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TABLE 1. Some Common Treatment Modalities of Cutaneous Warts [Download PDF] |
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Agent (U.S. commercial preparations) |
Usual Formulation and Regimen |
Wart Type* |
Complete Response RateH (%) |
References |
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Salicylic acid sa1icylic acid 17%:lactic acid:collodion 1:1:4 (e.g., Duofilm, Occlusal-HP, Wart-Off) |
daily for up to 12 weeks |
HW single PW MW |
67% 84% 50% |
(35) (35) (134) |
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Fixatives formaldehyde 3% glutaraldehyde |
daily (bedtime) daily |
PW MW |
94% 47% |
(34) (35) |
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Bleomycin |
1 mg/ml solution, 0.1-0.2 ml/wart, intralesional, x1 0.7% solution, |
HW MW PW |
-70% -55% -90% |
|
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Cantharidine (Cantharone,Verr-Canth) |
topical, x1 |
CW |
87% |
(53) |
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Podophyllin (Podocon-25 or Podofin) |
podophyllin 15%, qd |
single PW |
81% |
(95) |
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5-fluorouracil (5-FU) (Effudex cream 5%) |
2% 5-FU in propylene glycol, once daily
5% 5-FU in dimethyl sulfoxide (DMSO), once daily |
MW
MW |
47%
53% |
(134)
(134) |
|
Cryotherapy |
every 3 weeks, up to x6 |
CW HW PW |
41-45% -75% 29-50% |
(203) (35) (203) |
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Electrosurgery |
x1 |
PW |
65% |
(95) |
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CO2 laser surgery |
x1 |
CW periungual PW |
32% 71% 50-90% |
(251) (254) |
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* CW: cutaneous warts; HW: hand warts; PW: plantar warts; MW: mosaic warts † These rates are derived from the referenced studies. Because of great dissimilarities between the studies and the usual absence of controls, these rates are not necessarily comparable, and are provided for indication only. |
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TABLE 2. Common Treatment
Modalities of Anogenital Warts [Download PDF]
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Agent (U.S. commercial preparations) |
Usual Formulation and Regimen |
Complete Response Rate* (%) |
Relapse Rate* (%) |
Selected References |
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Imiquimod (Aldara, box of 12 single-use 250 mg packets) |
5% cream; self-applied, tiw, qod hs, # 16wk |
48 |
9, 23† |
(63) |
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Podophyllin (Podophyllum USP; Podocon-25 or Podofin; 15 ml bottles) |
25% in benzoin solution; qwk up to x6 |
35-51 |
60-85 |
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Podofilox (Condylox; 3.5 ml bottle with cotton-tipped applicators) |
0.5% solution; self-applied; bid x3 d |
57-72 |
32-50 |
|
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Trichloracetic acid (Bichloracetic acid 80%, 10 ml bottle; Tri-Chlor 80%; 15 ml bottle) |
50%-90% solution; q wk up to x6 |
64-83 |
55 |
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5-fluorouracil (Effudex cream; 25 g tube) |
5% cream; highly variable regimens |
43-58 |
- |
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Intralesional interferon α2b or n3 (Intron A, Alteron N) |
1 MU; tiw x3-8 weeks; from 1 to all lesions injected |
40-52 |
18-37 |
(157- 161) |
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Cold blade surgery |
scissor excision |
87-94 |
20-31 |
|
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Cryotherapy |
liquid nitrogen spray; 1 or 2 cycles qwk up to x6 |
64-76 |
19-40 |
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Electrosurgery |
variable techniques (e.g., electrocoagulation, electrocautery, fulguration,...) |
58-94 |
22 |
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CO2 laser surgery |
variable techniques |
93-99 |
49-65†† |
Abbreviations: qwk, once a week; d, day; bid, twice a day; tiw, thrice weekly; MU, million units.
* These numbers represent the 95% confidence limits, whenever appropriate, derived from the results of the selected studies.
† At 3 and 6 month follow-up, repectively.
†† Based on randomized, comparative studies.
TABLE 3. Suggested
Approaches to the Treatment of Warts [Download PDF]
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Type of Wart or Lesion |
Treatment Options* |
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Plantar and hand warts |
First line salicylic acid-based paints (H) cryotherapy (O)
Second line formaldehyde (H) glutaraldehyde (H) cantharidine (O) bleomycin (esp., periungual warts) (O) |
Third line electrosurgery (O) laser surgery (O) |
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Flat warts
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First line no treatment
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Second line cryotherapy electrocautery |
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Condylomata acuminata |
First line podofilox (H) cryotherapy (O) trichloracetic acid (O) podophyllin (O) scissor excision (O) (if few and small lesions) |
Second line electrosurgery (O) laser surgery (O) interferon (O) |
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* H: home treatment; O: office-based treatment |
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