Therapy guide · medical education
Warts & verrucas (verruca vulgaris): the full therapy pathway
The pharmacy treatment for warts genuinely works, and its own label sets the course at twelve weeks. Almost nobody gets past three. Here is the ramp built around that single fact, the honest clearance figures, and the clinic tier that starts where a finished course ends.
Before anything else
Not everyone should start at the bottom of this pathway. These presentations are reasons to
see a clinician without waiting out an over-the-counter trial first.
- A growth that bleeds, ulcerates, or grows steadily See a dermatologist soon
Squamous cell carcinoma and other skin cancers imitate warts convincingly, particularly on sun-exposed skin and in older adults, and the imitation is good enough that treating first and looking later is a genuine risk. Bleeding without injury, an eroded centre, or steady enlargement over weeks changes the question from which treatment to which diagnosis.
- Warts in the genital or anal area Worth a clinician visit
Anogenital warts are managed on an entirely separate pathway, with different treatments, a transmission conversation, and follow-up considerations that do not apply to a wart on a finger. No product on this page may be applied there, and every wart-remover label says so explicitly.
- Any wart on a foot belonging to someone with diabetes, neuropathy or poor circulation See a dermatologist soon
Wart treatments destroy tissue on purpose. In a foot that heals slowly, has reduced blood supply, or cannot feel a chemical burn developing, that controlled destruction becomes an ulcer, and foot ulcers in these groups escalate badly. This combination moves foot warts to a clinician or podiatry service from the outset.
- Numerous, spreading or unusually stubborn warts alongside immune suppression Worth a clinician visit
Extensive warts in someone taking immunosuppressive medication, living with a transplant, or with a known immune condition are not simply more of the same problem. Clearance depends on immune recognition that is deliberately dampened in these groups, and there is a recognised association between long-standing viral warts and skin cancer in transplant recipients that makes specialist oversight the right setting.
- A wart in a child that is being picked, bitten or spread along scratch lines Worth a clinician visit
Not dangerous, but genuinely worth acting on: the virus travels from a wart into any break in skin nearby, so picking and biting convert one wart into a row of them and periungual warts into a nail-fold problem that is much harder to treat. Covering it is the intervention, and it costs nothing.
Which part of this pathway applies?
Three treatment routes, one map of considerations, and four exits to a clinician live on this page. Seven questions, about a minute — the first screens for the things that outrank a wart entirely.
Answers stay in this browser. Nothing is sent anywhere, and one button clears them.
One thing to be clear about. This places a reader on the map and nothing more. It cannot see the growth, and several harmless things and one or two serious ones look convincingly like warts — so a routing suggestion here never outranks having an uncertain lesion examined.
What this looks like
There is no severity grade for warts in the way there is for acne or psoriasis. What clinical guidance sorts them by is form and site, because those decide the thickness of skin a treatment has to cross, what may legally be applied at home, and how much scarring risk any destructive method carries.
Common warts
The classic form, on the backs of hands, fingers, knees and around the nails, where the skin is ordinary thickness and treatment reaches the virus most easily.
What it looks like: Firm, raised, rough-surfaced growths with a cauliflower texture, skin-coloured to grey-brown, often several clustered together. Dark pinpoints are usually visible in the surface once the top layer is pared back.
Plantar warts and verrucas
The same virus under body weight, on the sole. Pressure pushes the growth inward instead of outward and builds a callus over the top of it.
What it looks like: A flattened, callus-ringed patch that interrupts the skin lines running across the sole, often more tender squeezed from the sides than pressed from above. Several may merge into a single mosaic plaque, which is the form that resists treatment most stubbornly.
Flat warts
Verruca plana: smaller, smoother and far more numerous, favouring the face, neck, backs of hands and shaved skin, where razors spread them along a line.
What it looks like: Dozens of small, flat-topped, skin-coloured or faintly brown bumps, often barely raised, sometimes arranged in a scratch-line. They are the form most likely to be mistaken for something else entirely, and the form no counter treatment is licensed to touch.
Warts around and under the nails
Not a distinct virus, but a distinct problem: growths at the nail fold and under the plate, common where nails are bitten or cuticles picked.
What it looks like: Rough thickening banking up against the nail fold, sometimes lifting or distorting the plate. These are the slowest to answer anything, the most painful to treat destructively, and the ones where damage to the nail matrix is a real consideration.
Three things that change the plan regardless of severity
A suppressed immune system
Clearance of a wart is immune work, so the medication that protects a transplanted organ or calms an autoimmune disease also removes the mechanism this condition normally resolves through. Warts in that setting are more numerous, more persistent, and more likely to need specialist management rather than a longer course of the same thing.
Diabetes, neuropathy or poor circulation in the feet
Every over-the-counter wart product carries the same warning against use on a foot in this situation, and it is not boilerplate: these preparations destroy tissue deliberately, and a foot that heals slowly or cannot report pain converts a small chemical burn into an ulcer. Foot warts here belong with a clinician or podiatrist from the first appointment.
Many warts at once, or warts that keep appearing
Treating twenty warts individually is neither practical nor how clinics approach it. High numbers shift the strategy from destroying each growth toward provoking an immune response that reaches all of them, which is the logic behind the immunotherapy tier and the reason a single treated wart can be followed by distant ones disappearing.
Skin that marks easily after injury
Freezing and other destructive methods work by injuring skin, and skin that responds to injury with lasting pale or dark patches can be left with a mark more visible than the wart was. This is a real trade-off in deeper skin tones and on the face, and it is a legitimate reason to prefer the slower chemical route or to wait.
What else it could be
- Corns and calluses — Both are thickened skin from pressure, and both sit where verrucas sit. Paring the surface separates them: a callus shows uniform layers, a wart shows pinpoint bleeding from clotted capillaries and interrupted skin lines.
- Molluscum contagiosum — A different virus producing smooth, dome-shaped, pearly bumps with a central dimple, usually in children. It resolves on its own and is not treated with wart preparations.
- Seborrhoeic keratosis — Warty, stuck-on brown growths that arrive with age and are entirely harmless. They are not infectious, do not respond to wart treatments, and are the commonest thing an adult treats for months as a wart.
- Skin cancers on sun-exposed skin — Squamous cell carcinoma in particular can look like a stubborn wart on a hand, forearm or face. A growth that bleeds, ulcerates, enlarges steadily or arrives alone on older sun-damaged skin is the reason a wart that behaves oddly gets examined rather than treated.
The pattern behind that list is worth stating plainly: everything in it is either harmless and untreatable by this page's methods, or serious and delayed by them. Both failure modes cost the same thing — months — which is why a growth that does not fit the description in the stage above is worth showing to someone before a twelve-week course begins.
Why it happens
A wart is a patch of skin whose growth instructions have been rewritten by human papillomavirus. The virus enters through a small break — a graze, a bitten cuticle, softened skin on a changing-room floor — infects the basal cells of the epidermis, and drives them to divide far faster than the surrounding skin. The rough, raised surface is that overproduction piling up, and the dark specks people take for seeds or roots are capillaries drawn up into the growth and clotted. Nothing about a wart is deep: it sits entirely within the epidermis, above the layer that scars, which is why a treated wart leaves no mark and an over-treated one can. The immune system eventually recognises the infected cells and clears them, and the whole difficulty of this condition is that eventually is measured in months to years.
Anyone with a rough growth on a hand or finger, a tender callus-like patch on a sole that hurts when squeezed from the sides, or a scatter of small flat bumps across the face and forearms. It is written especially for whoever has bought three different wart treatments and concluded that none of them work, because that is the single commonest way this condition is misread.
Orientation, not diagnosis. Genital and anal warts are a different pathway with different treatments, different transmission and different follow-up, and nothing on this page applies to them. Everything here concerns warts on ordinary skin. This page also assumes the growth is a wart: seborrhoeic keratoses, corns, calluses, molluscum contagiosum and — rarely but importantly — skin cancers all produce lumps that get treated as warts for months by people who never intended to gamble.
Everything on this route is available without a prescription The over-the-counter pathway
The ceiling here is unusual for this site, because the over-the-counter tier is not a weak substitute for the real treatment — it is one of the two best-evidenced options for this condition, and in head-to-head trials against clinic freezing it has repeatedly finished level. Pooling the randomised trials, salicylic acid clears roughly half of warts against roughly a quarter on placebo, and the same pooled analysis could not show a statistically significant advantage for cryotherapy over placebo at all. What limits this tier is therefore not potency. It is that half of courses fail even when completed, that nothing on the shelf may be applied to the face or to genital skin, that flat warts and periungual warts answer it poorly, and that the twelve-week commitment defeats most people long before the chemistry gets a chance. A pathway built on that reality escalates on a finished course, not on a disappointing fortnight.
Appropriate for: Common warts on hands, fingers, knees and elbows, and verrucas on the sole, in someone without diabetes or circulation problems in the feet, where the skin around the growth is intact and the plan can survive twelve weeks. Not appropriate for facial or flat warts, anogenital warts, or any growth whose identity is uncertain.
This is the only pathway on the site whose principal challenge is not choosing correctly but continuing. The product is cheap, the evidence behind it is better than most things sold in the same aisle, and the instruction printed on its own label runs to twelve weeks. What follows is that instruction broken into a routine that can survive a season, with the two weeks where most courses die marked in advance.
The rule this whole page turns on: twelve weeks, not three
Salicylic acid roughly doubles the clearance rate over placebo, and the label on the bottle sets the course at up to twelve weeks of near-daily application. What defeats it is almost never chemistry. It is that a wart at week three looks identical to how it looked on day one — because at week three it is supposed to — and the bottle goes into a drawer at exactly the point where nothing has happened yet and nothing was due to. Warts are the condition where both the treatment and its abandonment are entirely predictable, and the only variable actually under anyone's control is which of the two occurs.
