How to Treat Common Cutaneous Warts?german translation / full article
Common cutaneous warts (verrucae vulgares) are a frequent cause of consultation in family practice. Though harmless in most cases, many patients perceive them as annoying and as a cosmetic problem. Various therapeutic measures are available, either per prescription or over the counter. Is there reliable evidence from clinical studies supporting any of these treatment methods? Which type of therapy should be recommended as first line treatment? Which alternative therapy should be recommended if first line treatment fails?
The effectiveness of salicylic acid patches and solutions has been shown in meta-analyses of randomized controlled trials (evidence level Ia, grade of recommendation A, NNT 5). Salicylic acid is therefore recommended as first line therapy. There also exists evidence from several randomized controlled trials regarding the beneficial effect of a combination of salicylic acid and 5-fluorouracil, but evidence level must be downgraded because of study size and quality (evidence level IIa, grade of recommendation B, NNT 2,5). It is recommended to use this combination if salicylic acid alone fails. Studies on the effectiveness of cryotherapy are limited and inconsistent, and secure proof remains lacking. Evidence for all other chemo- or immunotherapeutic agents is limited to uncontrolled case series and therefore insufficient for a general recommendation.