Viral warts and verrucas are benign and self-limiting and can be managed within primary care.

NHS England (NHSE) has published new prescribing guidance for various common conditions for which over the counter (OTC) items should not be routinely prescribed in primary care (quick reference guide). One of these conditions is warts and verrucae.

Many of these products are cheap to buy and are readily available OTC along with advice from pharmacies. Some self-care medicines are available from shops and supermarkets. Please click here for further information, exceptions, and a patient leaflet.

Cryotherapy is not appropriate for viral warts on the hands and feet since it is painful; it can cause significant scarring and can exacerbate the condition. Surgical treatment is inappropriate for these lesions.

Salicylic acid / lactic acid

• Paint (salicylic acid 16.7% / lactic acid 16.7%) (£2.09 = 10ml)

Silver nitrate

• 95% caustic pencils (£4.47 = 1 x treatment set)
• 75% caustic applicators

Notes

1. Applicators are designed for use by medical professionals.

Salicylic acid in aqueous cream

• 10% (unlicensed preparation)

Notes

1. Salicylic acid in aqueous cream is one of the British Association of Dermatologists accepted unlicensed dermatological preparations.

Imiquimod

• Cream 5% (£48.60 = 12 x 250mg sachets)

Indications and dose

• Actinic keratosis - Treatment of mild to moderate field changes of the face and scalp in adults:
  • Apply to lesion 3 times a week at night for 4 weeks; assess response after a 4-week treatment-free interval; repeat 4-week course if lesions persist; maximum 2 courses
• Warts (external genital and perianal) (specialist input):
  • Apply thinly 3 times a week at night until lesions resolve (maximum 16 weeks)
• Superficial basal cell carcinoma (specialist input):
  • Apply to lesion (and 1 cm beyond it) on 5 nights each week for 6 weeks; assess response 12 weeks after completing treatment

Notes

1. Manufacturer advises cream should be rubbed in and allowed to stay on the treated area for 6–10 hours for warts or for 8 hours for basal cell carcinoma and actinic keratosis, then washed off with mild soap and water (uncircumcised males treating warts under foreskin should wash the area daily). The cream should be washed off before sexual contact.
2. The routine commissioning of imiquimod 3.75% (Zyclara) is not accepted in Devon for the treatment of actinic keratosis (see Commissioning Policy for more details)

Podophyllotoxin

• Cream 0.15% (£17.83 = 5g)
• Solution 0.5% (£14.86 = 3ml)

Indications and dose

• Genital warts affecting the penis or the female external genitalia:
  • Apply twice daily for 3 consecutive days; treatment may be repeated at weekly intervals if necessary for a total of four 3-day treatment courses