Four things that matter more than which pack goes into the basket
- The course is twelve weeks of near-daily application. That number comes off the label of the product itself, not from an opinion held here.
- Filing the softened white layer back between applications is half the treatment; acid left to build a crust ends up treating the crust.
- Nothing in this aisle goes on the face, on genital skin, on moles or birthmarks, on hair-bearing warts, or on a foot with diabetes, neuropathy or poor circulation.
- One file per wart, thrown away afterwards, never returned to shared kit — this virus spreads by contact, including from one part of a person to another.
Answer as you go and the chart tracks where you are. Nothing is sent anywhere.
- Before the first purchaseYou are here
Confirm it is a wart, and one this counter may treat
Separate a wart from the several harmless and one or two serious things that resemble one.
What this step involves
Morning
- Match the growth against the description A common wart is firm, raised and rough, with a cauliflower surface, usually on a hand, finger or knee. A verruca on the sole is flatter, ringed by callus, tender squeezed from the sides rather than pressed from above, and interrupts the skin lines that run across the foot. Both usually show tiny dark points once the surface layer is filed back — clotted capillaries, and the single most useful confirming sign available without a clinic.
- Check the growth is not behaving oddly Bleeding without injury, an eroded or ulcerated centre, steady enlargement over weeks, or a solitary rough patch appearing on sun-damaged skin in an older adult are all reasons to have it examined before treating it. The mimics that matter are not the harmless ones.
Evening
- Read the exclusions on the pack before buying it Every wart-remover label carries the same list: not on the face or mucous membranes, not on genital warts, not on moles or birthmarks, not on warts with hairs growing from them, and not at all where there is diabetes or poor blood circulation. Each of those is on the label because of a specific harm, and a growth in any of those categories leaves this pathway here. Browse all salicylic acid products →
Why this step: Two entirely different mistakes are prevented at this step, and they cost the same thing. Treating a seborrhoeic keratosis or a corn as a wart wastes a season; treating a squamous cell carcinoma as a wart wastes considerably more than that.
Ready for the next step?
Does the growth match the description, on skin the label permits treating?
Yes — a wart, on hand, foot, knee or elbow: Go to step 1 below and set the routine up before starting the clock. Go to step 1 ↓
It is on the face, in the genital area, or behaving oddly: This route ends here. A facial or flat presentation belongs on the branch for it above; anything bleeding, ulcerating or enlarging belongs with a clinician before any treatment starts.
- Week 0You are here
Build the routine before starting the clock
Make a twelve-week ritual survivable by making it short.
What this step involves
Morning
- Pick the format the site can actually keep A collodion liquid suits an awkward wart on a finger where a plaster will not sit. A 40% plaster suits a sole, where it survives a sock and holds contact through a working day. The clinical difference between them is small; the adherence difference is not, and adherence is the variable that decides this. Browse all salicylic acid products →
Evening
- Assemble the whole kit in one place The preparation, a disposable emery board reserved for this wart alone, waterproof tape, and something to protect the ring of skin around the growth — petroleum jelly applied to the margin, or a plaster with a hole cut to the size of the wart. Browse all moisturizers →
- Fix the routine to something that already happens Attaching the application to an existing nightly habit is not a productivity flourish; it is the difference between a twelve-week course and a three-week one, and it is the single highest-yield decision on this page.
Why this step: Every trial that produced the clearance figures quoted above tested a regimen with soaking, filing and daily application built into it. A course missing those components is not the treatment those trials measured.
Ready for the next step?
Is the kit assembled and the daily slot chosen?
Yes, both: Go to step 2 and start counting from the first application. Go to step 2 ↓
Not yet: Worth finishing before starting. A course begun without the filing kit becomes an acid-only course, which is a weaker version of the treatment that has to run just as long.
- Weeks 1-4You are here
Weeks 1 to 4: apply, file, and expect nothing
Establish the habit and correctly interpret an absence of results.
What this step involves
Morning
- File back the softened white layer Softened tissue only, and stopping well before anything pink or tender. Filing until it bleeds does not remove the wart faster; it opens fresh skin for the virus to move into and is one of the ways a single wart becomes several.
Evening
- Soak, dry, apply, cover A few minutes in warm water, dried thoroughly, the preparation applied only to the wart itself with the surrounding margin protected, then covered. Liquids are applied daily; high-strength plasters are usually changed every couple of days as the pack directs. Browse all salicylic acid products →
Why this step: This month is where the failure mode lives. The wart is expected to look unchanged, because the acid is working through dead tissue that has to be removed layer by layer before anything living is reached. An unchanged wart at week four is a course running normally, not a product that does not work.
Ready for the next step?
Has the routine actually run on most days this month?
Yes, most days: Go to step 3. The part that decides the outcome is the part that comes next. Go to step 3 ↓
It has been patchy: Restart the count from today rather than abandoning it. A patchy month is not a failed course, but it is not a month of the course either, and the twelve weeks measure applications rather than calendar time.
- Weeks 5-12You are here
Weeks 5 to 12: the stretch where courses are abandoned
Reach a real verdict instead of an imagined one.
What this step involves
Morning
- Keep filing, and watch the surface rather than the size A wart that is answering loses its texture before it loses its bulk: the cauliflower roughness flattens, the dark points thin out, and the skin lines that the wart interrupted start to reappear at the edges. Size is the last thing to change and the first thing people measure.
Evening
- Continue the nightly application without interruption Interruptions of more than a few days let the softened layer reharden, which effectively returns the course to an earlier week. Where the surrounding skin becomes sore, the answer is better margin protection and a night off, not abandonment. Browse all salicylic acid products →
- Photograph the site once a fortnight Change at this speed is invisible to daily inspection and is reliably underestimated from memory. A photograph in the same light every two weeks is the only honest record of whether anything is happening.
Why this step: Nearly every account of a wart treatment failing describes a course that ended between weeks three and five. The trials that found salicylic acid clearing around half of warts ran their treatment arms for six to twelve weeks, so a course stopped in week four has not produced a result that can be compared with anything.
Ready for the next step?
Have twelve weeks of applications actually accumulated?
Yes — twelve applied weeks: Go to the checkpoint below. Whatever the answer is now, it is a real one. Go to step 4 ↓
Not yet: Then the checkpoint is not due. Continuing to the twelfth week costs a few more minutes a night and is the only thing that makes the next tier's decision an informed one.
- ThroughoutYou are here
Stop it spreading while the course runs
Keep one wart from becoming several while the first is treated.
What this step involves
Morning
- Keep the wart covered in shared spaces A plaster over the site for swimming, communal showers and changing rooms, and footwear rather than bare feet on wet floors. The virus is picked up and passed on where skin is soft and floors are shared.
Evening
- Break the picking and biting habit Warts spread into any break in nearby skin, which is why bitten fingers grow rows of them around the nail folds and shaved skin grows them along a razor line. Covering the wart is the practical intervention, and it works better than instructions not to touch it. Browse all moisturizers →
- Keep the tools out of circulation Files, pumice, clippers and towels used on a wart do not go back into shared kit or a salon bag. This is the most frequent route by which one household member's verruca becomes two.
Why this step: Spread by self-inoculation is what turns a twelve-week problem into a two-year one, and it happens through ordinary handling rather than anything unusual. This step runs alongside every other one rather than after them.
Ready for the next step?
Is the wart covered in shared spaces and are the tools kept separate?
Yes: That is the containment side complete; it continues until the site has fully healed. Go to the checkpoint ↓
Not consistently: Worth fixing now rather than later — new warts appearing during a course are usually spread rather than treatment failure, and they reset the clock on the whole episode.
The twelve-week verdict
Twelve weeks counted from the first application, and only where applications have actually happened on most days.
How to judge it: By surface, not size. A wart that is clearing loses its rough texture first, then its dark points, and the skin lines that ran into it and stopped begin to run through it. Flat skin with continuous lines is cure; a smaller but still rough lump is partial and worth continuing.
After twelve applied weeks, what does the skin actually show?
Cured, with a fortnight of confirming still worth doing.
Continuing to protect the site for another two weeks costs little and matters more than it sounds: recurrence tends to happen at the site that just healed, and the virus can persist in skin that looks entirely normal. Keeping the area covered in shared spaces and keeping the tools separate is the whole of the aftercare.
Answering — the course extends rather than escalates.
A wart that has visibly flattened at twelve weeks is on its way, and stopping now is the most avoidable mistake left on this page. Continuing for a further four to eight weeks on the same routine is standard practice, and there is no separate benefit to switching product mid-response.
The over-the-counter tier is finished here.
Around half of completed courses end this way, which makes this the expected result rather than a disappointing one, and it is the moment this pathway was built to reach honestly. A completed course is also the strongest thing to carry into an appointment: the clinician is no longer being asked to guess whether the cheapest option would have worked, because that question has already been answered.
Stop, rather than escalate.
Sore, weeping or broken skin around the wart means the acid has reached tissue it was never meant to, and continuing makes both the wound and the spread risk worse. Stopping, letting the skin heal, and protecting the margin more carefully next time is the correct response; a spreading redness, increasing pain or discharge needs looking at rather than waiting.
An untried course, not a failed one.
This is the commonest honest answer at week twelve and it deserves saying plainly, because the alternative is that a working treatment gets recorded as a failure and the next tier starts from a false premise. A course that ran for three weeks has produced no evidence about anything. Restarting with the routine attached to a fixed daily habit is a better use of the next three months than moving up a tier that has its own costs.
What does not wait for week twelve
Four things end the count early rather than continuing it. A growth that starts bleeding, ulcerating, or enlarging steadily needs examining rather than treating. Redness spreading outward from the site, with increasing pain or discharge, suggests infection of the treated skin. Warts multiplying rapidly during a course, particularly alongside immune-suppressing medication, changes which route this belongs on. And pain that prevents ordinary walking is a reason to be seen now rather than at the end of a course that was never going to finish comfortably.
