Is there a best way to treat warts? No single treatment method may be relied upon to eliminate warts permanently. Treatment choice must depend on the age of the patient, location, appearance, and symptoms of the wart: - Facial: These warts are usually flat and can respond to treatment with topical tretinoin cream or imiquimod. Liquid nitrogen or pulsed dye laser may be used cautiously, but persistent hypopigmentation is an undesired side effect.
- Weight-bearing (plantar): These warts are treated with combinations of acid plaster or liquid acid preparations and/or pulsed dye laser. Glutaraldehyde or intralesional bleomycin may be used in refractory cases.
- Nails: Periungual warts may be treated with topical acids or cantharidin. Liquid nitrogen, often helpful in the treatment of common warts, should be used cautiously here because of the intense pain it causes, as well as risk of persistent nail deformity.
- Genital: Genital warts may be treated with liquid nitrogen, podophyllin or derivatives, topical acids, 5-fluorouracil, imiquimod, or cidofovir. Refractory warts may be treated with interferon. Carbon dioxide laser may also be indicated in some cases.
- Children: Salicylic acid plasters and liquids, cantharidin, liquid nitrogen, and pulsed dye laser have been used successfully. There are recent reports of success using oral cimetidine in prepubertal children with extensive common warts. Many warts regress without treatment. It is speculated that such warts are identified as foreign by the owner’s immune system, which then rejects the wart.
Smolinski KN, Yan AC: How and when to treat molluscum contagiosum and warts in children, Pediatr Ann 34:211–221, 2005. |
