid paint comprised 17% salicylic acid, 17% lactic acid, and 66% flexible collodion. In another study of 382 warts, 84% of patients were cured after 12 weeks of salicylic acid with lactic acid paint application. A separate study showed a 44% clearance with salicylic acid and lactic acid paint versus 47% of patients applying 10% glutaraldehyde.
Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang’ombe AR, Stamuli E, et al. BMJ 2011; 342: d3271.
A study on 240 patients treated by healthcare professionals with liquid nitrogen, for up to four treatments, 2 to 3 weeks apart, were compared with patient self-treatment with 50% salicylic acid daily, for up to 8 weeks. Overall, 14% had complete clearance at 12 weeks, with no significant difference between the two groups. Cryotherapy cost £100.00 more than salicylic acid.
Gibbs S, Harvey I, Sterling JC, Stark R. Cochrane Database Syst Rev 2003; CD001781.
According to 52 trials, meeting the criteria for inclusion in this review, the best evidenced therapy for cutaneous warts is for salicylic acid. Data pooled from six placebo-controlled trials, showed a cure rate of 75% in the salicylic acid group versus 48% in the placebo group.
Yazar S, Basaran EJ. J Dermatol 1994; 21: 329–33.
A randomized, placebo-controlled study with 35 patients in each group showed that, 1 month after treatment, 15 patients were cleared by three applications of a silver nitrate pencil, at 3-day intervals. Only four of the placebo group responded.
Ebrahimi S, Dabiri N, Jamshidnejad E, Sarkari B. Int J Dermatol 2007; 46: 215–17.
A topical solution of 10% silver nitrate, applied on to the warts on alternate days for 3 weeks, in 30 patients resulted in complete clearance in 63% of patients after 6 weeks in the treatment group versus no healing in the placebo group.
Nguyen NV, Burkhart CG. J Drugs Dermatol 2011; 10: 1174–6.
Other coolants are probably less effective than liquid nitrogen.
Youn SH, Kwon IH, Park EJ, Kim KH, Kim KJ. Ann Dermatol 2011; 23: 53–60.
In a retrospective study with 560 patients, a 2-week interval was compared with a 3-week interval between cryotherapy with liquid nitrogen. For the 2- and 3-week groups, cure rates were, 77% and 75%, respectively. Recurrence rates were 13% and 25%.
Two-week cryotherapy is optimal not only because of the rapid cure but also because of the lower recurrence rate.
Ahmed I, Agarwal S, Ilchyshyn A, Charles-Holmes S, Berth-Jones J. Br J Dermatol 2001; 144: 1006–9.
This prospective study of 363 patients compared application of liquid nitrogen with cotton wool bud versus cryo spray. After 3 months of treatment, liquid nitrogen cured 47% of patients with a cotton wool bud versus 44% with a cryo spray (p=0.8).
Bourke JF, Berth-Jones J, Hutchinson PE. Br J Dermatol 1995; 132: 433–6.
This study carried out on 225 patients showed a 45% cure rate for warts treated with liquid nitrogen. The mean times to clearance of warts in each group were 5.5, 9.5, and 15 weeks in the weekly, 2- and 3-weekly groups, respectively. The mean numbers of treatments needed to achieve clearance were similar in each group (5.5, 4.75, and 5 treatments). The study showed that clearance of the warts was related to the number of treatments received and it was independent of the interval between treatments.
Berth-Jones J, Bourke J, Eglitis H, Harper C, Kirk P, Pavord S, et al. Br J Dermatol 1994; 131: 883–6.
In a randomised trial 300 patients received cryotherapy with either one or two freeze–thaw cycles, at a 3-week interval. In addition, all subjects used keratolytic wart paints and plantar warts were pared prior to freezing. At 3 months, the cure rate was 57% from the single freeze technique versus 62% from the double freeze technique. In plantar warts, the cure rate was 41% from single freezing and 65% for double freezing whereas in the hand warts there was no additional benefit from the second freeze.
Shumer SM, O’Keefe EJ. J Am Acad Dermatol 1983; 9: 91–6.
