Treatment options for Plantar Warts

Tips

• It is essential to debride the hyperkeratotic tissue over and around plantar warts every 2 to 3 wks to ensure penetration of the medication.
• Combination therapy may be needed.

Medical treatment

• Salicylic Acid
  • Salicylic Acid liquid
    • Salicylic acid 12–26% in addition to lactic acid, in a quick‐drying collodion or acrylate base, is the treatment of first choice for plantar warts.
    • Persistent application of medication once each day for many weeks may be required.
    • The affected area is pared and then soaked in warm water to hydrate the keratin surface; then a drop of solution is applied with the applicator and allowed to dry.
    • The warts may be covered with a piece of adhesive tape to enhance drug penetration.
  • 40% Salicylic Acid Plaster
    • The plaster is cut to the size of the wart.
    • The backing of the plaster is removed and the sticky surface is applied to the wart and secured with tape.
    • The plaster is removed in 24 to 48 hours, and white keratin is removed.
    • Another plaster is applied.

• 5-FU cream 5% under tape over 12 weeks.
• Imiquimod
• Formalin:
  • Daily soaking for 30 minutes in 4% formalin solution.
  • The frm, fxed tissue is pared before subsequent soaking

• Cantharidin
• Immunothearpy
  • MMR
  • PPD
  • Candida antigen
• Vitamin D3 : intralesional injection of (0.2 ml ,5 mg/ml ) every two weeks for 4 treatment sessions or until recovery

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Physical treatment options

• Cryosurgery
  • A surgical blade is used to debulk the wart before freezing.
  • Cryotherapy is applied until a rim of iced tissue (white discoloration) about 1 mm in width is seen in the normal skin surrounding the wart.
  • The freeze is continued for 5–30 s depending on the size and site of the wart.
  • Continuous or pulsed spray for between 5 and 20 s, depending on the size and thickness of the wart.
  • Continuous freezing over 25 s is more likely to leave scarring.
  • Treatment should be repeated every 2- 3 weeks.
  • Excessive freezing times should be avoided over nerves, e.g on the sides of the fingers.
  • Pain is variable between patients( persist for many hours or even a few days).
  • Depigmentation may be a cosmetic concern in dark skinned patients.

• Laser
  • Pulsed dye laser.
  • Er : YAG
  • Nd : YAG
  • Carbon dioxide laser.