Nothing here needs monitoring in a clinical sense. What does need recording is the count: which day the first application happened, roughly how many days were missed, and a photograph every fortnight. Those three facts turn a vague sense that something has been tried for ages into the specific answer a clinician needs at the twelve-week mark.
Where the over-the-counter pathway ends
It ends at a completed course, which is a specific and deliberately narrow definition: twelve weeks of applications that actually took place, with filing between them. Everything above this line is available in a supermarket for the price of a sandwich, has better trial support than most of what surrounds it on the shelf, and finished level with professional freezing in the trials that compared them directly. What lies past it is not stronger chemistry so much as more force, more supervision and more cost — and the case for accepting those is built entirely on the course below having been finished first.
See what the clinic tier adds →Warts & verrucas (verruca vulgaris): the full therapy pathway · dermapproved.com/treatments/warts/ · not a diagnosis — confirm anything you act on with a clinician
What to expect
Two expectations need resetting before anything on this page works, and they pull in opposite directions. The first is about speed: this treatment produces no visible result for weeks, by design, because it works through dead tissue that has to be removed a layer at a time before living infected skin is reached. An unchanged wart at week four is a course running correctly. The second is about certainty: even completed properly, around half of courses do not clear the wart, and roughly a quarter of warts clear on placebo, which is the same fact viewed from the other side — the immune system finishes many of these regardless. Holding both at once produces the right posture, which is patience without illusion. Warts are a benign infection that resolves eventually, treatment shifts the odds of that happening sooner rather than guaranteeing it, and the treatments that shift the odds most are also the ones that hurt, mark or scar. Everything on this page is a negotiation between those facts.
- Count from the first application, never from the purchase — those dates are frequently weeks apart
- Judge by surface texture and returning skin lines, not by size; size is the last thing to change
- Missed days extend the course rather than ending it, but they are missed weeks, not calendar weeks
- A fortnightly photograph in the same light is the only reliable record of change this slow
- Sore surrounding skin means better protection, not a stopped course — that is where most courses actually die
This page is written to be returned to at week twelve rather than read once. The checkpoint above is the moment it was built for, and the honest answer at that point — cleared, answering, unchanged, or never really applied — routes to four genuinely different next steps. The site's photo tracker is built for exactly this kind of slow change, and the questions library carries the smaller queries that arise mid-course without needing an appointment.
What would bring you back sooner
Whatever step you are on, these do not wait for the end of a trial period. They are the same
presentations listed at the top of this page — repeated here because that is where they
matter, rather than where they were easiest to put.
- A growth that bleeds, ulcerates, or grows steadily See a dermatologist soon
- Warts in the genital or anal area Worth a clinician visit
- Any wart on a foot belonging to someone with diabetes, neuropathy or poor circulation See a dermatologist soon
- Numerous, spreading or unusually stubborn warts alongside immune suppression Worth a clinician visit
- A wart in a child that is being picked, bitten or spread along scratch lines Worth a clinician visit
Prescription only — from here on, this is a clinician's decision The prescription pathway
Why this tier exists. Roughly half of completed courses do not clear the wart, and there is no way to know in advance which half. That is the honest ceiling, and it is the reason the checkpoint below escalates on a finished course rather than treating persistence as an indefinite virtue.
Routes on this map split by where the wart sits, because site decides almost everything: what may legally be treated at a counter, how thick the skin above the virus is, and how much scarring risk any destructive method carries. All routes run on the same twelve-week clock.
The same pathway in full below — each step names what it involves, why it sits where it does, and what tells you it's time to move up. Tap any therapy to jump to its detail.
Common warts on hands, fingers and elsewhere (verruca vulgaris)
Rough, raised warts on ordinary skin away from the face — the presentation the over-the-counter tier was designed around, where the acid reaches the virus through the least amount of intervening tissue and clearance figures are at their most favourable.
You reach this column when: Twelve genuinely applied weeks have passed with no change in surface texture, or the wart has grown or multiplied during the course.
- In-office procedure
Clinic destruction, on a two-to-three-week rhythm
Why this step sits here: The clinic tier does the same job with more force and a limit on how many attempts are worth making. Two approaches sit level here rather than in order, and the pooled evidence adds one useful instruction: continuing the acid at home between sessions outperforms either method used alone.
Two comparable choices, differentiated by pain, access and what the surrounding skin can afford rather than by strength.
- Liquid nitrogen cryotherapy backed by large randomized trials
Freezing suits warts on hands and fingers, where a primary-care trial found it clearly ahead of both acid and waiting, and where pigment change on a hand is a smaller consideration than it would be on a face.
- Office-applied monochloroacetic acid backed by smaller studies
Applied acid suits anyone who cannot face the freeze: the randomised comparison found similar clearance with markedly less pain during the appointment, though the soreness afterwards is much the same.
When to move up
- A fair trial
- Three to four sessions at the stated interval, with acid continued at home in between, before the approach is judged.
- Improvement looks like
- The wart shrinking session by session, its surface flattening and its dark points thinning out, with normal skin lines advancing in from the edges.
- Move up if
- A defined course of sessions has ended with the wart substantially unchanged, or new warts continue to appear around the treated one.
→ The next step up this pathway.
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- In-office procedure
Blistering and removal, for a single stubborn wart
Why this step sits here: A wart that has survived a completed course and a course of freezing has demonstrated something about itself, and the options here treat it accordingly. Both carry costs the tiers below do not: a blistering agent can seed a ring of new warts around the site, and surgical removal exchanges a temporary growth for a permanent scar that on a weight-bearing surface may outlast the original complaint.
When to move up
- A fair trial
- A single application or procedure, with healing complete, before anything further is decided — typically three to four weeks.
- Improvement looks like
- The wart lifting away with the blister roof, or the surgical site healing flat with normal skin lines re-established across it.
- Move up if
- The wart returns in or around the treated site, or the count of warts is rising rather than falling.
→ The next step up this pathway.
- Specialist care
Resistant and multiple warts: the specialist tier
Intralesional therapyPrescription topicalsLaser and photodynamic therapyOral retinoids for multiple resistant wartsWhy this step sits here: At this point the strategy inverts. Destroying warts individually has been tried and has not held, so the tier reaches instead for treatments that act on all of them at once — by making the immune system notice an infection it has been tolerating, or by acting systemically. This is also where availability stops being uniform: what a clinic can offer here depends on its compounding access, its equipment and its country.
Parallel specialist choices, selected on numbers, sites and what a given service can actually supply.
- Intralesional immunotherapy or antimitotics backed by smaller studies
Reached for when there are several warts and the appeal of treating one to affect the rest outweighs the discomfort of injection.
- Prescription topicals at home limited evidence
Suits situations where repeat clinic visits are impractical, or where the skin involved is too thin and too visible for destructive methods.
- Laser or photodynamic therapy backed by smaller studies
Considered where a specialist service has the equipment and the wart has survived chemical and cold destruction, with cost usually the deciding factor rather than clinical suitability.
- Systemic retinoid therapy limited evidence
Confined to extensive resistant disease, most often where immune suppression explains why nothing local has held.
Beyond this the decisions belong entirely to a specialist who can see the skin, and the honest framing at this tier is worth carrying into the appointment: warts are a benign infection that the immune system clears eventually, and every treatment above has to justify its risk against that fact rather than against the wart alone.
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After a wart clears, and why the next few weeks matter
Clearance is confirmed by skin lines running unbroken through the site, not by the lump being gone. Recurrence in the following months is common because the virus can persist in skin that looks entirely normal, and the site most likely to produce the next wart is the one that just healed. Keeping the area covered while it settles, keeping files and clippers out of shared kit, and treating a returning roughness early rather than watching it for a month are what convert a cleared wart into a finished episode.
Verrucas on the sole (verruca plantaris)
The same virus under body weight. Pressure drives the growth inward and builds callus over the top, so every treatment on this route has a thicker barrier to cross and a longer clock — and every trial that separated plantar warts from hand warts found the plantar arm doing worse.
You reach this column when: Twelve applied weeks have passed with the patch unchanged, walking has become painful, or separate verrucas are merging into a mosaic plaque.
- In-office procedure
Clinic treatment, with the acid continued at home
Why this step sits here: On the sole the clinic tier is a smaller step up than it is on a hand, and the evidence says so: freezing did not beat acid on plantar warts in either of the large primary-care trials, and applied acid in the surgery matched freezing-plus-acid with less pain during treatment. What does have specific plantar support is technique — a second freeze after thawing improved plantar clearance in a way it did not for hand warts.
Two clinic-delivered options with comparable plantar results, differentiated mainly by how the appointment feels.
- Office-applied monochloroacetic acid backed by smaller studies
Suits the sole particularly well: the randomised trial found comparable clearance to freezing combined with acid, less pain in the chair, and a lighter burden between visits.
- Cryotherapy with a double freeze-thaw cycle backed by smaller studies
Chosen where a service is set up for it and the technique detail is available, since the second freeze is where the plantar-specific advantage was found.
When to move up
- A fair trial
- A defined course of three to four sessions at two-to-three-week intervals, with home treatment continuing throughout.
- Improvement looks like
- The plaque shrinking from its edges, pressure pain easing, and the callus rebuilding more slowly between visits.
- Move up if
- The defined course has finished without meaningful change, or walking remains painful enough to limit ordinary activity.
→ The next step up this pathway.
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- Specialist care
Mosaic and resistant plantar warts
Why this step sits here: Mosaic verrucas are the hardest form this condition takes, and the specialist tier approaches them knowing that. Injected treatments have the best network-analysis showing for plantar warts specifically, light-based options exist where a service is equipped, and surgery is present but placed last on purpose — a scar on a weight-bearing sole is a durable problem, and this tier is where the decision to accept one is actually made.