In this double-blinded study, warts were treated with intralesional bleomycin or placebo on two occasions, 2 weeks apart. Twenty-nine of 40 patients treated with intralesional bleomycin cleared compared to none in the placebo group.
Agius E, Mooney JM, Bezzina AC, Yu RC. J Dermatolog Treat 2006; 17: 112–16.
Delivery of bleomycin by Dermojet has also shown an efficacy of 90% complete or partial clearance after five treatments.
Dhar SB, Rashid MM, Islam A, Bhuiyan M. Indian J Dermatol Venereol Leprol 2009; 75: 262–7.
Intralesional bleomycin was significantly more effective than cryotherapy for treatment of cutaneous wart.
Ohtsuki A, Hasegawa T, Hirasawa Y, Tsuchihashi H, Ikeda S. J Dermatol 2009; 36: 525–8.
Six patients had 41 warts treated with ALA-PDT. Initially ALA cream was applied under occlusion for 5 hours. Thereafter, the treated area was irradiated with the light from a red light emitting diode with a dose of 126 J/cm2. This treatment was repeated at 3-week intervals. A cure rate of 68% was achieved after two treatments.
Lu YG, Wu JJ, He Y, Yang HZ, Yang YD. Photomed Laser Surg 2010; 28: 561–3.
In this study complete clinical response was observed in 17/18 patients after two sessions with ALA-PDT. At 6 months after termination of treatment, only one case relapsed, and the patient satisfaction rate was 89%.
Stender IM, Na R, Fogh H, Gluud C, Wulf HC. Lancet 2000; 355: 963–6.
Three treatments at weekly intervals, repeated if the warts persisted 4 weeks after the last treatment. In the active group 64/104 warts cleared versus 47/102 with placebo.
Focht DR, Spicer C, Fairchok MP. Arch Pediatr Adolesc Med 2002; 156: 971–4.
In this randomized study, 51 patients received treatment with either cryotherapy with a 10-second freeze, for a maximum of six treatments, every 2 to 3 weeks, or duct tape occlusion applied every 6 days followed by debridement of the wart upon removal of tape, for a maximum of 2 months. Complete resolution was achieved in 22/26 patients in the duct tape arm versus to 15/55 in the cryotherapy group.
de Haen M, Spigt MG, van Uden CJT, van Neer P, Feron FJM, Knottnerus A. Arch Paediatr Adolesc Med 2006; 160: 1121–5.
No significant effect of duct tape occlusion.
Wenner R, Askari SK, Cham PMH, Kedrowski DA, Liu A, Warshaw EM. Arch Dermatol 2007; 143: 309–13.
No difference between duct tape and moleskin occlusion.
Hursthouse MW. Br J Dermatol 1975; 92: 93–5.
In this double blind trial, topical 5-fluorouracil was applied daily on warts under occlusion, in 60 patients for 4 weeks. In the active group, 29 patients cleared versus eight in the placebo group.
Salk RS, Grogan KA, Chang TJ. J Drugs Dermatol 2006; 5: 418–24.
In this study, 40 patients were treated either with 5-fluorouracil 5% with tape occlusion or tape occlusion alone with regular debridement for 12 weeks. In the active group 19/20 patients achieved complete cure versus two of 20 in the tape occlusion group.
Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN. Int J Dermatol 2007; 46: 427–30.
In this double-blinded trial, 44 patients were treated with either 20% zinc oxide ointment or 15% salicylic acid combination, twice daily for 3 months. In the zinc oxide group, 50% patients were cured versus 42% with salicylic acid.
Sharquie KA, Al-Nuaimy AA. Ann Saudi Med 2002; 22: 26–8.
One hundred patients with 623 warts were the subject of this study divided into two groups. In the treatment group, 53 patients had 173 warts treated with 2% zinc sulfate intralesionally, whereas 176 warts were left untreated as control. Within 6 weeks in the treatment group 98% of the warts cleared versus none in the control group.
Gustafsson L, Leijonhufvud I, Aronsson A, Mossberg A-K, Svanborg C. N Engl J Med 2004; 350: 2663–72.
