Clinical Review

Management of cutaneous viral warts

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3339 (Published 27 May 2014) Cite this as: BMJ 2014;348:g3339
  1. Magnus D Lynch, dermatology registrar1,
  2. Jane Cliffe, general practitioner with specialist interest in dermatology2,
  3. Rachael Morris-Jones, consultant dermatologist1
  1. 1Department of Dermatology, King’s College Hospital, London SE5 9RS, UK
  2. 2The Surgery, The Gardens, London, UK
  1. Correspondence to: M D Lynch magnus.lynch{at}nhs.net

Summary points

  • Viral warts are common in children and most resolve spontaneously without treatment

  • Salicylic acid with regular paring and occlusion is the preferred treatment for cutaneous viral warts

  • Cryotherapy in combination with salicylic acid is recommended as second line treatment

  • Several third line treatments are available in secondary care that can be effective against warts recalcitrant to earlier treatments

The prevalence of cutaneous viral warts in the general population is estimated to be 7-12%. Many patients present to primary care with pain and discomfort along with other concerns, such as cosmetic appearance. Although cutaneous viral warts are ubiquitous, no definitive treatment exists. Nevertheless, most warts resolve spontaneously and a large proportion of the remainder respond to simple recommended treatment. For these reasons, potential treatments must have minimal side effects and a favourable risk profile.

Sources and selection criteria

We searched Medline, Embase, and the Cochrane databases for evidence relating to the treatment of cutaneous viral warts. Although a large number of trials have been published, the quality of evidence varied and only a few were randomised and of adequate sample size. Proof of efficacy is challenging, with relatively high rates of spontaneous resolution; furthermore, studies of second and third line treatments are limited as these treatments are typically reserved for recalcitrant warts.

High quality evidence based studies are lacking in this discipline owing to confounding factors such as high rates of spontaneous resolution and a subpopulation of warts that seem recalcitrant to most treatments. Occasionally in medicine the longer the list of potential treatments the less effective they seem to be, and this situation is exemplified by viral warts.1 2 This article focuses on the preferred treatment of viral warts in primary care and alternative management in secondary care.

What are cutaneous viral warts and how common are they?

Viral warts are benign papillomas that arise from infection of epidermal or mucosal cells with …

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