In the case of warts, there are numerous different medicinal approaches, both conventional and otherwise. Among these, we have preparations composed of salicylic acid which are commonly used to help get rid of a wart and is considered the first-line treatment for both children and adults. Let's explore in more detail here how salicylic acid can aid in the healing of warts.
Salicylic Acid and Warts: Is it effective in dissolving them?
Published on July 26, 2024, by Stéphanie, PhD, Doctorate in Life and Health Sciences — 13 min of reading
Themes:
Salicylic acid to rid the skin of warts?
Whether it's a flat wart or a thick wart, this minor skin condition is a source of discomfort, pain, and aesthetic inconvenience for many. Although in most cases they generally fade away spontaneously without therapeutic intervention, the skin warts can potentially last for months or even years. Therefore, many resort to the use of specially formulated products to accelerate the healing process, more easily and quickly rid the skin of the wart, and limit its spread.
Salicylic acid is one of the most common treatments used to combat warts. It has been in use for many years, and numerous controlled clinical trials have been conducted, demonstrating a modest effectiveness of topical salicylic acid treatment in the pooled data from various placebo-controlled studies, particularly on plantar and common warts. On average, a salicylic acid solution was able to cure 73% of warts within a few weeks, compared to 48% with a placebo. As for flat warts, there is less scientific evidence, and other therapies may be more effective in treating them, such as chemical peels with glycolic acid.
| References | Sample Size | Type of Wart | Intervention | Results |
|---|---|---|---|---|
| HAMADEH G. N. & et al. (2007) | 44 patients | Cutaneous Warts | Application of a salve containing 15% salicylic acid and 15% lactic acid twice daily for a period of 3 months | Healing rate of 9/22 (42%) with salicylic acid and lactic acid versus 11/22 (50%) with zinc oxide |
| EEKHOF J. A. H. & others. (2010) | 240 participants aged from 4 to 79 years old | Common warts (n = 116) and plantar warts (n = 124) | Daily self-application of an ointment containing 40% salicylic acid for 13 weeks | Healing rate of 20/82 (24%) with salicylic acid versus 30/76 (39%) with cryotherapy |
| SÁNCHEZ-BLANCO E. & al. (2011) | 20 patients aged between 7 and 16 years old | Flat warts on the face | Application of a topical gel containing 15% glycolic acid and 2% salicylic acid once a day for 8 weeks | Disappearance of wart-like lesions within 4 weeks in 7 patients (35%) and within 8 weeks in 13 patients (65%) |
| WATT I. & al. (2011) | 229 patients aged 12 years and over | Plantar Warts | Daily self-treatment with a 50% salicylic acid treatment for 12 weeks | Healing rate of 17/119 (14.3%) with cryotherapy versus 15/110 (13.6%) with salicylic acid |
| EEKHOF J. A. H. & al. (2013) | 219 patients aged between 4 and 79 years old | Common Warts and Plantar Warts | Daily self-application of a 40% salicylic acid ointment for 13 weeks | A healing rate of 20/42 (47.6%) was observed with salicylic acid, compared to 18/37 (48.6%) with cryotherapy |
| HOSSEINI S. M. & et al. (2015) | 60 patients aged 12 years and older | Plantar Warts | Topical application twice a day of a solution composed of 16.7% salicylic acid and 16.7% lactic acid for a duration of 4 weeks | Number of warts: reduction of 13.12% with 70% pyruvic acid and 23% with the salicylic acid + lactic acid blend; Wart size: reduction of 43.47% with 70% pyruvic acid and 37.40% with the salicylic acid + lactic acid blend |
| SÁNCHEZ G. & et al. (2015) | 75 patients aged between 7 and 62 years old | Persistent Plantar Warts | Topical application of a formula containing 1% cantharidin, 5% podophyllin, and 30% salicylic acid | Total disappearance of warty lesions in 72% of patients after the first treatment session and 100% after the second session |
| HEIRAN A. & al. (2016) | 66 patients aged between 7 and 60 years old | Common Warts | Application of a 16.7% salicylic acid solution and a 16.7% lactic acid solution for 4 weeks | A complete healing of 40.8% of warts was observed with the preparation composed of salicylic acid and lactic acid, compared to 74.1% of warts with 85% formic acid |
| KÖRVER J. E. M. & al. (2019) | 52 children and 83 adults | Cutaneous Warts | Topical application of a solution containing 1% cantharidin, 2% podophyllin, and 30% salicylic acid for a period of 3 to 4 weeks | Complete disappearance of warts in 86.5% of children (45/52) and 62.7% of adults (52/83) |