In this double-blinded study, 20/40 patients were randomized to have topical application of α-lactalbumin–oleic acid under occlusion for 3 weeks. Wart volume was reduced by 75% in all 20 patients in the active group versus three of 20 in the placebo group.
Buckley DA, Keane FM, Munn SE, Fuller LC, Higgins EM, Du Vivier AW. Br J Dermatol 1999; 141: 292–6.
This retrospective case series of 60 patients with resistant warts showed that 42/48 patients who regularly applied 0.01% to 6% DCP at 1- to 4-week intervals after initial sensitization achieved clearance of the warts after five treatments.
Upitis JA, Krol A. J Cutan Med Surg 2002; 6: 214–17.
In this retrospective series, 211 patients were sensitized for treatment of palmoplantar and periungual warts. Of 154 patients, 135 cleared completely with an average of five treatments over a 6-month period.
Choi JW, Cho S, Lee JH. Ann Dermatol 2011; 23: 282–7.
This study assessed the efficacy DCP as an adjunctive to cryotherapy. Retrospective charts review of 124 patients with warts showed that DCP may be a successful adjuvant to cryotherapy in reducing the number of cryotherapy sessions.
Choi MH, Seo SH, Kim IH, Son SW. Pediatr Dermatol 2008; 25: 398–9.
After 12 months follow-up, 93% of patients treated with DCP and 76% treated with cryotherapy showed clinical clearance.
Silverberg NB, Lim JK, Paller AS, Mancini AJ. J Am Acad Dermatol 2000; 42: 803–8.
In this retrospective study, 61 children had their warts treated with home application of 0.2% squaric acid, 3 to 7 nights per week, for at least 3 months, after initial sensitization with 2% squaric acid on the forearm. Complete clearance after 7 weeks of this treatment occurred in 58% of patients, partial clearance occurred in 18%, and no response in 24%.
Srivastava PK, Bajaj AK. Indian J Dermatol 2010; 55: 367–9.
Autowart injection was prepared by removing part of a wart, crushing it under aseptic condition, suspending in water for injection than injecting in the gluteal region. Results were evaluated in 53 patients; 35 had complete resolution in 2 months, 12 patients showed partial improvement, whereas six had no improvement.
Clifton MM, Johnson SM, Robertson PK, Kincannon J, Horn TD. Pediatr Dermatol 2003; 20: 268–71.
In this study, 47 patients received four times mumps or candida antiserum intralesionally every 3 weeks. Complete clearance was seen in 20 patients and 14 of these patients experienced resolution of all distant warts.
Johnson SM, Horn TD. J Drugs Dermatol 2004; 3: 263–5.
This study showed that 146/206 patients treated with a combined Candida, mumps and trichophyton antigen achieved complete clearance after five treatments.
Hengge UR, Goos M. Ann Intern Med 2000; 132: 95.
In this trial, 65 patients with warts and molluscum were treated with topical imiquimod and achieved 56% clearance of recalcitrant warts after 9.5 weeks of treatments.
Grussendorf Conen EI, Jacobs S, Rübben A, Dethlefsen U. Dermatology 2002; 205: 139–45.
In this study, 10 of 37 patients cleared with imiquimod applied twice daily for 19 weeks.
Park HS, Choi WS. J Dermatol 2008; 35: 491–8.
In this study, 120 patients had their warts treated with PDL. The overall clearance rate was 49.5%. The clearance rates of flat warts, periungual warts, plantar warts and common warts were 68%, 51%, 48%, and 44%, respectively. Overall, the response rates of pediatric warts were superior to those of adult warts; however, those trends were not statistically significant. The highest clearance rate was at a fluence of 9.5 J/cm2.
Schellhaas U, Gerber W, Hammes S, Ockenfels HM. Dermatol Surg 2008; 34: 67–72.
In this study, 73 patients with warts were treated with a PDL every 2 weeks over a period of 24 weeks until complete clearance. They used a laser energy density of 8–12 J/cm2, with a spot size of 5 mm and pulse duration of 450 µs. The minimum follow-up period was 6 months. After one session, complete clearance was achieved in 15% of patients, after five sessions 48%, and after 10 sessions 89% of patients showed remission.
