Therapeutic target
- Elimination of the warts
Therapy recommendations
- Mechanical (keratolysis/detachment of horn cells with curettage/scraping) or
- Chemical ablation (dell warts, verrucae vulgaris) with salicylic acid – of the further (see below).
- Condyloma therapy (condylomata) in pregnancy: wait, because high spontaneous remission rates (further recommendations see below).
- See also under “Surgical therapy” and “Other therapy” (eg, cryotherapy, laser therapy.
Many other substances are available, some as “off-label use” (use outside the indication areas or the group of people for which the drugs are approved by the drug authorities) and should be used after consultation with a dermatologist.
The following substances can be used in principle:
- Cidofovir
- Digoxin and furosemide as a gel (both agents inhibit potassium influx into the cell; ionic anti-viral therapy, ICVT); warts became smaller and viral load lower with few side effects
- Formaldehyde
- Glutaraldehyde
- Green tea leaf extract (10%; green tea catechins) for condyloma therapy.
- In case of repeated recurrences (recurrence of the disease), the current guideline (see below) recommends a combined sequential therapy: surgical therapy (see below “Surgical therapy”) ensures a rapid removal of the external skin lesions as well as a reduced viral load, the subsequent local therapy with green tea catechins may allow complete healing.
- Imiquimod (for anogenital warts, 5% Imiquimod in the form of a cream reduces the amount of HPV-6); also for condyloma therapy.
- Potassium hydroxide solution (KOH), 5%.
- Monochloroacetic acid
- Lactic acid
- Mycobacteria vaccination (for anogenital warts, vaccination reduces the HPV-6 and HPV-11 burden).
- Sodium nitrite (cream, 3-9%).
- Oxalic acid
- Podophyllotoxin 0.5%
- Nitric acid
- Silver nitrate
- Trichloroacetic acid (TCA): 10-80% acid (!) for condyloma therapy.
- Zinc sulfate
- Citric acid (cream, 4.5-9%)
- 5-Fluorouracil contraindicated in pregnancy!
For pharmacotherapy of HPV-related warts, see: HPV/Medicinal therapy.
Further notes
- A phase III study demonstrated that 0.7% cantharidin (natural product; belongs to the group of terpenoids) as a local therapy is very effective in the treatment of mollusca contagiosa (dell warts): number of molluscs reduced by 70 to 80%; skin lesions disappeared completely in every second patient.