One question belongs in this appointment more than any other, and it is not which treatment: it is what happens if none of them is used. A painless verruca on an adult sole that has resisted three tiers is a reasonable candidate for being left alone and watched, and a specialist who raises that possibility is not giving up on it.
Keeping a cleared sole clear
Verrucas are picked up where feet are bare and floors are wet, and the same environments that produced one produce the next. Footwear in communal showers and around pools, a plaster over any healing site while swimming, and drying between the toes are the whole of the prevention story, and they are worth continuing for months after the skin looks normal rather than stopping the week it does.
Flat warts, and any wart on the face (verruca plana)
Numerous small flat warts, on the face, neck, backs of the hands or along a shaving line. This route has no over-the-counter rung, and that is a licensing fact rather than an editorial judgement: every wart-remover label excludes the face and mucous membranes, because the acid that clears a wart from a knuckle scars thin facial skin.
- Prescription topical
Prescription creams chosen for thin skin and high numbers
Why this step sits here: Where there are twenty flat warts on a face, destroying them one at a time is neither practical nor wise, so the first prescription move treats the whole area at once with something the skin can survive. Retinoids and immune modulators both work slowly and both produce visible inflammation while they do it, which is worth knowing before starting rather than discovering in week two.
When to move up
- A fair trial
- Two to three months of the schedule a prescriber sets, since these agents work gradually and the inflammation they cause is not itself the result.
- Improvement looks like
- The bumps flattening into the surrounding skin and the affected area losing its faint texture, usually across the whole region rather than lesion by lesion.
- Move up if
- A full course has passed with no flattening, or the inflammation has become more troubling than the warts were.
→ The next step up this pathway.
- In-office procedure
Careful, low-energy destruction in a specialist setting
Why this step sits here: Destruction is possible on a face, but only at settings and depths chosen for it, which is why this rung belongs to dermatology rather than to a general clinic. The governing concern is not clearance but what is left behind: gentle freezing, light chemical treatment and light-based options are all capable of trading a barely visible flat wart for a permanently pale mark, and that risk is higher in richly pigmented skin.
Flat warts on a face are the clearest case on this page for the option of doing nothing. They are the form most likely to resolve spontaneously, they cause no symptoms, and every method that removes them can leave a mark that is more noticeable than they were — so a decision to wait, taken deliberately with a clinician who has confirmed what they are, is a legitimate outcome of this branch rather than a failure to reach the end of it.
Warts on immunosuppressed skin
Transplant recipients, people on immunosuppressive or biologic medication, and people with immune conditions do not have a more severe version of this condition — they have a different one. Clearance normally depends on immune recognition, and where that is deliberately dampened the arithmetic behind every tier above changes. This is a map of considerations rather than a ladder, because the sequence belongs to the team already managing the underlying situation.
Numerous or rapidly multiplying warts
High numbers push treatment away from destroying lesions individually and toward approaches that act across all of them. Systemic retinoid therapy, rarely justified for warts otherwise, is used in this group precisely because the alternative is an endless queue of individual procedures.
A single wart that has resisted everything, or looks unusual
The association between long-standing viral warts and squamous cell carcinoma in transplant recipients is the reason a resistant lesion here is examined rather than treated again. Removing it with the tissue sent for examination answers two questions at once, which is why surgery sits earlier on this route than on any other.
Ordinary limited warts, on stable immunosuppression
Not everything changes. A couple of hand warts in someone whose immunosuppression is stable are still treated with acid and filing, and still freezing if that fails — with a lower threshold for review, a longer expected clock, and the treating team told rather than bypassed.
Warts & verrucas (verruca vulgaris): the full therapy pathway · dermapproved.com/treatments/warts/ · not a diagnosis — confirm anything you act on with a clinician
When the rules change
Two groups the main routes above quietly assume away, and for whom the ordinary answer changes enough to be worth setting out separately.
During pregnancy
Warts frequently multiply during pregnancy and frequently settle afterwards, which shapes the whole approach: the goal is usually to hold the situation comfortably rather than to clear it on a deadline.
What can be used
- Topical salicylic acid on a limited area, generally regarded as low risk and usually confirmed with a midwife or clinician
- Soaking, filing and occlusion, which carry no pregnancy consideration at all
- Every containment measure on this page — covering, footwear, keeping tools separate
- Watchful waiting, which is a stronger option here than at any other time
What comes off the table
- Systemic retinoid therapy, which is absolutely contraindicated and remains so for a defined period after any course
- Topical fluorouracil and topical retinoids
- Elective destructive procedures, commonly deferred rather than prohibited
The distinction worth holding is between contraindicated and deferred. The systemic tier is genuinely off the table; freezing is not pharmacologically problematic and is usually postponed because it is an elective procedure that hurts and blisters, which is a different kind of no.
In children
Children clear warts substantially faster than adults, and the younger the child the faster it tends to be — which means the strongest argument in paediatric wart treatment is frequently for doing less rather than more.
What can be used
- Watchful waiting with covering, particularly where the wart causes no symptoms
- Salicylic acid courses, which are used in children and were included in the trials behind the clearance figures
- Covering a wart that is being picked or bitten, which prevents more spread than any instruction does
- Filing done by an adult, gently, stopping well short of anything tender
What comes off the table
- Painful destructive procedures as a first move in a young child
- Home freezing kits near a nail fold, where the nail matrix is at risk
- Treating a large number of small flat warts individually
The practical question in a child is rarely which treatment but whether the treatment is worse than the wart. A painless growth on a knee in a six-year-old sits at one end of that judgement; a painful verruca stopping a child from running sits at the other, and the two deserve genuinely different answers.
How an appointment actually happens, what to take to it, and how to keep your skin liveable while a prescription or procedure does its work.
What seeing a dermatologist actually looks like
General practice is the right first door for almost everything on this page, and in several countries a pharmacist or podiatrist can settle the identity question before an appointment is needed at all. Primary care confirms what the growth is, delivers or arranges freezing and applied acid, and manages the foot warts that should never be treated at home. Podiatry is the parallel route for verrucas, particularly where callus reduction is part of the job or the foot carries risk. Dermatology referral fits a narrower set: diagnostic uncertainty, warts that have survived a completed course and a course of clinic treatment, high numbers, and anything in the immunosuppressed group.
What to bring
- The dates — when it appeared, when the first application actually happened, and roughly how many days were missed
- The product itself, or a photograph of its active-ingredient line, since strength and format both matter and neither is memorable
- Photographs at intervals, because change at this speed is invisible to inspection and badly reconstructed from memory
- A full medication list, particularly anything immune-suppressing, which changes the route rather than the dose
- An honest count of how many warts there are now against how many there were three months ago
Questions worth asking
- Is this definitely a wart, and is there anything about it that makes that less certain?
- Given a completed twelve-week course has already happened, what does the evidence support next?
- How many sessions of this are worth doing before the approach is reconsidered?
- What mark is this likely to leave, and does that risk change for skin that marks easily?
- What is the case for leaving it alone, given it may resolve on its own?
- What stops the next one appearing while this one is treated?
Cost and access. The economics run the right way round here for once, and it is worth saying so: the best-evidenced option is the cheapest thing in the aisle, and it is the one people abandon. Clinic freezing is inexpensive or free in publicly funded systems though not always offered for warts, since they are frequently classed as a self-limiting cosmetic problem. Applied acid in a surgery costs little where it is available. The expensive end is entirely private — laser and photodynamic sessions are priced per visit and rarely funded, which makes cost, rather than clinical suitability, the usual reason that tier is or is not reached.
One thing is worth raising early in a general practice appointment, because it saves an argument: many health systems do not routinely fund wart treatment, on the grounds that warts resolve on their own. That position is defensible on the evidence and infuriating when a verruca has made walking painful for a year. Naming the functional problem — pain, spread, occupational impact — rather than the wart itself is what usually distinguishes the two conversations.
Finding someone to see
The route to a clinician differs by country, and for this condition the first door is rarely a dermatologist — primary care, pharmacy and podiatry cover most of the map, with specialist referral reserved for the resistant end.
- US Find a Dermatologist American Academy of Dermatology Board-certified dermatologists searchable by location and condition; primary care handles most warts first.
- Canada Find a Dermatologist Canadian Dermatology Association Certified dermatologists by city or postal code, usually reached through a family doctor's referral.
- UK Warts and verrucas NHS The NHS page sets out when to see a GP and notes that funding for freezing varies by area.
- Australia Warts and verrucas healthdirect (Australian Government) Sets out when a doctor should be involved, and links through to the national service finder.
Regions are listed where a route could be verified; absence here reflects what we could confirm, not what exists.
Skincare alongside therapy
Supporting care on this page has two jobs, and neither is treating the wart. The first is protecting the ring of ordinary skin around a growth from a preparation designed to dissolve tissue. The second is containment — stopping one wart from becoming a row of them while the course runs.
One idea covers both: the acid should meet the wart and nothing else. Every measure below is either a way of confining it to where it belongs or a way of repairing skin that has been caught by it, and the reason they matter over twelve weeks is cumulative — a margin that stings a little each night becomes the reason a course ends in week five.
While a twelve-week course is running
The preparation is doing controlled damage, and the surrounding skin is not the target. Protecting that margin properly is what makes twelve weeks tolerable, and tolerability is the only variable this treatment's success actually depends on.