Fernández-Guarino M, Harto A, Jaén P. J Dermatolog Treat 2011; 22: 226–8.
In this observational study, 19 patients were initially treated with MAL (methyl aminolevulinic acid) under occlusion for 4 hours then with PDL. Warts were treated weekly until they cleared or for a maximum of six sessions. Almost 53% of the warts cleared, and 26% of the patients demonstrated complete clearance of all viral warts.
Smucler R, Jatsová E. Photomed Laser Surg 2005; 23: 202–5.
In this study, PDL 595 nm, 20 J/cm2 was combined with PDT using ALA was compared against PDL alone. After combined therapy, 100% of warts were cured in 24 patients. Combined therapy was most effective.
Mitsuishi T, Sasagawa T, Kato T, Iida K, Ueno T, Ikeda M, et al. Dermatol Surg 2010; 36: 1401–5.
In 31 patients, CO2 laser was used for ablation of 35 warts, and the defects were covered with artificial dermis. Follow-up periods ranged from 3 to 12 months. Complete clearance was achieved in 31/35 warts after one treatment. After complete remission, HPV DNA was not detected in the upper epidermis of the postoperative site.
Serour F, Somekh E. Eur J Pediatr Surg 2003; 13: 219–23.
In this case series, 40 children with 54 warts were treated with CO2 laser ablation under local anesthesia. Healing time was 4 to 5 weeks and there was no recurrence at 12 months. Hypopigmentation was noticed in 11 cases.
Wollina U. J Cosmet Laser Ther 2003; 5: 35–7.
Complete resolution of warts was observed in 31/35 patients after treatment with Er : YAG laser, followed with topical podophyllotoxin for 3 days on, 4 days off for up to six cycles.
Huo W, Gao XH, Sun XP, Qi RQ, Hong Y, Mchepange UO, et al. J Infect Dis 2010; 201: 1169–72.
In this study, 54 patients had their warts treated with local hyperthermia of 44°C with an infrared emitting source for 30 minutes a day for 3 consecutive days plus 2 additional days 2 weeks later. Within 3 months, 54% of patients in the treatment group were cured versus 12% of in the control group.
Stern P, Levine N. Arch Dermatol 1992; 128: 945–8.
In this placebo controlled, randomized trial, 13 patients had their 29 warts, treated by a handheld radiofrequency heat generator device, between one and four times, for 30–60 seconds so that a temperature of 50°C was achieved in the warts. Complete clearance was achieved in 86% in heat therapy group versus 41% in the control group.
Pfau A, Abd el Raheem TA, Baumler W, Hohenleutner U, Landthaler M. Acta Derm Venereol 1994; 74: 212–14.
A woman achieved a complete clearance after two treatments with Nd : YAG laser hyperthermia.
Faghihi G, Vali A, Radan M, Eslamieh G, Tajammoli S. Skinmed 2010; 8: 70–1.
In this trial, 34 patients applied 85% formic acid in distilled water solution on their warts on one side of the body and only distilled water as placebo on the other side of the body, every other day, using a needle puncture technique, every 2 weeks for 3 months. Complete clearance was achieved in 91% of patients who received formic acid versus 10% in the placebo group.
Bhat RM, Vidya K, Kamath G. Int J Dermatol 2001; 40: 415–19.
In this placebo-controlled trial, 100 patients received up to 12 treatments with 85% formic acid puncture technique on alternate days or placebo. In the active group, 46 patients showed clearance of their warts after five treatments compared with three treatments in the placebo group after 12 treatments.
Rodríguez-Cerdeira C, Sánchez-Blanco E. Clin Aesthet Dermatol 2011; 4: 62–4.
All 20 patients who applied a fine layer of glycolic acid 15% and salicylic acid 2% gel to their warts once daily clinically were cured within 8 weeks.
Al-Hamdi KI, Al-Rahmani MA. Indian J Dermatol 2012; 57: 38–41.
In this open trial, 250 patients were treated topically with either 5% or 10% KOH solution once nightly. At the end of fourth week, 80% and 82% of patients respectively showed a complete clearance.
