Treatment

Description

Local physical destructive therapy

– Cryotherapy with liquid nitrogen, electrocautery, and ablative lasers

– Cryotherapy with liquid nitrogen is most commonly used for cutaneous and anogenital warts

– Repeated sessions every 3-4 weeks required until lesions are fully resolved

– Adverse effects include pain, urticarial reaction, blistering, ulceration, posttreatment hypopigmentation or depigmentation in treated areas

Topical salicylic acid preparations

– Available in different concentrations

– Painless, for self-application, lacks adverse effects, can be used without prescription (OTC)

– Usually used for cutaneous warts (treatment should last ≤12 weeks)

Topical immunomodulators (imiquimod)

– Imiquimod is a TLR 7 agonist enhancing immune response against HPV

– Topical imiquimod available in Canada in 2 formulations: 5% (Aldara) once a day on 3 nonconsecutive days/wk for up to 16 weeks and 3.75% (Vyloma) once daily for up to 8 weeks

– Approved for treatment of external anogenital warts

Podophyllum resin–derived topical cytotoxic therapy

– Used for treatment of external anogenital warts

– Available as podophyllum resin (podophyllin) and podophyllotoxin

– Podophyllum resin (podophyllin), marketed in Canada as Podofilm 25%, is applied in office by physician

– Podophyllotoxin, marketed in Canada as Condyline, applied by patient bid for 3 consecutive days with 4 days off treatment for up to 4 weeks

– Should not be used in pregnancy

Trichloroacetic acid

– Available in different concentrations; commonly used in 60%-90% concentrations

– Can be used for cutaneous and anogenital warts

– Treatment applied by physician, resulting in physical destruction of proteins within warts by chemical coagulation

– Can cause severe chemical burns if used by inexperienced individuals

Topical fluorouracil

– Topical fluorouracil is an antimetabolite; topical formulations can be used off-label for cutaneous warts

– Can be applied daily (or less frequently) under occlusion for up to 3 months

– Usually associated with adverse effects in treated areas (eg, pain, severe irritation, erythema, edema, blistering, ulceration, dyspigmentation, deep scarring)

– Should not be used in pregnancy

Sinecatechins

– Approved for treatment of external anogenital warts

– Commercially available in Canada as Veregen

– Botanical drug as a green tea extract

– Mechanism of action not clear

– Applied tid for up to 16 weeks

Other (based on small cases series and case reports)

– Topical and systemic cidofovir

– Systemic and intralesional injection of IFN alpha and IFN beta

– Immunotherapy with intralesional injection of Candida albicans antigen

– Immunotherapy with intralesional injection of MMR vaccine

– Immunotherapy with intralesional injection of Mycobacterium w or BCG vaccine

– Oral cimetidine

The provided trade (brand) names are valid for Canada.