Do
- Ring the healthy skin around the wart with an occlusive ointment before each application, or cut a hole in a plaster to the exact size of the growth
- Moisturise the surrounding skin in the morning, away from the treated area, so it stays intact rather than cracking
- Take a night off where the margin becomes sore, and improve the protection rather than abandoning the course
- Wash hands after every application, and keep the file, pumice and any towel used on the site out of shared circulation
Avoid
- Applying to skin that is already broken, weeping or infected
- Filing until the site bleeds, which spreads the virus into fresh skin rather than removing it
- Layering exfoliating skincare over or beside the treated area, which compounds irritation the acid is already causing
What that looks like on a shelf: an occlusive to seal at night, a barrier moisturizer, a gentle cleanser.
After freezing, acid or a procedure in clinic
Every clinic method leaves a wound of some kind — a blister, a burn, or a surgical site — and the fortnight afterwards decides how it settles. Two things matter here: keeping the site clean and covered, and protecting new skin from sunlight while its pigment is still deciding what to do.
Do
- Keep the site covered and dry until the blister or crust separates on its own
- Leave a blister roof intact where possible; it is a dressing the body supplied
- Use sun protection over healing skin on hands, face and any exposed site for several months, since new skin marks easily
- Report spreading redness, increasing pain or discharge rather than waiting for the next appointment
Avoid
- Deroofing or draining a blister early, which converts a covered wound into an open one
- Filing or picking at the site while it heals, which is how a treated wart seeds warts around it
- Returning to communal pools and showers with an open site uncovered
What that looks like on a shelf: a daily sunscreen, a gentle cleanser, a barrier moisturizer.
Containment, throughout and afterwards
Warts spread by contact — from floor to foot, and from one part of a person to another through any small break in skin. Almost every case of one wart becoming five is this happening quietly during the months it takes to treat the first.
Do
- Cover the wart with a plaster for swimming, communal showers and changing rooms
- Wear footwear on wet communal floors rather than going barefoot
- Keep the wart covered where picking or biting is a habit, since covering works better than instruction
- Give the site its own disposable file and discard it, rather than cleaning and reusing one
Avoid
- Sharing towels, socks, shoes or nail tools while a wart is present
- Salon manicures and pedicures over an untreated periungual wart or verruca
- Shaving over flat warts, which is how a scatter becomes a line of them
What that looks like on a shelf: a barrier moisturizer, a gentle cleanser.
The supporting shelf
An occlusive to seal at night
A barrier moisturizer
A gentle cleanser
A daily sunscreen
None of this treats the infection, and it is worth being clear that it is not sold as doing so. What it does is protect the twelve weeks the actual treatment needs, which on this condition is the scarcer resource. The most common reason a course ends prematurely is not boredom but a sore, cracked margin of healthy skin that made the nightly application unpleasant — and that is entirely preventable with an ointment ring and a correctly cut plaster.
Every therapy named above, in full. Look things up here; it is not meant to be read end to end.
Every therapy, explained
Reference, not reading — every therapy named anywhere above, described the way a clinician would describe it. Nobody reads this section end to end; open the one you were sent here for. Which one is right for you is the appointment's job, not this page's.
Over the counter
Available without a prescription. Each one opens with what to look for on a label, which is the part that stays true regardless of which brand is on the shelf that month.
Over-the-counter Salicylic acid wart removers
Keratolytic destruction
Generally compatible
Salicylic acid wart removers
Keratolytic destruction
The one over-the-counter category with genuine meta-analytic support for treating warts, sold at strengths between roughly 17% and 40% as a licensed wart-remover drug product.
At the shelf
Salicylic acid 17% liquid or 40% plaster, sold in the foot-care or first-aid aisle as a wart remover.
The active-ingredient line is the only thing worth reading, and it sorts the category instantly. A wart remover declares salicylic acid at 17% or 40% with 'wart remover' as its stated purpose; a skincare product declares it at 0.5% to 2% for blemishes and cannot do this job at any duration. Between the two licensed formats the choice is practical rather than clinical — a liquid suits an awkwardly shaped wart on a finger, a plaster survives a sock and a shoe better, and adherence over twelve weeks is the only variable that reliably separates outcomes. Both formats carry the same twelve-week instruction and the same exclusions.
Watch out for: Premium pricing on identical chemistry, and any pack whose promise is speed — nothing at this strength clears a wart quickly, and the packs that imply otherwise are selling the expectation that ends courses.
- 17% collodion liquid — Painted on daily, dries to a film, peels off with the softened layer. The format most trials used.
- 40% medicated plaster or pad — A high-strength patch changed every couple of days — less fiddly, better suited to a sole under a sock.
- Gels and sticks — The same chemistry in tidier packaging, chosen mainly for where the wart sits and how likely the film is to be rubbed off.
Browse all salicylic acid products in our catalog →
Read the label
- Salicylic acid 17% wart remover liquid — label DailyMed (US National Library of Medicine)
- Salicylic acid 40% wart remover pads — label DailyMed (US National Library of Medicine)
How it works
Salicylic acid breaks the bonds between keratinocytes in the thickened layer over and around the wart, so successive layers of infected tissue soften and can be filed away rather than piling up. The mild persistent inflammation it produces is thought to contribute a second, immunological effect, which is one explanation for why untreated warts elsewhere sometimes fade during a course.
What the evidence says strong
Pooled randomised trials put clearance around 52% with salicylic acid against 23% on placebo, with a risk ratio for cure of roughly 1.6; head-to-head trials against professional cryotherapy have found no significant difference for plantar warts.
Typical course
Applied once or twice daily for common and plantar warts, with the softened layer filed back between applications, for up to twelve weeks — the duration printed on the label rather than a target invented here.
Commonly discussed side effects
- Stinging on application, especially where the surrounding skin is exposed
- Redness, soreness and peeling of the skin around the wart
- Occasional chemical burn where the acid strays or is occluded too tightly
- Temporary pale or dark discolouration of the treated skin
Worth knowing
- Never on the face, on mucous membranes, on genital skin, on moles or birthmarks, or on hair-bearing warts
- Never on a foot affected by diabetes, neuropathy or impaired circulation
- Protect the surrounding skin — a ring of petroleum jelly or a precisely cut plaster keeps the acid where it belongs
- Not for use on skin that is already broken, infected or inflamed
Pregnancy: Topical salicylic acid applied to a small area is generally regarded as low risk in pregnancy, and warts frequently multiply during it; the sensible modification is to treat a limited area rather than many warts at once, and to confirm the plan with a midwife or clinician.
Why it sits where it does: It opens every route on this page because it is simultaneously the cheapest option, one of the best-evidenced, and the only one whose success depends almost entirely on something the reader controls.
Over-the-counter Soaking, paring and occlusion
Preparation and technique
Generally compatible
Soaking, paring and occlusion
Preparation and technique
The unglamorous technique layer around the acid — the part that separates a course that works from the identical product used ineffectively for the same twelve weeks.
At the shelf
The cheapest emery boards sold in multipacks, and waterproof tape wide enough to cover the wart and a margin.
This is the one part of the shelf where spending more buys nothing at all. A multipack of disposable emery boards is better practice than a single good file, because the point is that each wart gets its own and it is thrown away rather than cleaned; the same logic applies to a cheap pumice used once on a verruca and binned. Waterproof tape matters more than it sounds: over twelve weeks the difference between a preparation that stays in contact overnight and one that ends up on a bedsheet is most of the difference between the two arms of a trial.
Watch out for: Electric callus removers and salon-grade files, which encourage filing far past the softened layer, and any device that has to be cleaned rather than discarded.
- Warm soak before application — A few minutes of water softens the surface so acid penetrates rather than sits.
- A dedicated emery board or pumice — One per wart, never shared, never returned to a communal manicure kit.
- Waterproof tape or a plaster over the top — Holds the preparation in contact and stops the film being rubbed off inside a shoe.
How it works
A wart builds a thickened, dead cap over itself, and on the sole body weight adds callus on top of that. Acid applied to that cap softens dead tissue that is already dead. Removing the softened layer between applications means each new application starts closer to living infected tissue, and occlusion keeps the preparation in contact through a working day instead of transferring it to a sock.
What the evidence says promising
Paring and occlusion are standard components of the regimens tested in salicylic acid trials rather than separately randomised interventions, so their contribution is inferred from the protocols that produced the trial results rather than isolated.
Typical course
A few minutes of soaking and gentle filing before each application, for as long as the course runs, with the file kept for that wart alone.
Commonly discussed side effects
- Soreness if filing goes past softened tissue into living skin
- Bleeding, which means the filing has gone too deep and the virus has been given a fresh surface to spread onto
Worth knowing
- Filing until it bleeds spreads the virus rather than removing it — softened white tissue only
- Files, pumice and clippers used on a wart do not go back into shared kit
- Filing is done by whoever is being treated or by an adult helping, never in a nail salon
- On a foot with diabetes or poor circulation, none of this is done at home
Pregnancy: Nothing in soaking, filing or taping carries any pregnancy consideration; it is the mechanical half of a course and remains available throughout.
Why it sits where it does: It sits alongside the acid rather than below it because the two are one treatment. Trials that produced the clearance figures on this page tested a regimen with filing built in.
Browse the whole catalog for this condition:
What changed recently: Nothing has changed at this counter for a long time, and the stability is informative rather than disappointing: salicylic acid remains the active in the wart-remover category, at the same strengths and with the same twelve-week instruction. The one recent development worth naming is easy to misread — a cantharidin product reached the United States market in 2023 as an approved prescription treatment, but its approval is for molluscum contagiosum, not warts. Cantharidin used on warts remains an off-label, clinic-applied practice, and the approval of a related product for a different condition does not change that.
Prescriptions and procedures
About the brand names below. Generic names carry this page. Wart removers are sold under many brand names in every market and the only line worth reading on any of them is the active ingredient: salicylic acid at 17% in a liquid or 40% in a plaster, with 'wart remover' as the stated purpose. That single line separates a licensed drug product from a skincare exfoliant containing the same molecule at a twentieth of the strength, and from the cosmetic 'wart' products that promise appearance rather than removal. Where a region is missing from a brands section, that reflects what we could verify rather than proof of absence.
