Current Options for the Treatment of Warts

SEPTEMBER 01, 2005
Shannon W. Fields

Warts are a type of infection caused by viruses in the human papillomavirus (HPV) family. More than 100 types of HPV exist, and different categories cause different types of warts. Warts can grow on any part of the body, including on the skin, the inside of the mouth, the genitals, or the rectal area. The infection is typically contracted through direct contact, although secondary contact, such as with locker room floors or swimming pools, is also a possible means of transmission. Several options are available for treating warts, depending on the location and the type of infection.

Types of Warts

The 5 primary types of warts, each with distinct characteristics, are as follows:

Common warts (verrucca vulgaris) are generally raised warts with a rough surface, and are often referred to as seed warts, because their appearance may resemble that of a small seed stuck to the skin. While this type of wart can occur anywhere, it is most commonly found on the hands, particularly the knuckles and nail folds.

Plantar warts (verruca vulgaris) are found on the soles of the feet, and are most often found under the skin's surface as a result of the pressure caused by body weight. Plantar warts are usually hard and flat and may appear with a black dot in the center, which is actually the wart's blood supply. These warts may be painful and are often the most difficult type to resolve. Plantar warts may occur in clusters, which are also known as mosaic warts.

Plane warts (verruca plana) are usually round with flat tops and smooth surfaces. These can occur anywhere on the body, but are common on the backs of the hands, the faces of children, and commonly shaved areas, such as women's legs or men's faces.

Filiform warts (verruca filiformis) are long, slender warts which are typically found on thin-skinned areas such as the eyelids, armpits, or neck area.

Genital warts (condylomata acuminata) are a common problem among sexually active adults, and can be found in or around the vagina, around the anus, in the rectum, as well as on the vulva, cervix, or penis. The appearance of these warts varies, as more than 30 strains of HPV exist which can infect the genital tract, but genital warts are typically soft and may develop a cauliflower-like appearance and can appear alone or in groups.

Treatment Options

The type of treatment depends on the location, type, and number of warts. Options include the following:

OTC Medications

OTC medications typically contain salicylic acid as the active ingredient. This drug, which can be found as an ointment or a topical solution, softens the skin and causes the layers to peel away, removing the wart with it.

Prescription Remedies—Commercially Available

  • Condylox (podofilox)
  • Penlac (ciclopirox)

Prescription Remedies—Compounded Preparations

Prescription remedies often are prepared by a compounding pharmacist. With a compounded preparation, many combinations and dosage forms are possible, and there is a great deal of flexibility for the prescribing physician. Preparations include the following:

  • Acyclovir ointment or suppositories
  • Dinitrochlorobenzene solution
  • Diphenylcyclopropenone topical solution
  • Podophyllum solution, ointment, or gel
  • Lactic acid and salicylic acid in flexible collodion
  • Trichloroacetic acid topical solution
  • Dibutyl squarate solution
  • Salicylic acid gel
  • 5-fluorouracil
  • Cimetidine cream
  • Deoxy-D-glucose (often used in combination with cimetidine)
  • Cantharidin

Nonpharmacologic Options

Cryotherapy involves the use of liquid nitrogen, which is applied to the surface, freezing the wart. This type of treatment is usually carried out in a clinician's office and can be painful. Cryotherapy may need to be repeated for large areas or clusters of warts.

Surgical excision is the most rapid means of treatment, but it is painful and requires the use of a local anesthetic. This treatment is particularly useful for removing large warts.

Laser treatment destroys the wart(s) by using a precise laser beam and electrocautery. Discomfort following this type of treatment is common.

Ms. Fields is with the International Journal of Pharmaceutical Compounding and is a pharmacy technician at Innovative Pharmacy Solutions in Edmond, Okla.