Bohlooli S, Mohebipoor A, Mohammadi S, Kouhnavard M, Pashapoor S. Int J Dermatol 2007; 46: 524–6.
In this prospective study, 25 patients had fig tree latex applied on their warts, on one side of the body, and cryotherapy on the other side. Self-application of fig tree latex three times daily for at least 4 days resulted in 44% clearance rate versus 56% clearance in the cryotherapy group.
Soroko YT, Repking MC, Clemment JA, Mitchell PL, Berg RL. Phy Ther 2002; 82: 1184–91.
Twenty patients were treated with iontophoresis using 2% sodium salicylate solution on three occasions, a week apart and assessed 3 months after treatment. One patient had complete clearance, three demonstrated large reductions in wart area, and 12 patients exhibited measurable reduction in wart area.
Hirose R, Hiro M, Shakuwa T, Udano M, Yamada M, Koide T, et al. J Dermatol 1994; 21: 248–53.
A cure rate of 72% was achieved in 25 patients treated topically with glutaraldehyde. The treatment did not cause pain or permanent pigmented change.
Glutaraldehyde is suitable for home treatment as there is no need for special instruments or special technique required and the cure rates are almost equal to those with cryotherapy.
Prigent F, Iborra C, Meslay C. Ann Dermatol Venereol 1996; 123: 644–6.
Case reports like this led to the withdrawal of a glutaraldehyde product from the market in France in December 1995.
Vickers CFH. Br Med J 1961; 2: 743–5.
A survey of 646 children with plantar warts showed that 3% formalin foot soaks, 15 to 20 minutes each night for 6 to 8 weeks, cured 80% of all plantar warts.
The US National Toxicology Program (on 10 June 2011) described formaldehyde as ‘known to be a human carcinogen.’
Gupta R. Indian J Dermatol 2011; 56: 513–14.
All the warts cleared within 8 weeks in 10 patients treated with topical 0.1% adapalene gel after paring of warts. This was followed by occlusive dressing with polythene sheet for 1 week and continued until the clearance of all the warts.
Berman B, Davis-Reed L, Silverstein L, Jaliman D, France D, Lebwohl M. J Infect Dis 1986; 154: 328–30.
Patients had their warts injected with either interferon-α2 0.1 mL 105 units or placebo. Three of four patients treated with interferon were cured after nine injections given over 3 weeks versus one of four in the placebo group.
Gibbs RC, Scheiner AM. Cutis 1978; 21: 383–4.
Curettage can be an effective treatment for single or few warts particularly filiform warts. However, this treatment is painful and can result in scarring. A questionnaire study looked at the response of warts on extremities following curettage and electrocautery under local anesthesia. Only 23/100 questionnaires were returned of which 22 had responded to treatment.
Field S, Irvine AD, Kirby B. Br J Dermatol 2009; 160: 223–4.
Davis MD, Gostout BS, McGovern RM, Persing DH, Schut RL, Pittelkow MR. J Am Acad Dermatol 2000; 43: 340–3.
Yilmaz E, Alpsoy E, Basaran E. J Am Acad Dermatol 1996; 34: 1005–7.
In this study, 70 patients received cimetidine 25–40 mg/kg/day or placebo for 3 months. The cure rate of the 54 evaluable patients in the active and placebo group was similar, 32% vs 31%.
Rogers CJ, Gibney MD, Siegfried EC, Harrison BR, Glaser DA. J Am Acad Dermatol 1999; 41: 123–7.
This double-blind study showed a similar result; however, a trend towards efficacy in younger patients was noted.
Glass AT, Solomon BA. Arch Dermatol 1996; 132: 680–2.
In this prospective study, 20 patients received cimetidine 30–40 mg/kg/day. Complete resolution or a dramatic improvement was achieved in 84% of the 18 patients after 3 months.
Parsad D, Saini R, Negi KS. Austral J Dermatol 1999; 40: 93–5.
In this double-blind study, 48 patients received either cimetidine alone or in combination with levamisole 150 mg, on 2 consecutive days per week, for 12 weeks. In the levamisole plus cimetidine group, 15 patients were cured compared to eight in the cimetidine only group.