The label links below point to the primary product information or a national medicines source. Prescription treatments described on this page are used off-label for cutaneous warts in most markets, which is ordinary practice for this condition rather than a warning sign — but it does mean the label being linked frequently describes a different indication, and that is worth knowing when reading one.
Device Home freezing kits
Self-applied cold destruction
Individualized — ask a clinician
Home freezing kits
Self-applied cold destruction
Pressurised cold applied through a foam tip or applicator to freeze the wart at home, sold as an alternative to weeks of acid.
- Dimethyl ether and propane applicators — The common supermarket format, reaching around minus fifty degrees at the tip.
- Nitrous oxide devices — A colder pen-style variant sold in some markets.
How it works
Rapid cooling forms ice crystals inside cells and ruptures them, destroying the infected tissue and provoking an inflammatory response that may help the immune system find the virus. The temperature reached is substantially warmer than the liquid nitrogen used in clinics, which is the source of both its safety margin and its weaker effect.
What the evidence says limited
Evidence for home freezing devices is thin, and the pooled trial data for cryotherapy in general did not show a statistically significant advantage over placebo — the freezing that does outperform is the aggressive professional kind, which these devices cannot reproduce.
Typical course
A single application repeated at intervals stated on the pack, usually to a maximum of three or four attempts before the product itself directs the user elsewhere.
Commonly discussed side effects
- Sharp pain during and shortly after freezing
- Blistering, sometimes blood-filled, over the following days
- Lasting pale or dark marks where the skin has been injured
- Damage to the nail if used close to a nail fold
Worth knowing
- The same exclusions as the acids apply — not on the face, genital skin, moles, or a compromised foot
- Freezing over a nail fold risks the nail matrix and can produce permanent nail deformity
- Cold injury in skin that marks easily can leave a paler patch more visible than the wart
- Repeated attempts beyond the pack's limit are not a strategy; the pack's limit is the honest one
Pregnancy: There is no systemic exposure to consider, so the question is practical rather than pharmacological: freezing hurts, blisters and marks, and most clinicians would suggest deferring an elective wart treatment of this kind rather than avoiding it outright.
Why it sits where it does: It sits on the over-the-counter rung as an option rather than the recommendation, because it is what most people reach for when the acid feels too slow — and it is worth knowing before that purchase that the evidence runs the other way.
Procedure Cryotherapy with liquid nitrogen
Clinic-delivered cold destruction
Generally compatible
Cryotherapy with liquid nitrogen
Clinic-delivered cold destruction
Professional freezing, repeated on a rhythm of two to three weeks until the wart clears or the course is called.
- Spray or cotton-bud application — Liquid nitrogen at around minus 196 degrees, applied for a timed freeze.
- Double freeze-thaw cycles — A second freeze after thawing, which the trial evidence supports specifically for plantar warts.
How it works
Liquid nitrogen destroys tissue far more thoroughly than a home device, and the blister that follows lifts the infected epidermis away from the layer beneath. The inflammation is also part of the treatment: it recruits immune attention to a virus the body had been ignoring, which is why clearance sometimes continues between sessions.
What the evidence says promising
Cryotherapy performed level with self-applied salicylic acid for plantar warts in a randomised trial, and outperformed both acid and watchful waiting for common warts in a primary-care trial; pooled analyses favour aggressive over gentle freezing and favour combining freezing with acid over either alone.
- Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial
- Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial
- Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials
Typical course
Sessions two to three weeks apart, with a limit set in advance rather than open-ended — commonly three to four attempts before the approach is reconsidered.
Commonly discussed side effects
- Significant pain during the freeze and for hours afterwards
- Blistering, sometimes blood-filled, and a wound that takes a week or two to close
- Lasting pigment change, more likely and more visible in deeper skin tones
- Nerve injury where treatment sits over a finger's side, and nail deformity near the matrix
Worth knowing
- Aggressive freezing clears more warts and causes more harm; the trade is deliberate and worth discussing before the first session
- Pigment loss after freezing can be permanent, and is a stronger consideration on visible skin and in richly pigmented skin
- Not appropriate for people with cold-related conditions such as cryoglobulinaemia or severe Raynaud phenomenon
- Repeating indefinitely because sessions are available is not a plan; a fixed number and a review point is
Pregnancy: Freezing involves no drug absorption and is generally considered acceptable during pregnancy where treatment is wanted, though the pain and the blistering lead many clinicians and patients to postpone an elective course.
Why it sits where it does: It is the clinic's default first move after a completed over-the-counter course, and the tier where evidence for combining methods is strongest.
Procedure Office-applied acids
Clinic-delivered chemical destruction
Individualized — ask a clinician
Office-applied acids
Clinic-delivered chemical destruction
Strong acids applied by a clinician at concentrations far beyond anything sold across a counter, coagulating the wart tissue in place.
- Monochloroacetic acid — Applied in the surgery at intervals; trialled directly against freezing in general practice.
- Trichloroacetic acid — A related agent used at various concentrations on a weekly rhythm.
- Silver nitrate — A caustic pencil or solution, cheap and widely used, on thinner evidence.
How it works
These agents denature the proteins of the infected tissue on contact, producing a controlled chemical burn that separates over the following days. Applied in a surgery rather than at home because the concentrations leave no margin for a slipped drop, and because the surrounding skin has to be masked before application.
What the evidence says promising
Monochloroacetic acid matched cryotherapy for common warts in a randomised primary-care trial and matched cryotherapy-plus-acid for plantar warts, with less treatment pain; silver nitrate cleared common warts in a small placebo-controlled trial but rests on much thinner evidence overall.
Typical course
Applications every one to two weeks in the surgery, over a course of similar length to a freezing course, with the treated area kept covered between visits.
Commonly discussed side effects
- A chemical burn and subsequent wound at the treated site
- Pain in the days after application rather than during it
- Staining of skin, black and temporary, from silver nitrate
- Scarring where the burn extends past the wart
Worth knowing
- These concentrations are not obtainable or usable outside a clinical setting, and attempting the same with stronger shop-bought products causes real injury
- The surrounding skin has to be protected before application
- Not used on the face, near the eyes, or on mucosal skin
- The same foot exclusions apply as for every destructive method
Pregnancy: Systemic absorption from a small treated area is negligible, but these are elective treatments that produce wounds, and the usual position is to weigh the case individually rather than proceed by default.
Why it sits where it does: It sits beside freezing rather than above it, because the trial that compared them found comparable clearance with less pain during treatment — which makes it a choice about fit rather than a step up in strength.
Procedure Cantharidin blistering
Clinic-applied blistering agent
Individualized — ask a clinician
Cantharidin blistering
Clinic-applied blistering agent
A blistering agent derived from beetle secretion, painted on in clinic and removed hours later, which lifts the wart off inside a blister.
- Compounded cantharidin solutions — Applied in clinic, occluded for a set period, then washed off.
- Combination formulations with salicylic acid and podophyllin — Compounded preparations used in some centres for resistant warts.
How it works
Cantharidin causes the epidermal cells to separate from one another, so a blister forms within the epidermis and the roof of that blister carries the infected tissue away as it heals. Because the split happens above the layer that scars, the technique can clear a wart without leaving a mark.
What the evidence says limited
Evidence for cantharidin in cutaneous warts is small-scale and largely uncontrolled, with the better trial data belonging to a different condition entirely.
Typical course
Applied in the surgery, occluded for a set number of hours, washed off at home, and repeated at intervals of a few weeks where the first application helped.
Commonly discussed side effects
- A blister at the site, sometimes large and uncomfortable
- A ring of new warts around the treated blister, a recognised and unwelcome pattern
- Pain as the blister forms, several hours after leaving the clinic
- Temporary pigment change while the site heals
Worth knowing
- Used on warts off-label in most markets; the approved cantharidin product is licensed for molluscum contagiosum, which is a different condition
- Never applied by the patient and never left on beyond the stated time
- Not used on the face or on genital skin
- Availability varies enormously by country and by whether a compounding pharmacy is reachable
Pregnancy: Data in pregnancy are lacking and the treatment is elective, so the usual course is to defer rather than to establish safety on a wart.
Why it sits where it does: It sits in the middle tier as a painless-at-the-time alternative for people who cannot tolerate freezing, on evidence that is honestly thinner than its popularity in some clinics implies.
Procedure Curettage, electrosurgery and blunt dissection
Surgical removal
Individualized — ask a clinician
Curettage, electrosurgery and blunt dissection
Surgical removal
Physical removal under local anaesthetic, reserved for single stubborn warts rather than offered early.
- Curettage with cautery — Scraping the wart out under local anaesthetic and sealing the base.
- Blunt dissection — Separating a plantar wart from the surrounding tissue along its natural plane.
- Electrosurgery — Destroying the tissue with heat generated by current.
How it works
The infected tissue is removed or destroyed outright rather than persuaded to leave. The limitation is anatomical: warts sit in the epidermis but surgical removal necessarily reaches the layer beneath, so the technique trades a wart for a scar, and on a weight-bearing sole that scar can be more troublesome than the growth was.
What the evidence says limited
Supported mainly by older uncontrolled series rather than randomised comparison, with clearance rates that look impressive on paper and recurrence rates that complicate them.
Typical course
A single session under local anaesthetic, with a wound taking two to three weeks to heal and activity limited afterwards where the site is on a foot.
