Topical treatment

Topical agents include: keratolytic agents, virucidal agents and immunomodulators.

Keratolytic agents

Keratolytic agents are the most popular first-line treatment of warts and are particularly suitable for young children, who can apply at home creams, ointments, tapes or quick-drying acrylate lacquers containing salicylic acid in concentrations ranging from 10% to 40%.

Virucidal agents

Both glutaraldehyde and formaldehyde combine with keratin and produce skin desiccation with viral destruction. Effectiveness is comparable to that of keratolytic agents.


Topical immunotherapy with strong topical sensitizers—squaric acid dibutylester (SADBE) or diphenylcyclopropenone (DPCP)—is an effective and painless treatment for multiple warts. A preparation of SADBE or DPCP 2% in acetone is used for sensitization. After 21 days weekly applications are carried out with dilutions ranging from 0.001% to 1% according to the patient's response. The objective of treatment is to induce a mild contact dermatitis.

Imiquimod acts as an immunomodulator owing to its capacity to induce cytokine (especially interferon alpha) production. Although imiquimod has only been used for treatment of genital and facial warts, its effectiveness in these regions suggests its possible use for periungual warts.

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