13.7 Preparations for warts and calluses

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
  • Paint, 16.7% salicylic acid, 16.7% lactic acid (£1.71 = 10ml)
  • Ointment 50% salicylic acid in a paraffin base (£2.88 = 5g)
Glutaraldehyde
  • Solution, 10% glutaraldehyde (£2.07 = 10ml)
Silver nitrate
  • Silver nitrate 95%, potassium nitrate 5% (£2.44 = pack)
  • Applicator 75%
Salicylic acid in aqueous cream
  • 5%, 10%, 20% (unlicensed preparations)

Notes

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

Anogenital warts

Imiquimod
  • Cream 5% (£48.60 = 12 sachets)

Indications and dose

  • Warts (external genital and perianal): Apply thinly 3 times a week at night until lesions resolve (maximum 16 weeks)
  • Superficial basal cell carcinoma: apply to lesion (and 1 cm beyond it) on 5 nights each week for 6 weeks; assess response 12 weeks after completing treatment
  • Actinic keratosis: 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

Notes

  1. For basal cell carcinoma and actinic keratosis, imiquimod cream hould be rubbed in and allowed to stay on the treated area for 8 hours, then washed off with mild soap and water
Podophyllum
  • Podophyllin paint, compound, BP
Podophyllotoxin
  • Cream 0.15% (£17.83 = 5g)
  • Solution 0.5% (£14.49 = 3.5ml)

Indications

  • Genital warts affecting the penis or the female external genitalia

Dose

  • 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
Imiquimod 3.75% (Zyclara®)

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)

 

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