Commonly discussed side effects
- A permanent scar at the treated site
- Pain during healing, and difficulty walking where the site is weight-bearing
- Recurrence at or around the scar, which is common enough to be expected rather than surprising
- Bleeding and, occasionally, infection of the wound
Worth knowing
- A scar on the sole of a foot can hurt for longer than the wart did — this trade is the reason surgery sits late rather than early
- Recurrence in a surgical scar is harder to treat than the original wart
- Not a first-line option for numerous warts, and impractical for mosaic plaques
- Reserved for lesions where the diagnosis is also in question and tissue is worth examining
Pregnancy: Local anaesthetic and minor surgery are compatible with pregnancy where they are necessary; a wart is rarely necessary, so the usual advice is to wait.
Why it sits where it does: It sits high on the ladder despite being conceptually the simplest option, because it is the only one on this page that reliably exchanges a temporary problem for a permanent one.
Procedure Intralesional therapy
Injection into the wart
Avoid in pregnancy
Intralesional therapy
Injection into the wart
Injecting an agent into the wart itself, either to force the immune system to notice the infection or to poison the dividing cells directly.
- Immunotherapy antigens — Candida, measles-mumps-rubella and tuberculin preparations injected to provoke recognition of the virus.
- Bleomycin — An antimitotic injected directly into resistant warts, used in specialist settings.
- Fluorouracil with local anaesthetic — An antimetabolite injection used for palmoplantar and common warts in some centres.
How it works
The immunotherapy versions exploit an existing immune memory: injecting an antigen the body already recognises creates a local inflammatory response, and the immune cells recruited to it encounter the viral proteins alongside. That is why treating one wart can clear untreated warts elsewhere, which no destructive method achieves. The antimitotic versions work differently and locally, halting cell division in tissue that is dividing far too fast.
What the evidence says promising
Network meta-analysis of plantar wart trials placed intralesional bleomycin among the few treatments significantly better than no treatment; the immunotherapy antigens are supported by numerous small randomised trials with wide variation in preparation and protocol.
Typical course
Injections every two to three weeks for a small number of sessions, with response judged across the course rather than after one.
Commonly discussed side effects
- Pain during injection, which is the principal reason people decline the tier
- Flu-like symptoms after antigen injection
- With bleomycin, tissue damage, nail changes and Raynaud phenomenon in treated digits
- Local swelling and blistering in the days afterwards
Worth knowing
- Used off-label for warts; preparations and protocols vary widely between centres
- Bleomycin is not used in pregnancy, in people who are immunosuppressed, or in digits with impaired circulation
- Antigen immunotherapy requires prior exposure or vaccination to the antigen used to have any effect
- Access depends heavily on local practice, and availability is not evenly distributed
Pregnancy: Bleomycin and fluorouracil are contraindicated in pregnancy, and the immunotherapy antigens are not used electively during it either. This whole tier waits.
Why it sits where it does: It sits near the top because it is where the strategy changes: everything below destroys one wart at a time, and this is the first tier whose mechanism can clear warts nobody treated.
Prescription topical Prescription topicals
Immune modulators and antiproliferatives
Avoid in pregnancy
Prescription topicals
Immune modulators and antiproliferatives
Creams a prescriber can supply that either recruit the immune system to the infected skin or interrupt the rapid cell division driving the growth.
- Imiquimod cream — An immune-response modifier applied at home over weeks to months.
- Topical fluorouracil — An antimetabolite cream, often under occlusion, for resistant or numerous warts.
- Topical retinoids — Used particularly for flat warts on the face, where destructive methods carry a scarring cost.
How it works
Imiquimod stimulates local innate immune signalling, effectively raising an alarm at the site so that immune cells arrive and encounter the virus. Fluorouracil blocks a step in DNA synthesis, which affects the wart's fast-dividing cells more than the surrounding skin. Retinoids normalise the way keratinocytes mature and are the gentlest option for the thin, delicate, many-lesioned presentation on a face.
What the evidence says limited
Trial data for these agents in non-genital warts are small and heterogeneous; the systematic reviews could not pool most of them, and their use rests substantially on clinical experience rather than large randomised comparison.
Typical course
Applied at home on a schedule set by the prescriber, over weeks to several months, with reviews built in rather than left open-ended.
Commonly discussed side effects
- Redness, crusting and erosion at the application site, which is partly the intended effect
- Flu-like symptoms with imiquimod in some people
- Photosensitivity and prolonged inflammation with fluorouracil
- Pigment change while treated skin settles, particularly on the face
Worth knowing
- Used off-label for cutaneous warts in most markets, which is a reason for a prescriber to set the schedule rather than a reason to avoid them
- Fluorouracil is avoided in pregnancy and where there is a known dihydropyrimidine dehydrogenase deficiency
- Facial application needs a conservative schedule; the inflammation these produce is visible
- Not obtainable over a counter, and preparations sold online as equivalents are not
Pregnancy: Fluorouracil and topical retinoids are avoided in pregnancy; imiquimod has limited data and is not used electively. Where warts appear or multiply during pregnancy, the usual approach is mechanical or to wait until afterwards.
Why it sits where it does: It is the first prescription rung for flat and facial warts, where the destructive methods that lead every other route carry an unacceptable scarring cost.
Procedure Laser and photodynamic therapy
Light-based treatment
Individualized — ask a clinician
Laser and photodynamic therapy
Light-based treatment
Specialist light-based options for warts that have survived everything below them, delivered in dermatology settings rather than general practice.
- Pulsed dye laser — Targets the blood vessels feeding the wart rather than the wart itself.
- Ablative lasers — Carbon dioxide and erbium systems that vaporise the tissue directly.
- Photodynamic therapy — A light-activated agent applied first, then illuminated, destroying the treated tissue.
How it works
Pulsed dye laser heats the dilated capillaries that supply the wart, cutting off its blood supply while sparing the surface. Ablative lasers remove the tissue outright, with the plume they generate carrying viral particles and requiring proper extraction. Photodynamic therapy uses a compound the abnormal cells take up preferentially, then activates it with light so the damage concentrates where the compound accumulated.
What the evidence says promising
Pooled trial data support photodynamic therapy for cutaneous warts, and laser comparisons report wide ranges of complete response with settings differing substantially between studies, which limits how far one centre's results transfer to another.
Typical course
Several sessions spaced by weeks, in a specialist setting, with cost and access frequently the deciding factors rather than clinical suitability.
Commonly discussed side effects
- Pain during treatment, often requiring local anaesthesia
- Blistering, crusting and a healing period of one to two weeks
- Pigment change and, with ablative techniques, scarring
- A stinging, burning session with photodynamic therapy that many find harder than expected
Worth knowing
- Rarely funded by public systems for warts, and priced per session in private ones
- Ablative laser generates infectious plume and needs proper extraction — this is a reason it belongs in equipped settings
- Reported success rates vary widely between studies using different devices and settings
- Photosensitising agents make the treated skin sun-sensitive for a period afterwards
Pregnancy: Light-based treatment involves no systemic drug, but the photosensitising agents used in photodynamic therapy have limited pregnancy data and these are elective procedures, so deferral is usual.
Why it sits where it does: It sits at the specialist end because access, cost and the spread in reported results all make it a considered choice rather than a next step.
Prescription oral Oral retinoids for multiple resistant warts
Systemic therapy
Avoid in pregnancy
Oral retinoids for multiple resistant warts
Systemic therapy
Tablets used off-label by specialists for the small group with many warts that have resisted everything else, particularly where the immune system is compromised.
- Acitretin — A systemic retinoid used in specialist practice for extensive resistant warts.
- Isotretinoin — The same class by a different route, trialled for multiple recalcitrant common warts.
How it works
Retinoids alter how keratinocytes proliferate and differentiate, which slows the overproduction the virus is driving and thins the growths from within rather than destroying them from the surface. Because the effect is systemic, it reaches every wart at once, which is the whole reason to consider a tablet for a skin infection.
What the evidence says limited
Supported by small randomised trials in recalcitrant multiple warts reporting clearance well above placebo, in populations selected for having failed everything else — informative for that group and not generalisable beyond it.
Typical course
A course of some months under specialist supervision, with blood monitoring, and with strict pregnancy prevention requirements throughout and for a defined period afterwards.
Commonly discussed side effects
- Dryness of lips, eyes, skin and nasal passages, in essentially everyone
- Raised blood lipids and liver enzymes, monitored by blood tests
- Muscle and joint aches
- Hair thinning and increased skin fragility with prolonged use
Monitoring
Blood tests for liver function and lipids before and during the course, and pregnancy prevention monitoring as required by the regulatory programme in the country of prescription.
Worth knowing
- Powerfully teratogenic — pregnancy prevention requirements are absolute and extend well beyond the last dose, and for acitretin that period is measured in years
- Used off-label for warts and reserved for extensive resistant disease rather than offered for a single lesion
- Not combined with tetracycline antibiotics
- Alcohol converts acitretin into a longer-lived compound, which changes the pregnancy prevention period
Pregnancy: Absolutely contraindicated in pregnancy and in anyone who might become pregnant during or after the course without the required precautions. This is the strictest single restriction on the page and it applies to a treatment used for a benign viral infection, which is itself a reason it sits where it does.
Why it sits where it does: It is the last rung because the risk profile only makes sense against extensive disease that has exhausted everything below, most often in someone whose immune system cannot do this job unaided.
On the horizon
Pipeline information current as of 2026-09-01
Treatments for cutaneous non-genital warts at phase 3 or later, or recently reaching a market, with the stage verifiable from a regulator or trial registry rather than from a manufacturer's outlook.
This changes nothing about what to do now. Nothing in this section changes what is worth doing now, and on this condition the emptiness of it is itself the finding — the best-evidenced treatment here is decades old, costs very little, and is available without an appointment.
Recently arrived
Cantharidin approved in the United States — for molluscum contagiosum, not warts (2023). A cantharidin product was approved by the FDA in July 2023 as a topical treatment for molluscum contagiosum in adults and children aged two and over. It is worth naming here precisely because it is so easily misread: cantharidin has been used off-label on warts by clinics for decades, an approval now exists for the molecule, and the approval is for a different condition. Cantharidin applied to a wart remains an off-label, compounded, clinic-delivered practice, and the evidence supporting it there has not changed.
