Most common warts on the hand are treated in the physician’s office with cryotherapy with liquid nitrogen. Cryotherapy is effective for warts on the back of the hands and fingers but is less effective for those on the palms and soles. Freezing the palms and soles is very painful. Warts that have been frozen often blister. The blister may contain blood and can be drained by the patient with a pinprick. Warts may require repeated freezing on different office visits. Outpatient cryo-spray preparations available in the drug store are less effective than in the office treatment.
Warts may be treated on an outpatient basis with nonprescription Sal-Acid preparations. The salicylic acid pads or gels are applied and may be covered with tape to encourage penetration of the medication. Soaking the wart in warm water for about 5 minutes prior to application of medication will enhance penetration of the salicylic acid. White macerated scale will appear and should be paired or scraped off so that additional applications of salicylic acid can be applied to the surface of a wart. There are new prescription strengths of salicylic acid gels that contain 26 or 27% salicylic acid. The key to using topical medications is to remove the macerated tissue so that further applications can effectively penetrate into the wart.
Imiquimod cream may be tried with daily application to resistance plantar and common warts. The medication is only moderately effective and very expensive.
There are numerous home remedies for treating warts. Everyone has stories about how warts disappeared after being rubbed with a potato or a banana peel. There may be a place for such suggestive therapy. Covering a wart with duct tape for several days was reported to be effective but subsequent reports found this technique not to be effective.
Plantar warts that do not cause pain when walking may be best left to resolve on their own. Aggressive surgical or cryotherapy treatment of plantar warts may result in a painful scar that could cause a lifetime of discomfort.