Treatment of nongenital cutaneous warts

Numerous treatments for nongenital cutaneous warts are available, although no single therapy has been established as completely curative. Watchful waiting is an option for new warts because many resolve spontaneously. However, patients often request treatment because of social stigma or discomfort. Ideally, treatment should be simple and inexpensive with low risk of adverse effects. Salicylic acid has the best evidence to support its effectiveness, but it is slow to work and requires frequent application for up to 12 weeks. Cryotherapy with liquid nitrogen is a favorable option for many patients, with cure rates of 50 to 70 percent after three or four treatments. For recalcitrant warts, Candida or mumps skin antigen can be injected into the wart every three to four weeks for up to three treatments. More expensive treatments for recalcitrant warts are offered in many dermatology offices. Photodynamic therapy with aminolevulinic acid has the best evidence of effectiveness compared with pulsed dye laser, intralesional bleomycin, and surgical removal using curettage or cautery.