Place in therapy
Salicylic acid, a keratolytic agent, and lactic acid, a lubricant/moisturizer, are often found in combination products for wart treatment. This treatment modality is currently one of the most effective topical therapy for warts1,2. It has been effectively tested on common warts on hands and feet, palmer, and plantar warts3. It is the preferred treatment for adults and children1,2. A recent Cochrane meta-analysis concluded that salicylic acid + lactic acid combination therapy is both effective and safe, and that there is no evidence that any other treatments such as cryotherapy, intralesional bleomycin, topical 5-flurouracil, photodynamic therapy, and pulsed dye laser have an advantage over salicylic acid + lactic acid therapy in terms of higher cure rates and/or fewer adverse effects. At best cryotherapy is as effective as salicylic acid + lactic acid2. Also, 40% salicylic acid monotherapy does not appear to be more effective than this combination for the treatment of mosaic plantar warts5. However, this modality should be used cautiously in pregnancy and breastfeeding4. It is contraindicated in individuals with diabetes, peripheral vascular disease, or impaired circulation4.
Salicylic acid works by destroying hyperkeratotic tissue and lactic acid has been suggested to work synergistically with salicylic acid2. Low risks of scarring and minor side effects including burning and irritation have been reported2,4. But this treatment modality takes time to work2,4. When applied once daily, it can take up to 12 weeks or several months for treatment to occur2,4. Combining this treatment modality with occlusive dressing has been shown to be more effective than just salicylic acid +lactic acid alone6. Some studies have also suggested lightly paring the wart before applying salicylic acid + lactic acid to enhance the efficacy of this combination therapy3.
References
1. Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneuous warts: systematic review. BMJ. 2002;325(7362):461.
2. Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006;(3): CD001781
3. Dhar S, Kumar B, Kaur I. Treatment of warts with salicylic acid and lactic acid in flexible collodion wart paint. Indian J Dermatol Venereol Leprol. 1994;60:286-9.
4. Mallin A. Chapter 54—Plantar Warts. In: Patient Self Care. 2nd ed. Canadian Pharmacists Association;2010. p. 501-5.
5. Bunney MH, Nolan MW, Williams DA. An assessment of methods of treating viral warts by comparative treatment trials based on standard design. Br J Dermatol. 1976;94:667-79.
6. Veien NK, Madsen SM, Avrach W, Hammershoy O, Lindskov R, Niordson AM, Stahl D. The treatment of plantar warts with a keratolytic agent and occlusion. J Dermatolog Treat. 1991;2:59-61.
.
Salicylic acid, a keratolytic agent, and lactic acid, a lubricant/moisturizer, are often found in combination products for wart treatment. This treatment modality is currently one of the most effective topical therapy for warts1,2. It has been effectively tested on common warts on hands and feet, palmer, and plantar warts3. It is the preferred treatment for adults and children1,2. A recent Cochrane meta-analysis concluded that salicylic acid + lactic acid combination therapy is both effective and safe, and that there is no evidence that any other treatments such as cryotherapy, intralesional bleomycin, topical 5-flurouracil, photodynamic therapy, and pulsed dye laser have an advantage over salicylic acid + lactic acid therapy in terms of higher cure rates and/or fewer adverse effects. At best cryotherapy is as effective as salicylic acid + lactic acid2. Also, 40% salicylic acid monotherapy does not appear to be more effective than this combination for the treatment of mosaic plantar warts5. However, this modality should be used cautiously in pregnancy and breastfeeding4. It is contraindicated in individuals with diabetes, peripheral vascular disease, or impaired circulation4.
Salicylic acid works by destroying hyperkeratotic tissue and lactic acid has been suggested to work synergistically with salicylic acid2. Low risks of scarring and minor side effects including burning and irritation have been reported2,4. But this treatment modality takes time to work2,4. When applied once daily, it can take up to 12 weeks or several months for treatment to occur2,4. Combining this treatment modality with occlusive dressing has been shown to be more effective than just salicylic acid +lactic acid alone6. Some studies have also suggested lightly paring the wart before applying salicylic acid + lactic acid to enhance the efficacy of this combination therapy3.
References
1. Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneuous warts: systematic review. BMJ. 2002;325(7362):461.
2. Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006;(3): CD001781
3. Dhar S, Kumar B, Kaur I. Treatment of warts with salicylic acid and lactic acid in flexible collodion wart paint. Indian J Dermatol Venereol Leprol. 1994;60:286-9.
4. Mallin A. Chapter 54—Plantar Warts. In: Patient Self Care. 2nd ed. Canadian Pharmacists Association;2010. p. 501-5.
5. Bunney MH, Nolan MW, Williams DA. An assessment of methods of treating viral warts by comparative treatment trials based on standard design. Br J Dermatol. 1976;94:667-79.
6. Veien NK, Madsen SM, Avrach W, Hammershoy O, Lindskov R, Niordson AM, Stahl D. The treatment of plantar warts with a keratolytic agent and occlusion. J Dermatolog Treat. 1991;2:59-61.
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