Tretinoin cream for the treatment of warts?

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Tretinoin cream for the treatment of warts?

Healthylife Pharmacy3 June 2015|4 min read

Warts are quite common, especially in children, teens, and young adults. They are caused by the human papilloma virus, commonly referred to as its acronym, HPV. There are at least 150 different types of HPV and certain types tend to affect certain areas of the body more commonly. One type causes plantar warts on the feet; another type may cause genital warts. Common skin warts may be caused by several different HPV types and no antiviral therapy is available that effectively, affordably, and safely kills HPV in common skin warts. Traditional therapy for warts includes cutting them off with a surgical blade, freezing them off with liquid nitrogen, or burning them off with salicylic acid. These approaches are designed to physically remove or chemically destroy HPV and the wart at the same time. However, recurrence is common. Newer approaches such as tretinoin cream, cimetidine, and imiquimod may hold promise for people who are suffering from common warts.

Tretinoin cream as a treatment of warts

While it is better known as an acne treatment, tretinoin is also a topical treatment for skin warts. Tretinoin, or trans retinoic acid, is a derivative of vitamin A. Topical tretinoin works by irritating the skin provoking normal skin cells to grow and multiply. Growing skin causes the warts to scale over and slough of, ultimately replacing the wart with smooth, healthy skin. Topical tretinoin is available in various strengths and formulations such as creams and gels. Since it is a skin irritant, the concentration or strength of the treatment is usually limited by the patient's ability to tolerate itching and burning at the treatment site. Ideally one would use the most concentrated strength of tretinoin cream available that produces tolerable side effects. Moreover, several weeks of once or twice daily application of tretinoin cream is usually needed to eliminate skin warts. Tretinoin cream is not considered a first-line treatment for warts, which means that other treatments such as salicylic acid and liquid nitrogen cryotherapy (i.e. freezing) are usually tried first. Nevertheless, topical tretinoin cream is effective in individuals who have difficult to treat skin warts.

Treating warts with oral cimetidine

Oral cimetidine is widely used as a treatment for gastroesophageal reflux disease and heartburn. Cimetidine is a histamine (H2) receptor blocker that reduces acid production in the stomach. The drug may also help affect histamine receptors on the immune system cells, helping them to fight HPV more effectively. There is only a limited amount of research to support the use of cimetidine to treat warts. Open label studies have shown that rather high doses of cimetidine taken four times a day over the period of several months may get rid of warts. On the other hand, more rigorous clinical studies have failed to show that oral cimetidine is any better than placebo at treating common skin warts. While additional clinical studies are needed to determine whether cimetidine is effective at treating warts, early data suggest that this form of treatment is not terribly effective and certainly not as beneficial as other wart treatments.

Imiquimod for common skin warts

For many years, a topical cream containing 5% imiquimod has been used to treat non-genital warts. While the type of HPV that causes genital warts is different than skin wart HPV types, this immunomodulator may still be beneficial. A small clinical study showed that imiquimod 5% cream applied topically, once a day for four weeks completely eliminated common skin warts in 9 out of 10 patients treated. Perhaps more impressively, there were no recurrences in the group that was successfully treated with the medication. Imiquimod may be particularly useful in people who have depressed immune systems. The topical treatment is also helpful in cases where other wart treatments have failed. Another benefit of imiquimod is that it can be successfully applied by patients outside of the doctor's office. The immunomodulator is not usually considered a first-line treatment by most physicians. Nonetheless, imiquimod does not scar like some other wart treatments, so the cream may be considered a first-line treatment for people with warts on the face or anywhere that scarring may be a concern. Imiquimod 5% cream is generally well tolerated, though patients may experience pain or irritation in and around the warts during therapy. If this occurs, treatment should be stopped until the skin warts are no longer painful. There are less concentrated forms of imiquimod available; however, it is unclear whether these dilute creams are as effective in treating common skin warts or cause fewer side effects than the 5% preparation.

Can duct tape actually treat warts?

Duct tape has long been used as a home remedy to treat common skin warts. In fact, physicians have historically recommended that patients first try duct tape before moving on to cryotherapy or acid treatment. In this approach, the doctor or parent simply covers the wart in duct tape until the wart is gone. Duct tape has actually been compared to cryotherapy for the treatment of common skin warts. Unfortunately, the results of these trials have been contradictory to one another. Initial reports children with skin warts showed duct tape was better than cryotherapy. Conversely, subsequent clinical trials with larger numbers of patients failed to show any benefit to duct tape. In light of these trial results, physicians no longer routinely recommend the use of duct tape for the treatment of common skin warts. Interestingly, the original study that showed duct tape to be effective used the most common color of duct tape, namely silver, while later studies use clear duct tape that is substantially less adherent. Silver duct tape uses a rubber-based adhesive while clear duct tape uses an acrylic-based adhesive. While this difference in adhesive may not explain the difference in the clinical trial results (though it could), anyone wishing to use duct tape to treat common skin warts should probably use the silver duct tape rather than the clear variety.

References

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