| Drug/Therapy | Indication | Dose | Duration |
|---|---|---|---|
| Patient-applied | |||
| Imiquimod 5% cream (Aldara) | Cutaneous, external and internal (selected) genital warts | Apply once daily before bedtime, three times a week
Wash the affected area with soap and water 6-10 hours following the application |
Up to 16 weeks
|
| Podofilox 0.5% solution or gel (Condylox) | External genital warts | Apply twice daily for up to 3 days, followed by no therapy for 4 days
Total daily volume not to exceed 0.5 mL |
Up to 4 weeks/cycles |
| Salicylic acid (various brand names and strengths) | Cutaneous warts | Apply patch or solution at bedtime after soaking and paring lesion with nail file or pumice stone
Use higher concentration (eg, 40% patches) if thicker skin (eg, soles) involved
May use together with occlusive dressing (eg, duct tape)
|
Assess after 2 weeks, may need treatment for weeks or months |
| Provider-applied | |||
| Cold knife conization | Cervical intraepithelial neoplasia | Performed with a scalpel to remove a cone shaped area of the cervix. Includes the removal of the entire transformation zone. | Follow up with cervical cytology and colposcopy 3 months after procedure. |
| Cryotherapy | Cutaneous warts, external genital warts, cervical intraepithelial neoplasia grade I (CIN I)
|
Applied as liquid nitrogen spray, or a soaked swab, or as a nitrous oxide cooled cryoprobe (CIN I) .
Cutaneous: Aim for freeze to disappear within 60 seconds (plantar or palmar), including tissue 2-3 mm beyond the margins of the wart. CIN I: Perform a 3-minute freeze using the cryoprobe then allow the cervix to thaw. Repeat at least once. |
Can be repeated every 3 weeks |
| Infrared coagulation | Cutaneous, external and internal genital warts, anal intraepithelial neoplasia | Apply 1.5 second pulse of irradiation in the infrared range to affected tissue. Debride coagulated tissue using biopsy forceps. |
|
| Laser | External and internal genital warts, cervical and anal intraepithelial neoplasia | Using protective eye wear, a CO2 laser is directed at the affected tissue which is destroyed by vaporization (visible lesions). | For conization, follow up with cervical cytology and colposcopy 3 months after procedure. |
| Loop electrosurgical excision procedure (LEEP) | Cervical intraepithelial neoplasia | A loop-shaped thin wire with a current is used to excise the transformation zone. | Follow up with cervical cytology and colposcopy 3 months after procedure. |
| Podophyllin resin 25% (Podocon-25) | External genital warts | Apply to affected area, then wash off after 6 hours. Not to exceed 0.5 mL per session.
May be used in combination with cryotherapy.
|
May repeat therapy in 1 week. |
| Scissor (or knife) excision | External genital warts | Lesion is excised down to normal tissue with cauterization. | |
| Tricholoroacetic acid (TCA) 80% | Cutaneous, external and internal warts, anal intraepithelial neoplasia | Small amount applied to lesion until it appears white or frosted and allowed to dry. Ensure that surrounding, healthy tissue not exposed to acid. | Can repeat every week for up to 6 weeks. |