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. | |
BCG, bacille Calmette-Guérin; bid, 2 times a day; HPV, human papillomavirus; IFN, interferon; MMR, measles, mumps, and rubella; OTC, over the counter; tid, 3 times a day; TLR, toll-like receptor. |