Amer M, Tosson Z, Soliman A, Selim AG, Salem A, Al-Gendy AA. Int J Dermatol 1991; 30: 738–40.
In this double-blind study, 40 patients received levamisole 5 mg/kg for 3 days every 2 weeks for 5 months. In the treatment group, 60% achieved clearance versus 5% in the controls.
Schou M, Helin P. Acta Derm Venereol 1977; 57: 449–54.
This placebo-controlled study of 49 patients with warts treated with levamisole failed to show any significant effect.
Cassano N, Ferrari A, Fai D, Pettinato M, Pellè S, Del Brocco L, et al. G Ital Dermatol Venereol 2011; 146: 191–5.
The aim of this open label study was to determine the effects of nutraceutical oral supplementation containing methionine, echinacea, zinc, and probiotics on the response of cutaneous warts to conventional standard therapy with salicylic and lactic acids or cryotherapy with liquid nitrogen. All 172 eligible patients were allocated to conventional standard therapy alone or combined conventional standard therapy with nutraceutical oral supplementation for 4 months. Complete remission was achieved in 55% of patients in the conventional standard therapy group versus 86% in the conventional standard therapy and oral supplementation group at 6 months follow-up.
Mun JH, Kim SH, Jung DS, Ko HC, Kim BS, Kwon KS, et al. J Dermatol 2011; 38: 541–5.
In this study, complete resolution was achieved in 26/31 patients treated with oral zinc sulfate 10 mg/kg up to a maximum dose of 600 mg/day for 2 months.
Al-Gurairi FT, Al-Waiz M, Sharquie KE. Br J Dermatol 2002; 146: 423–31.
In this trial of 80 patients with viral warts and a low level of serum zinc, 40 patients were treated with oral zinc sulfate at a dose of 10 mg/kg daily up to 600 mg/day and followed up for 6 months. In the zinc sulfate group, complete clearance of warts was observed in 87% patients after 2 months of treatment versus none in the placebo group.
Rahimi AR, Emad M, Rezaian GR. Int J Dermatol 2008; 47: 393–7.
In this study, 60 patients with viral warts were randomized to treatment regimen with smoke from leaves of Populus euphratica tree or conventional cryotherapy once weekly for a maximum of 10 treatments. At 22 weeks follow-up, 16/24 patients treated with smoke from leaves of the euphratica tree were cured versus 13/28 treated with cryotherapy.
Gelmetti C, Cerri D, Schiuma AA, Menni S. Pediatr Dermatol 1987; 4: 254–8.
Sixteen of 20 children with resistant warts achieved complete clearance after treatment with etretinate 1 mg/kg/day for 3 months. The other four children had significant improvement in their warts.
El-Khayat RH, Hague JS. J Dermatolog Treat 2011; 22: 194–6.
A patient with extensive periungual warts achieved a rapid and complete response to treatment with acitretin 25 mg daily for 3 months.
Proietti I, Skroza N, Bernardini N, Nicolucci F, Tolino E, La Viola G, et al. Dermatol Ther 2011; 24: 581–3.
A patient was successfully was treated with acitretin for 12 weeks.
Spanos NP, Williams V, Gwynn MI. Psychosom Med 1990; 52: 109–14.
Treatment of Skin Disease Comprehensive Therapeutic Strategies 4e
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Salicylic acid preparations
Silver nitrate
Cryotherapy with dimethyl ether and propane
Cryotherapy with liquid nitrogen
Bleomycin
Photodynamic therapy (PDT)
Duct tape
5-Fluorouracil
Zinc
α-Lactalbumin–oleic acid
Immunotherapy
Imiquimod
Pulsed dye laser
Pulsed dye laser with PDT
CO2 laser
Er : YAG laser
Intense pulsed light
Formic acid
Glycolic acid
Potassium hydroxide
Fig tree latex
Salicylate iontophoresis
Glutaraldehyde
Formaldehyde
Adapalene
Interferon
Curettage and cautery
Cidofovir
Cimetidine
Levamisole
Echinacea
Oral zinc
Euphratica
Etretinate
Acitretin
Hypnotherapy
