Warts and Verrucas

Overview of Verrucas and Warts

• Verrucas (plantar warts) and warts (common warts) are caused by human papillomavirus (HPV).
• The treatment aim is to remove the wart or verruca, alleviate symptoms, and prevent spread. The majority of cases resolve on their own, but various treatments can speed up recovery and reduce discomfort.

1. Zinc Therapy

There is some evidence supporting the use of zinc as a treatment for warts and verrucas, though it's not a first-line treatment.

Mechanism:

• Zinc is thought to modulate the immune response and stimulate local immune mechanisms that fight the virus.
• Some studies suggest that oral zinc supplementation can help clear warts in children, while topical zinc preparations may have a role in wart treatment.

Use of Zinc:

• Oral Zinc: Some studies recommend oral zinc sulfate (10-20 mg per day for children) as a treatment option for recalcitrant warts, though the evidence is not strong enough to recommend it as a routine treatment for all patients.
• Topical Zinc (Zinc oxide or Zinc sulfate): There is limited evidence to suggest its efficacy when applied topically, but it may be used as a secondary option if other treatments fail.

Sources:

• NICE Guidelines - Warts and Verrucas
• DermNet - Zinc for Warts

2. Duct Tape Occlusion Therapy

Duct tape is a non-invasive method that has shown moderate efficacy for the treatment of warts and verrucas, especially in children.

How it works:

• The exact mechanism is not entirely clear, but duct tape is thought to work by irritating the skin, stimulating an immune response, or by causing maceration of the wart, which helps it to be shed.

Treatment Protocol:

1. Apply a piece of duct tape to the wart or verruca for 6 days.
2. After 6 days, remove the tape and soak the wart in warm water.
3. Gently remove any dead tissue with a pumice stone or nail file.
4. Leave the wart uncovered overnight and repeat the process for several weeks until the wart resolves.

Evidence:

• Research has shown that duct tape occlusion therapy can be effective in treating warts in children, with some studies suggesting it may be more effective than cryotherapy (freezing treatment).
• One study from 2002 published in the Archives of Pediatrics & Adolescent Medicine found duct tape occlusion therapy to be more effective than cryotherapy for common warts in children.

Sources:

• NHS Warts and Verrucas Treatment
• DermNet - Duct Tape for Warts

3. Cryotherapy (Not recommended for children with warts/verrucas)

While cryotherapy (freezing) is a commonly used treatment for warts in adults, it is not recommended for children due to potential risks such as severe pain and scarring, and it is generally less effective in children under the age of 12.

Why Cryotherapy is Not Recommended for Children:

• Pain and distress: Cryotherapy can be painful, especially for children.
• Less effective: Studies show that cryotherapy tends to be less effective in children compared to adults.
• Potential for scarring: Freezing can lead to scarring, which can be more significant in younger patients.

Sources:

• NHS Warts and Verrucas – Cryotherapy
• CKS – Warts and Verrucas Treatment

4. Salicylic Acid (Topical Treatment)

Salicylic acid is one of the most effective treatments for warts and verrucas. It works by gradually removing the layers of the wart or verruca.

Treatment Protocol:

• Apply a salicylic acid gel or patch (such as Compound W or Bazuka) to the wart or verruca.
• Cover with a bandage or adhesive dressing.
• Repeat daily for several weeks until the wart or verruca resolves.

Considerations:

• Salicylic acid can be irritating to the skin, so it's important to avoid using it on normal skin around the wart.
• This treatment is usually very effective but can take a few weeks to show results.

Sources:

• NHS - Salicylic Acid for Warts

6. Laser Therapy - available privately

In cases where other treatments fail, laser therapy might be used to treat stubborn warts. However, it is typically reserved for cases that do not respond to other treatments and is not routinely recommended for children.

Summary of Key Points:

• Cryotherapy is generally not recommended for children due to pain, ineffectiveness, and risk of scarring.
• Duct tape and zinc therapy can be effective and are considered safe for children.
• Salicylic acid and cantharidin are effective topical treatments for both warts and verrucas.
• For persistent warts, immunotherapy or laser treatment may be considered, though they are often last-resort options.

Further Reading and Links:

1. NHS: Verrucas and Warts Treatment
2. DermNet: Warts
3. NICE Guidelines on Warts and Verrucas
4. CKS - Warts and Verrucas