Treatment of warts should start with imiquimod (Aldara) cream applied once a day until the wart is gone (Item 104-6). With this approach, there is no scar to deal with, no billing for an office procedure, and a much better outcome for the patient. Cryotherapy often fails and has to be repeated. In addition, it leaves ugly wounds that require treatment to prevent infection.
—Lin Faeth, NP, Fresno, Calif.

Many treatments for warts have been reported. A superlative comprehensive review of the literature on this subject is available (Clin Med Res. 2006;4:273-293, also without charge at [accessed July 16, 2007]). Currently, no single modality is effective for all patients. It is also difficult to rely only on an evidence-based approach to wart therapy (Am Fam Physician. 2005;72:647-652, also without charge at [accessed July 16, 2007]) because this may not include newer therapies and agents or modalities that yet to be evaluated by randomized controlled trials.

In addition, each method of wart therapy has its own advantages and disadvantages. For example, topical immunotherapy (imiquimod 5% cream) for the treatment of nongenital warts in children features less pain and trauma compared with salicylic acid, cryotherapy, or laser treatment. However, the prolonged length of average treatment (two to six months) and the high cost of the medication are disadvantages. To further assess the efficacy of imiquimod for nongenital warts, randomized controlled trials are warranted.
—Philip R. Cohen, MD (106-17)

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