When to Initiate Referral

  • Symptomatic, rapidly progressing, or numerous warts
  • Warts in immunosuppressed patient

Treatment Basics

  • New cases of warts can be observed clinically without treatment. If treatment is desired, options vary based upon location and number of lesions.

Warts on the Face, Neck, Axillae, Inguinal Folds or Genitalia:

  • Tretinoin 0.025% or 0.05% cream/gel to the lesions, 3 to 5 nights per week as tolerated. Note: Topical retinoids may be irritating and should be avoided in patients with eczema. They should not be applied close to the eyes.

Warts on the Trunk or Extremities

  • Duct tape occlusion daily
  • Otc salicylic acid 17% solution or otc salicylic acid 40% plasters nightly
  • Gentle nightly abrasion with pumice stone or nail file, not to be used on other areas
  • In-office treatments (cantharidin, curettage, or liquid nitrogen) every 4 to 6 weeks if available and pediatrician has experience with treatments