Treatment

The kindest treatment if it is painless is to leave it hoping that it will resolve spontaneously. Treatment may be indicated:

• for a painful plantar wart
• in immunosuppressed
• in resistant cases
• if the patient prefers when they understand the natural history of the plantar wart

Options include:

• first-line treatments
  • salicylic acid as plasters, colloidon, gel, paint or combined with podophyllum resin. The addition of lactic acid theoretically makes it more effective. Often takes as long as 8 weeks to work and surrounding skin needs protection - need a dextrous well motivated patient
  • formaldehyde and gluteraldehyde are not used much as they produce sensitisation, desiccation, and are unpleasant
• second-line treatments
  • cryotherapy is generally effective. It usually needs at least 2 treatments, 4 in resistant cases.
• third-line treatments
  • options include surgical excision or curettage and bleomycin injections, topical immunotherapy, pulsed dye laser, CO2 laser, photodynamic therapy, and retinoids (1).

Reference:

• (1) Shankar S et al. Nongenital warts: recommended approaches to management. Prescriber 2007;18(4):33-44