Guideline sources The following summarized guidelines for the management of cutaneous warts are prepared by our editorial team based on guidelines from the British Association of Dermatologists (BAD 2014) and the American Association of Family Physicians (AAFP 2011). 1 2 Guidelines 1. Medical management Salicylic acid: As per BAD 2014 guidelines, apply salicylic acid for the treatment of patients with cutaneous warts. B As per AAFP 2011 guidelines, apply salicylic acid as first-line therapy in patients with cutaneous warts. B Other destructive agents: Insufficient evidence to support the use of other destructive agents for the treatment of patients with cutaneous warts, such as: phenol I cantharidin I glycolic acid 5% I pyruvic acid I trichloroacetic and monochloroacetic acid I https://web.pathway.md/diseases/rec0CDKIPO2wSvEgm 1/4 6/23/23, 3:36 AM Cutaneous warts Pathway trichloroacetic and monochloroacetic acid I silver nitrate I citric acid 50% I formic acid. I Virucidal agents: insufficient evidence to support the use of virucidal agents, such as formaldehyde or glutaraldehyde, for the treatment of patients with cutaneous warts. I Antiproliferative agents: Consider applying topical 5-fluorouracil or bleomycin for the treatment of patients with cutaneous warts. C Insufficient evidence to support the use of other antiproliferative agents for the treatment of patients with cutaneous warts, such as: dithranol I topical retinoids I systemic retinoids I vitamin D analogues I podophyllin and podophyllotoxin I cidofovir. I Immunological therapy: Insufficient evidence to support the use of the following immunological agents for the treatment of patients with cutaneous warts: H2RAs I zinc oxide and zinc sulfate I imiquimod I systemic immunotherapy agents such as interferon, IgAnd valaciclovir. I 2. Nonpharmacologic interventions Duct tape: As per BAD 2014 guidelines, insufficient evidence to support the use of occlusotherapy in patients with cutaneous warts. I As per AAFP 2011 guidelines, do not use duct tapes for the treatment of patients with cutaneous warts. D Alternative and complementary therapies: Insufficient evidence to support the use of complementary and alternative treatment options in patients with cutaneous warts, such as: psychological treatments I herbal treatments I homeopathy I acupuncture I https://web.pathway.md/diseases/rec0CDKIPO2wSvEgm 2/4 6/23/23, 3:36 AM Cutaneous warts Pathway 3. Therapeutic procedures Cryotherapy: As per BAD 2014 guidelines, consider performing cryotherapy for the treatment of patients with cutaneous warts. C As per AAFP 2011 guidelines, perform cryotherapy with liquid nitrogen as first-line therapy in patients with cutaneous warts. B Show 2 more Intralesional injections: As per BAD 2014 guidelines: Consider performing intralesional injections of 5-fluorouracil or bleomycin for the treatment of patients with cutaneous warts. C Insufficient evidence to support the use of intralesional immunotherapy in patients with cutaneous warts. I As per AAFP 2011 guidelines: Consider performing intralesional injections with Candida or mumps skin antigen for the treatment of patients with recalcitrant warts with a positive skin antigen pretest. B Consider performing intralesional injections with bleomycin for the treatment of patients with recalcitrant warts, although the effectiveness is unproven. B Photodynamic therapy: As per BAD 2014 guidelines, insufficient evidence to support the use of photodynamic therapy for the treatment of patients with cutaneous warts. I As per AAFP 2011 guidelines, consider performing photodynamic therapy with ALA plus applying topical salicylic acid for the treatment of patients with recalcitrant warts. B Pulsed dye laser: As per BAD 2014 guidelines, consider performing pulsed dye laser for the treatment of patients with cutaneous warts. C As per AAFP 2011 guidelines, consider performing pulsed dye laser for the treatment of patients with recalcitrant warts, although the effectiveness is unproven. B Hyperthermia: insufficient evidence to support the use of hyperthermia in patients with cutaneous warts. I Contact immunotherapy: consider offering contact immunotherapy for the treatment of patients with cutaneous warts. C 4. Surgical interventions Surgical methods: insufficient evidence to support the use of surgical interventions in patients with cutaneous warts. I https://web.pathway.md/diseases/rec0CDKIPO2wSvEgm 3/4 6/23/23, 3:36 AM Cutaneous warts Pathway References 1. J C Sterling, S Gibbs, S S Haque Hussain et al. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014 Oct;171 4 696 712. Open 2. Elie Mulhem, Susanna Pinelis. Treatment of nongenital cutaneous warts. Am Fam Physician. 2011 Aug 1;84 3 288 293. Open https://web.pathway.md/diseases/rec0CDKIPO2wSvEgm 4/4