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Warts Treatment

   

Plantar Warts

Warts on the soles of the feet tend to develop callosities over them and become painful. These should be pared down carefully or scraped with a pumice stone and a salicylic acid preparation applied. Collodion flex containing salicylic acid is suitable, as are combinations of salicylic and lactic acid (Salactol, Compound W), or one of the proprietary salicylic acid plasters can be used. The treated area should be covered with an occlusive plaster. When effective the wart turns white and the area becomes slightly tender. If this is ineffective then a podophyllin preparation can be employed.

Podophyllin is a mixture of toxic alkaloids obtained by extracting the root of the mandrake plant. There are podophyllin paints and collodion flex preparations as well as proprietary ointment preparations (Posalfilin). The latter are particularly useful for plantar warts; the paints and flexes are more useful for genital warts (see opposite). Treatment with formalin or glutaraldehyde had a vogue but does not seem to have much advantage over other treatments.


Warts around the big toe. Plantar warts can be very painful

If these measures do not work then locally destructive treatment by freezing with liquid nitrogen or a cryoprobe, or electrocautery and curettage, will be required. These methods of treatment are usually available in hospital out-patient clinics but the waiting lists for patients with warts are often so long that the warts resolve before the appointment comes round. Even these vigorous procedures do not always succeed and warts often recur at the treated sites. If treatment is too vigorous, permanently painful scars can result, for which no one is thanked.

Multiple Warts

Solitary warts on the hands or two or three on the fingers don't often need treatment but when there are multiple warts on the fingers and around the nails (paronychial) active treatment should be considered. The same treatments are available for these as for plantar warts, and they are generally more successful for these lesions. Plane warts on the face, neck or hands don't often need treatment, but if multiple lesions are present then one of the liquid salicylic acid or salicylic-lactic acid film preparations (such as Duofilm) is suitable.


Extensive plane warts affecting the neck and lower face. This young man had suffered from these from many year .There was no identified immune defect in this patient.

Genital and Perianal Warts

These always need treatment as they tend to spread quickly to sexual partners. Tincture of podophyllin is the most popular treatment for these and is best carried out by a specialist department. Usually treatment starts with a single application of a 5 per cent podophyllin solution which is washed off after four or five hours. If this is ineffective, stronger tinctures (up to 20 per cent) are used. In recent years the active alkaloid (podophyllotoxin) has been extracted from the resin and made available in a pure form as a 0.5 per cent paint (Condyline). If podophyllin treatment is successful, the warts become inflamed and painful and then drop off.

If podophyllin is unsuccessful then more vigorous destructive measures may be necessary, such as electrocautery. For obvious reasons this should be administered by an expert in this technique.

Perianal warts seem to be more common in male homosexuals, who are also prone to harbour other venereal disorders including HIV disease. It has become routine practice to check whether such patients have evidence of syphilis with blood tests.