Wart removal and treatment, home remedy by Ray Sahelian, M.D.

Many natural home remedies have been proposed for wart removal. Warts tend to resolve spontaneously within a couple of years in children, whereas adults with warts almost always have them for the rest of their lives. Over-the-counter medications containing salicylic acid are often used in removing warts.

Treatment

A variety of treatment modalities have been described for cutaneous warts. We sought to determine the safety and efficacy of a topical formulation of cantharidin, podophyllotoxin, and salicylic acid in the treatment of plantar warts. This combination treatment is widely used in Europe and elsewhere but has not been described in the podiatric medical literature. A retrospective study was conducted of 144 patients with simple or mosaic plantar warts who were treated with a topical, pharmacy-compounded solution of cantharidin, 1%; podophyllotoxin, 5%; and salicylic acid, 30%. All of the patients, aged 8 to 52 years, were treated according to the authors' standard protocol. Of the 144 patients, 92 were being treated for the first time. None of the 52 previously treated patients had received more than one other type of treatment in the past. After 6 months of follow-up, complete eradication of the plantar warts was noted in 138 of the 144 patients (95.8%). Of these patients, 125 (86.8%) required a single application of the solution, and 13 (9.0%) needed two or more applications. No significant adverse effects or complications were observed. A topical solution of cantharidin, podophyllotoxin, and salicylic acid was found to be safe and effective in the treatment of simple and mosaic plantar warts. This formulation is a promising alternative treatment modality for plantar warts. J Am Podiatr Med Assoc. 2008 Nov-Dec. Application of cantharidin and podophyllotoxin for the treatment of plantar warts. Escuela Universitaria de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.

Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 rm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non-responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)-induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard-to-treat palmoplantar HPV warts was investigated. Thirty-five patients with hard-to-treat warts(palmar or plantar) with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7-11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed. After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes,wound infections or scarring. The therapy of hard-to-treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced. J Cosmet Laser Ther. 2003 Apr. Er:YAG laser followed by topical podophyllotoxin for hard-to-treat palmoplantar warts.Wollina U.Department of Dermatology, Hospital Dresden-Friedrichstadt, Dresden, Germany.

Occlusion therapy for wart removal
Covering up a wart with transparent duct tape or moleskin, commonly referred to as occlusion therapy, hardly ever cures warts in adults. Even when a treated wart resolves, it usually recurs within months. Since duct tape is an inexpensive, nontraumatic way to treat warts, Dr. Rachel Wenner, from the University of Minnesota in Minneapolis, and her associates decided to try it on adult patients and compare the results with those achieved with moleskin occlusion. So patients wouldn't know which treatment they received, the researchers used moleskin alone (Dr. Scholl's Moleskin Plus) on 46 patients, and duct tape (Scotch Transparent Duct Tape) applied to the adhesive side of moleskin for 44 patients. Small pads were cut out that would cover each patient's largest "target" wart. The wart was first pared with a scalpel blade and the pad was applied. Patients were allowed to use reinforcing tape to hold the pad in place. Their instructions were to wear a pad for 7 days, remove it for 1 night, then soak the wart and lightly scrape it with an emery board the next morning before reapplying another pad. The subjects' average age was 54 years, the average number of warts was 1.4 per person, and the average wart diameter was 5.3 mm. About two thirds of the subjects had tried other treatments, including liquid nitrogen and salicylic acid. Most had had warts for years or even decades. After 2 months, there were no significant difference between the two groups; the wart cleared up in 21 percent in the duct tape group and 22 percent in the moleskin group. However, of the 17 warts that disappeared, 9 returned within 6 months. Dr. Rachel Wenner says previous studies that reported occlusion therapy was successful in most patients, the trial included children, not adults.  Archives of Dermatology, March 2007.