![]() Migration of topical medications also dilutes the active ingredients and thus their clinical strength.Īn eight-year-old female with extensive warts on the fingers had failed multiple cryotherapy treatments with PCP. Since unaffected skin is far more sensitive, irritation results, and the patient is forced to stop treatment before the wart has resolved completely. This is in large part due to the fact that these medications may not dry quickly enough, and often migrate from the hyperkeratotic wart to perilesional skin. In practice, topical treatments are unreliable and may cause extensive irritation to the surrounding unaffected skin. If topical treatments could predictably resolve warts in a few weeks with minimal side effects, they would certainly become the treatment of choice for many warts. Keep in mind that all of the cure rates referred to above were achieved over a period of one to three months. This combination represents a significant advance when compared with topical monotherapy. In plantar warts, the response was 63 percent vs. The therapeutic response across all studies in common warts was 63.4 percent (complete healing) for 5-FU/SA vs. In 2011 it was approved for the treatment of actinic keratosis in Europe under the name Actikerall. This medication has been approved in Europe for more than 30 years under the trade name Verrumal. 4 Given the effectiveness of monotherapy with topical medications, it is logical that combination topical therapy would be investigated to achieve higher cure rates.Ī systematic literature analysis and meta-analysis of randomized-controlled studies (RCTs) of a drug combination containing 0.5% 5-FU and 10% SA in the treatment of common and plantar warts proved to be far superior to 5-fU alone. 3 5-Fluorouracil (5-FU) is also modestly effective, with reported cure rates of 23 perent. Imiquimod is approved for anogenital warts and has demonstrated a cure rate of 44 percent for cutaneous warts. Currently the only topical treatment FDA-approved for the treatment of warts is salicylic acid. This is especially true in younger patients who cannot tolerate the pain and prolonged recovery from physical treatments. Topical medication is, in theory, an attractive way to treat warts. 2 These issues have fueled many panel discussions, internet message board threads, and experimentation with lasers and numerous medications. Not only are warts stigmatizing socially, but in one study, half of patients reported moderate to severe discomfort from their warts. 1 Hyfercation is more effective, but like other treatment options, it has limited use in younger patients or patients with warts in sensitive areas. This is evident when looking at our two most well-researched treatment methods: cryotherapy and salycilic acid, with 49 percent and 52 percent cure rates, respectively. The unfortunate fact is that the majority of cases require multiple, often painful treatments, and recalcitrant cases are common. Cutaneous warts are one of the most common and difficult conditions we treat in dermatology.
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