Place in therapy
Topical salicylic acid should be considered a first line initial agent in the treatment of both plantar and common warts.1 A Cochrane systematic review assessed a variety of local treatments for non-genital warts and found the best available evidence for topical treatments containing salicylic acid.2 Other pharmacological agents, including cryotherapy, have not proven to be more effective than topical salicylic acid in the treatment of plantar warts.1,3,4 More recently, a trial comparing cryotherapy with salicylic acid found that cryotherapy is significantly better for the treatment of common warts, but there was no significant difference for plantar warts. 3 It should be noted, as with all wart treatments, high quality trials for wart treatment are lacking and are warranted in the future.1
Topical salicylic acid is considered a very safe option compared to other alternatives such as cryotherapy.5 When used properly, the most common side effects are minor irritation and burning.5,6 Therefore, it is typically chosen over cryotherapy, despite the fact that cryotherapy has shown better evidence with common warts. Salicylic acid’s onset of action is often slow and therefore patient adherence is very important for the best outcomes.1 If the patient’s only concern is healing time rates, cryotherapy may be selected over salicylic acid. In terms of specific patient populations, topical salicylic acid is pregnancy risk category C and the manufacturer does not recommend the product during breastfeeding.7 The product should not be used for more than 12 weeks or by patients with diabetes or peripheral vascular disease.6 Overall, salicylic acid has reasonable effectiveness, few side effects, low cost, and is convenient making it a first line agent in the treatment of warts.1
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Topical salicylic acid should be considered a first line initial agent in the treatment of both plantar and common warts.1 A Cochrane systematic review assessed a variety of local treatments for non-genital warts and found the best available evidence for topical treatments containing salicylic acid.2 Other pharmacological agents, including cryotherapy, have not proven to be more effective than topical salicylic acid in the treatment of plantar warts.1,3,4 More recently, a trial comparing cryotherapy with salicylic acid found that cryotherapy is significantly better for the treatment of common warts, but there was no significant difference for plantar warts. 3 It should be noted, as with all wart treatments, high quality trials for wart treatment are lacking and are warranted in the future.1
Topical salicylic acid is considered a very safe option compared to other alternatives such as cryotherapy.5 When used properly, the most common side effects are minor irritation and burning.5,6 Therefore, it is typically chosen over cryotherapy, despite the fact that cryotherapy has shown better evidence with common warts. Salicylic acid’s onset of action is often slow and therefore patient adherence is very important for the best outcomes.1 If the patient’s only concern is healing time rates, cryotherapy may be selected over salicylic acid. In terms of specific patient populations, topical salicylic acid is pregnancy risk category C and the manufacturer does not recommend the product during breastfeeding.7 The product should not be used for more than 12 weeks or by patients with diabetes or peripheral vascular disease.6 Overall, salicylic acid has reasonable effectiveness, few side effects, low cost, and is convenient making it a first line agent in the treatment of warts.1
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