13.7 Preparations for warts and calluses

Click here for anogenital warts

ChoiceDrugDosage
Most warts resolve without treatment
Encourage self-care with OTC products as appropriate
1st choiceOcclusal® cutaneous solution, (salicylic acid 26%)Dose: For common and plantar warts, apply daily
or
Salactol ® paint (salicylic acid 16.7%, lactic acid 16.7%)Dose:
For warts, particulary plantar warts, verrucas, corns and calluses, apply daily
or
Salatac® gel (salicylic acid 12%, lactic acid 4%)Dose:
For warts, verrucas, corns and calluses, apply daily

Prescribing Notes

  • Most warts resolve without treatment within months and treatment is required only if the warts are painful, unsightly, persistent, or cause distress.
  • Treatments are available over-the-counter from pharmacies and many patients can be encouraged to self-care.
  • These preparations are suitable for all cutaneous warts except facial and genital warts.
  • Formaldehyde gel may be useful for persistent plantar mosaic warts.
  • Wart removing preparations are keratolytic. They can cause irritation, therefore application to normal or broken skin should be avoided. Surrounding skin to the wart can be protected by applying soft paraffin.
  • Rub the wart surface gently with a file or pumice stone once weekly; treatment may need to be continued for up to 3 months.

Anogenital warts – General notes

  • The treatment of anogenital warts should be accompanied by screening for other sexually transmitted diseases.
  • Patients with a limited number of external warts or keratinised lesions may be better treated with cryotherapy or other forms of physical ablation.

Anogenital warts

ChoiceDrugDosage
1st choicePodophyllotoxin 0.5% solution (Warticon®, Condyline®)

Dose:
Apply twice daily for 3 consecutive days; treatment may be repeated at weekly intervals if necessary for a total of five 3-day treatment courses

2nd choiceImiquimod 5% cream (Aldara®)

Dose:
Warts (external genital and perianal) apply thinly 3 times a week at night until lesions resolve (max. 16 weeks)

Prescribing Notes

  • Surrounding skin should be protected when treating anogenital warts.
  • Podophyllotoxin cream is not recommended for use by either women or men as it soaks into underwear and is less effective than the solution which dries into the skin.
  • Podophyllotoxin solution may be used for soft, non-keratinised external anogenital warts.
  • Imiquimod is relatively expensive and should only be used when other treatments have failed.
  • Imiquimod cream should be rubbed in and allowed to stay on the treated area for 6-10 hours; then washed off with mild soap and water. The cream should be washed off before sexual contact. Imiquimod may damage latex condoms and diaphragms.
  • Imiquimod is the only drug licensed for perianal warts.
  • Podophyllotoxin and imiquimod should not be used during pregnancy.