Destructive therapies for cutaneous warts: A review of the evidence

Abstract

COMMON WARTS (Verruca vulgaris), plantar warts (Verruca plantaris) and flat/plane warts (Verruca plana), collectively known as cutaneous warts, are benign growths of the skin caused by the human papillomavirus (HPV). In Australia, up to 24% of children and 5% of adults are affected. 1 A break in the epidermal barrier of the skin allows entry of HPV and subsequent infection of basal epithelial cells. HPV replicates alongside the natural lifecycle of epithelial cells, and is eventually released from desquamated keratinocytes on the surface of warts, potentially infecting other sites via direct contact or through fomites. 2 Cutaneous warts generally self-resolve. Up to two-thirds of immunocompetent children experience spontaneous clearance of their cutaneous warts by two years of age. 3 Adults tend to take longer. Patients might request treatment for their warts when they cause discomfort, functional impairment, social ostracism, are numerous, grow large or raise concerns regarding transmission. 4 Treatment for cutaneous warts can be painful, scar, cause pigmentary disturbances and might not be effective. 5 Therefore, clinicians should be wary of the evidence behind the efficacy of cutaneous wart treatment. This review summarises high-quality studies investigating the efficacy of chemical and physical destructive wart therapies. MethodsWe performed a literature review (up to June 2021) of published articles for wart management from the MEDLINE and Embase databases. No language restrictions were applied. We considered systematic reviews, randomised controlled trials (RCTs), cohort studies and case series. Case reports were excluded. For MEDLINE, we used the Boolean operation to combine MeSH terms 'warts' AND 'therapeutics'. For Embase, we used the Boolean operation to combine MeSH terms 'Verruca vulgaris' AND 'therapy'. We included studies that investigated chemical or physical destructive therapies.

Comparison of Cryotherapy and Topical Salicylic Acid in Common Warts: A Systematic Review and Meta‐Analysis

“…Moreover, all salicylic acid can cause chemical burns so it should not be applied to poor healing areas such as neuropathic feet, except for few very low-strength ones. Tus, they are forbidden to apply on the face because of risk of irritant burning [26]. Since both salicylic acid and cryotherapy have a higher probability of adverse reactions and recurrence, photodynamic therapy might be a better choice with better efcacy, fewer adverse reactions, and lower recurrence rates [27].…”

Cutaneous Squamous Cell Carcinoma Masquerading as a Verruca: Case Report and Literature Review of Coexisting Wart and Invasive Squamous Cell Carcinoma on the Hand

“…Common management approaches for treating a verruca can either be destructive (cantharidin, citric acid, cryotherapy, electrosurgery, formic acid, glycolic acid, laser surgery, monochloroacetic acid, phenol, pyruvic acid, salicylic acid, silver nitrate, surgical excision, trichloroacetic acid, and zinc oxide), immune modulating (interferon, intralesional candida antigen, Th-1 (T helper type 1) stimulating vaccination, and topical imiquimod), antiproliferative (bleomycin, 5-fluorouracil, podophyllin, podophyllotoxin, and vitamin D analogues), or antiviral (cidofovir and retinoids). Researchers have also suggested to consider evaluating a patient for immunodeficiency if they have recalcitrant warts, despite treatment with two or more modalities, that persist for more than 18 months [ 1 , 2 ]. In addition, it might be reasonable to consider a biopsy of the clinically suspected verruca in a patient whose lesion is chronic and/or fails to respond to therapy.…”

“…Therefore, there are several clinical variants of this contagious viral infection and each is associated with one or more human papillomavirus strains. The types of verrucae include butcher’s warts, common warts (such as filiform warts and verruca vulgaris), cystic warts, flat (plane) warts, genital warts, oral warts, and palmar and plantar warts [ 1 , 2 ].…”

Prognostic value of HPV genotyping in cutaneous warts​

“…In contrast, the placebo arms exhibited a cure rate of 23% (range 5-73%; . Another fact to consider is that practically all except very low-strength SA can cause chemical burns and should not be used in areas of poor healing such as neuropathic feet (Truong et al, 2022).…”