In late-stage development
Applying a phase-3 floor to cutaneous warts leaves the section empty, and padding it would misrepresent a field that is genuinely quiet. Most current research activity sits at the small-trial end — intralesional immunotherapy protocols, device-based heating, and formulation work aimed at getting existing agents through thick plantar skin — and almost none of it is running the kind of large randomised comparison that would move a guideline. The claim to treat most sceptically remains the private clinic's: light-based and device treatments are marketed considerably ahead of the evidence supporting them, and their reported response rates vary widely between studies using different settings.
Things people arrive asking about
Warts attract folk remedies more than almost any other skin condition, partly because they resolve on their own often enough to make anything applied beforehand look effective. Placed honestly here rather than dismissed, since several are harmless and one or two have real trial data.
- Duct tape occlusion limited evidence
The most-studied home remedy on the list and the most contradictory. One trial in children reported it clearly beating freezing; two better-controlled trials found no advantage over an inactive covering, and the pooled analysis of the controlled trials found none either. Harmless and cheap, and a reasonable component of an acid course rather than a substitute for one.
- Hydrogen peroxide solutions backed by smaller studies
A randomised trial found 3% and 6% solutions applied under occlusion for an hour daily clearly better than saline over six weeks, with mild hypopigmentation the only side effect reported. Genuinely interesting and genuinely single-trial, which is why it sits here rather than on a rung above.
- Zinc, taken orally or applied backed by smaller studies
Small trials point in both directions: oral zinc sulphate outperformed placebo in one and matched it in another, and adding it to a course of freezing produced no benefit. Topical zinc oxide has one small comparison in its favour. Not harmful at sensible doses, not established, and not a reason to delay something better evidenced.
- Kitchen remedies — vinegar, garlic, banana peel limited evidence
No controlled evidence supports any of them for warts. Apple cider vinegar deserves a specific caution rather than a shrug: it is an acid applied without any of the concentration control or margin protection a licensed product provides, and chemical burns from it are a recognised presentation. The comparison worth making is against a 17% product that costs very little and has been through trials.
- Tea tree, sandalwood and other essential oils limited evidence
One small open-label study of sandalwood oil in children reported good results with no control group, which is the level of evidence the whole category sits at. Contact allergy to tea tree oil is common enough to matter over a twelve-week application, and an allergic reaction on skin already being treated is difficult to interpret.
- Hypnosis and suggestion limited evidence
Not folklore, and worth taking more seriously than it usually is — a small randomised trial found hypnotic suggestion outperforming placebo, and the immune-mediated nature of wart clearance makes a psychological effect less absurd than it first sounds. The evidence remains small and old, and it is a supplement to a real course rather than an alternative.
- HPV vaccination as a treatment for existing warts limited evidence
Vaccination prevents infection by the types it covers, and the types causing common skin warts are largely not those types. Small studies of vaccine injected directly into resistant warts report responses, which is a different intervention altogether. Being vaccinated is worth doing on its own merits and is not a treatment for a wart already present.
Common questions
How long does a wart last if nothing is done about it?
Longer than most people expect and shorter than they fear. In a prospective cohort of primary schoolchildren, half were free of their warts within a year with no treatment, and younger children cleared faster. Adults are generally slower, and warts that have already lasted a year or more tend to keep going. That is why an untroubling wart in a child is a reasonable candidate for watching, and a painful verruca in an adult that has outlasted a year is not.
Why did three weeks of a wart remover do absolutely nothing?
Because three weeks is roughly a quarter of the course, and the first weeks are spent working through dead thickened tissue before any living infected skin is reached. The label on the product sets the course at up to twelve weeks of near-daily application, and the trials behind its clearance figures ran their treatment arms for six to twelve weeks. A wart that looks identical at week three is a course behaving exactly as expected.
Are the little black dots inside a wart seeds or roots?
Neither, and the belief that they are is why warts get dug at. They are capillaries drawn up into the growth and clotted, and they are one of the most useful confirming signs available without a clinic — filing the surface back and finding pinpoint dark specks distinguishes a wart from a corn or callus fairly reliably. Warts have no roots; the whole growth sits within the outer layer of skin, above the level that scars.
Can a wart spread to other people, and to other places on the same person?
Both, and the second is more common than the first. The virus enters through small breaks in skin, so picking or biting a wart moves it to the finger doing the picking, shaving over flat warts spreads them along a razor line, and filing until a site bleeds gives it fresh skin to occupy. Between people it travels on wet communal floors, shared towels and shared nail tools, which is why covering the site and keeping the file disposable is worth more than any additional product.
Is a verruca different from a wart, or is it the same thing?
The same virus family in a different place, and the difference that matters is mechanical. On the sole, body weight pushes the growth inward instead of letting it build outward, and callus forms over the top of it, so treatment has a thicker barrier to cross. Every trial that reported hand and foot warts separately found the foot arm doing worse, whichever treatment was tested — which is the argument for the high-strength plaster format and for reducing the callus before each application.
Is it safe to treat a wart during pregnancy?
Topical salicylic acid applied to a small area is generally regarded as low risk, so a course for a limited number of warts usually remains available, with a midwife or clinician confirming the plan. What is set aside is most of what sits above it: the prescription creams are avoided, the systemic retinoid tier is absolutely contraindicated, and freezing is commonly deferred as an elective procedure that hurts and blisters. Warts often multiply during pregnancy and often settle afterwards, which is a genuine argument for patience rather than a consolation.
Do home freezing kits work as well as the freezing done in a clinic?
No, and the gap is a matter of physics rather than branding. Clinic liquid nitrogen reaches around minus 196 degrees; a supermarket applicator reaches roughly a quarter of that depth of cold. The pooled trial evidence could not show a significant advantage for cryotherapy over placebo at all, and where freezing did outperform, it was the aggressive professional version — which also caused more pain and more marking. Salicylic acid has the better evidence and the lower price, and it is the option most people skip on the way to the freezing kit.
Sources and further reading
The staging, escalation points, and therapy descriptions on this page are anchored to published clinical guidelines rather than editorial judgment.
What this page is built on
- British Association of Dermatologists' guidelines for the management of cutaneous warts 2014
- Topical treatments for cutaneous warts (Cochrane review)
The studies behind this pathway
The studies this page leans on, with what each one is doing here. Every PubMed link was resolved against the National Library of Medicine's own record during authoring; where a source could not be confirmed that way, no link is attached rather than a plausible one.
- British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 The structure of this page — ladder order, the place of each tier, and the position of the destructive and immunological options.
- Topical treatments for cutaneous warts The salicylic acid risk ratio of 1.56 against placebo, the finding that aggressive freezing outperforms gentle, and the null result for duct tape.
- Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials The pooled cure rates quoted throughout — 23% on placebo, 52% with salicylic acid, 58% combining acid with freezing.
- Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial The finding that self-applied acid and professional freezing were equally effective for warts on the sole, at twelve weeks and at six months.
- Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial The site-dependent result behind the branch split — freezing ahead for common warts, no meaningful difference between freezing, acid and waiting for plantar warts.
- Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial The placement of office-applied acid level with freezing rather than below it, and the note about less pain during treatment.
- Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study The figure that half of primary schoolchildren with warts are clear within a year untreated, and that younger children clear faster.
- Natural history of warts. A two-year study The original observational work establishing that untreated warts resolve over a period of years, which every later treatment trial is measured against.
- Efficacy of 10% silver nitrate solution in the treatment of common warts: a placebo-controlled, randomized, clinical trial The inclusion of silver nitrate among the office-applied options, and the honest characterisation of its evidence as thin.
- Evaluation of different concentrations of hydrogen peroxide solution (3% and 6%) as a potential new therapeutic option of nongenital warts: A randomized controlled triple-blinded clinical trial The lower-evidence entry for hydrogen peroxide, including the occlusion protocol and the single reported side effect.
- The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart) The positive half of the contradictory duct tape evidence, and the origin of a remedy that outlived its own replication.
- Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial The controlled replication that found no advantage over an inactive covering, which is why duct tape sits in the lower-evidence section.
- Topical antimitotic treatments for plantar warts are more beneficial: A Bayesian network meta-analysis of randomized controlled trials The standing of intralesional bleomycin among the few plantar wart treatments significantly better than no treatment.
- Cutaneous warts: an evidence-based approach to therapy The primary-care framing of this condition, and the position that most warts are managed without referral.
Everything above traces to the sources below. Warts are unusually well served at the top of the evidence pyramid and unusually poorly served in the middle: one national guideline and two large syntheses, then a very long tail of small trials that none of them could pool.
Guidelines and systematic reviews
The BAD guideline supplies the structure of this page; the two syntheses supply the numbers quoted throughout.
- British Association of Dermatologists' guidelines for the management of cutaneous warts 2014 British Journal of Dermatology The management framework this page's ladder order follows.
- Topical treatments for cutaneous warts Cochrane Database of Systematic Reviews Eighty-five trials and 8,815 participants — the source of the salicylic acid risk ratio and the finding on aggressive versus gentle freezing.
- Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis British Journal of Dermatology Where the cure-rate figures on this page come from, including the placebo rate that makes them interpretable.
Patient information
Written to be read rather than cited, and useful for checking what a health system will and will not fund.
- Warts and verrucas NHS (UK) Includes the plain statement that pharmacy treatments take up to three months, and the note that funding for freezing varies by area.
- Warts: diagnosis and treatment American Academy of Dermatology The AAD's public account of what dermatologists offer and when.
- Viral wart DermNet A fuller clinical description with images of each form, useful for telling one from another.
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