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  • Presentation

High-Yield Pearls for Management of Warts with Therapeutic Updates

Description

The presentation discusses various treatment options for managing warts, emphasizing the need for tailored approaches based on patient characteristics and wart presentation. Most warts tend to resolve spontaneously, particularly those present for less than two years. The discussion highlights the limited but significant evidence from a Cochrane review favoring salicylic acid and cryotherapy, while also noting that cryotherapy might not be ideal for painful plantar warts. Various topical treatments like imiquimod and vitamin D are covered, though many lack comprehensive studies. The presentation explores emerging therapies, including Burdasmer gel and other antiviral compounds, along with the potential use of intralesional therapies for tougher cases. The role of the HPV vaccine is also discussed, particularly for patients under 26, as it shows promise in wart clearance. Procedural updates include therapies such as photodynamic therapy and microwave treatment, which have shown efficacy but are often costly. The document concludes by underscoring the necessity of combination therapies and the importance of patient-centered decision-making in wart management, given the diverse treatment landscape and limited high-quality data.

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Conclusions

  • Most warts, especially new ones, tend to spontaneously resolve.
  • Warts that persist for more than two years are less likely to respond to treatment.
  • Salicylic acid is considered safe and has modest efficacy for treating warts.
  • Cryotherapy may be effective in cases where salicylic acid has failed or in combination with it.
  • Intralesional treatments demonstrate equal or greater efficacy compared to first-line treatments like salicylic acid or cryotherapy, especially for refractory cases.
  • Cryotherapy can have painful side effects, especially for plantar warts, where no trials have shown it to be better than placebo.
  • Topical vitamin D can be beneficial for patients concerned about dyspigmentation, although some other treatments may be more effective.
  • Topical cidofovir has shown potential benefits but lacks large-scale studies for common warts and can be costly.
  • Combination therapies, such as microneedling with topical agents, may enhance treatment efficacy and reduce the number of sessions needed.
  • New treatment options, such as berdazimer gel and ionic antiviral therapy, are currently in development and may soon be available.
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