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Cutaneous warts are a common presenting complaint in children and adolescents. Common, plantar, or flat warts are cutaneous manifestations of the human papillomavirus. The treatment of wart s poses a therapeutic challenge for physicians. No single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. These approaches are discussed to demonstrate the evidence supporting common therapies and provide a guideline for physicians. Evidence supports the at home use of topical salicylicacid and physician administered cryotherapy. Intralesional immunotherapy for nongenital cutaneous warts may be an option for large or recalcitrant warts.
Warts are the cutaneous manifestations of human papillomavirus (HPV). Warts may exist in different forms given the epithelial surface and HPV type responsible for the infection. Common warts (Verruca vulgaris) (Figures 1 and 2), plantar warts (Verruca plantaris) (Figure 3), flat or planar warts (Verruca plana), and genital warts (Condyloma acuminata) are some of the clinical manifestations of HPV infection.1
Warts are estimated to occur in up to 10 percent of children and young adults. The range of greatest incidence is between 12 and 16 years of age.1 Warts occur with greater frequency in girls than in boys. The peak incidence is at 13 years of age in females and 14.5 years of age in males.1
A study2 examining the natural progression of warts indicated that warts will spontaneously clear after two years without treatment in 40 percent of children. Warts typically continue to increase in size and distribution and may become more resistant to treatment over time.3 Children with treatment resistant warts potentially may be reservoirs for HPV transmission. In addition, warts can be painful depending on their location (e.g., soles of the feet and near the nails) and viewed as socially unacceptable when located on visible areas (e.g., hands and face).4
Therapies and Treatment Strategies
Treating warts is a therapeutic challenge for family physicians. No single therapy has been proven effective at achieving complete remission in every patient.4 As a result, many different approaches exist, including observation and treatments that can be combined for greater effectiveness.4 The results of evidence-based approaches to wart therapy are discussed in this article to demonstrate the evidence for common therapies.4–6 A Cochrane review5 rated the randomized controlled trials (RCTs) of local treatments for cutaneous warts as generally weak because of poor methodology and reporting. Additionally, the average cure rate for placebo preparations was 30 percent.5 Each treatment decision should be made on a case-by-case basis according to the experience of the physician, patient preference, and the application of evidence-based medicine.6 Immunocompromised patients with warts may exhibit incomplete clearance, and the warts may be resistant to treatment.7The two most common treatments for warts are patient-applied salicylic acid and physician-administered cryotherapy with liquid nitrogen.5
Prevention[edit]
Gardasil is an HPV vaccine aimed at preventing cervical cancers and genital warts. Gardasil is designed to prevent infection with HPV types 16, 18, 6, and 11. HPV types 16 and 18 currently cause about 70% of cervical cancer cases,[7][8] and also cause some vulvar, vaginal,[5] penile and anal cancers.[6] HPV types 6 and 11 are responsible for 90% of documented cases of genital warts.[10] Unfortunately the HPV vaccines do not currently prevent the virus strain responsible for verrucas (plantar warts).
Treatment[edit]
There are many treatments and procedures associated with wart removal. A review of clinical trials of various cutaneous wart treatments concluded that topical treatments containing salicylic acid were more effective than placebo.[11] Cryotherapy appears to be as effective as salicylic acid, but there have been fewer trials.[11]
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