Freezing is better than acid for common warts but the same for plantar warts
A recent Alberta Tools for Practice1review noted the following:
Quality primary care evidence finds warts resolve with cryotherapy (39% of participants) versus salicylic acid (SA) (24%) more than no treatment (16%) at 13 weeks.
For plantar warts: Cryotherapy 30%, SA 33%, no treatment 23% (none statistically significant).2 Cryotherapy has more pain and blistering (up to ~80%), but greater patient satisfaction (~70%). Evidence for duct tape is limited and inconsistent.
For plantar warts, consider paring to overlying skin (to confirm it is a wart and to see the “salt and pepper” capillaries, or a corn which disappears) and applying topical SA (40% strength). This is much less painful that freezing and appears to be just as effective. If that fails then cryotherapy is reasonable.
A suggestion is to keep a supply of salicylic acid in the clinic and give small lots to patients to save on prescription costs.
- Alberta tools for Practice # 173
- Bruggink SC, Gussekloo J, Berger MY, et al. CMAJ. 2010; 182:1624-30. Click here
Gems are chosen by the Goodfellow director Dr. Bruce Arroll to be either practice changing or practice maintaining. The information is educational and not clinical advice.