Treatment of Warts in Pediatrics: A Review

Abstract

Cutaneous warts, or verruca vulgaris, are a viral skin condition caused by the Human Papilloma Virus (HPV) that are very common in children. Many physicians struggle with treatment of warts, due to the resistant nature of the lesions. There are a variety of treatment modalities that are offered. The goal of this paper is to review the different treatments that are beneficial and safe to use for warts in the pediatric population. We will break down the adverse effects, benefits, and efficacy of each of the options. Literature review Check for updates groups: physical or chemical destruction, immune modulating agents, and antiproliferation agents. The goal of this review is to examine and assess each of the different treatment options. Treatments Destructive methods Salicylic acid: Salicylic acid is a topical chemical agent that destroys the epithelial layer infected by the wart. It is considered a type of destructive treatment. A systematic review reported a cure of 75% with salicylic acid compared to 48% cure rate placebo after reviewing data from six different studies [5]. It is still considered the only treatment that is approved by the Food and Drug Administration (FDA) [6]. Therefore, salicylic acid is considered a first line treatment. A Cochrane systematic review assessed six studies comparing placebo versus salicylic acid treatment, showing a significant improvement in reduction of warts with the administration of salicylic acid recording a 95% Confidence Interval 1.20 to 2.03 [7]. There were no significantly harmful side effects reported except minor skin irritation [7]. Another study found that it was beneficial to file the wart down alongside the treatment with salicylic acid [8]. Salicylic acid may be a favorable option for children due to the lack of significant side effects. However, reported duration of treatment with salicylic acid is approximately 3 to 6 months until clearance of warts, making this option a relatively lengthy treatment course [6]. Cryotherapy: Cryotherapy is another type of destructive wart treatment. This technique includes "freezing" a wart with liquid nitrogen for 20-30 seconds with treatments repeated every 3 to 4 weeks until resolution [6]. A systematic analysis examined 3 trials that showed