| YOON H-S. & al. (2020) | 50 patients | Periungual Warts | Application once a day of a preparation containing 0.5% of 5-fluorouracil and 10% salicylic acid | Healing rate of 25/50 (50%) |
| ABOELDAHAB S. & et al. (2022) | 1 man aged 54 years | Plantar Warts | Intralesional injection of platelet-rich plasma combined with a twice-daily local application of a 30% salicylic acid solution | Complete disappearance of warts after three injection sessions, combined with local application of salicylic acid between sessions, and no recurrence after a follow-up of nine months since the last session |
| DRAGO F. & et al. (2022) | 17 patients | Ano-genital Warts | Application of a 0.5% 5-fluorouracil solution/10% salicylic acid | Complete disappearance of warts in 15 patients (88%) after three months of treatment |
| SRIVASTAVA A. & et al. (2022) | 1 man aged 35 years | Periungual wart | Application of podophyllin (25%) and salicylic acid (5%) three times a week for 4 weeks | Complete disappearance of the lesion and no recurrence after 3 months of discontinuing the treatment |
| ELETHAWI A. M. D. & et al. (2023) | 60 patients | Flat Warts | Treatment with a 30% salicylic acid solution | A reduction of 35% in the number of warts was observed in patients treated with 30% salicylic acid, and a 47% reduction was noted in patients treated with 70% glycolic acid. |
By what mechanism?
Thesalicylic acid is an organic acid that acts on warts by dissolving the protein connections that hold the layers of the skin together. This causes the destruction of the epidermal cells infected by the virus. Furthermore, it is suggested that it also creates local inflammation, which activates the immune response and thus stimulates the production of antibodies to counter the human papillomavirus.
Salicylic acid does not have the ability to deactivate viral particles. A risk of recurrence may arise due to the presence of residual human papillomaviruses.
How to use topical salicylic acid on warts?
Lotion, cream, gel, clear varnish, ointment... various salicylic acid-based preparations at different concentrations (10 - 70%) are marketed, whether they are over-the-counter or prescription. Treatments are also available in the form of a dressing. Research suggests using an over-the-counter wart remover containing 17% salicylic acid for small warts. They can be applied daily for several weeks to thin and "strip" the warts. However, for larger warts, higher concentrations of salicylic acid, up to 70%, can be used but require a doctor's intervention.
Before commencing the treatment, ensure to cleanse the affected area with water and soap.
Gently remove the thickness of hardened skin on top of the wart using a rough surface (pumice stone, file, etc.) to aid the solution in penetrating the skin for better efficacy.
Then, immerse the wart in warm water for approximately 5 minutes to soften the wart tissue that needs to be treated.
Dry thoroughly and dab the entire surface of the wart with a small amount of salicylic acid solution using an applicator. Ensure it only contacts the wart and not the surrounding skin.
Cover the wart with an occlusive dressing after treatment to keep the salicylic acid in place and prevent the wart from spreading.
This process must be repeated daily until the wart has completely disappeared, which typically takes at least 12 weeks. With repeated applications, the salicylic acid softens the dead tissues containing the virus so that it can be easily removed.
Before attempting any significant treatment, consult a doctor to avoid misunderstandings, as well as skin reactions or undesirable side effects.
Any contraindications?
However, salicylic acid used for treating warts is not recommended for certain individuals.
children under the age of 2 years, where it is generally recommended to wait for the spontaneous healing of the warty lesions;
individuals with diabetes or peripheral vascular disorders, as the treatment may cause skin lesions;
thepregnant women, where it is preferable to treat warts by cryotherapy or to wait until after childbirth to begin treatment.
Although it is a safe treatment with very few side effects, salicylic acid should not be used on sensitive areas such as the face at such concentrations, due to a risk of hypo- and hyperpigmentation.
Sources
JOHNSON S. M. & al. Cutaneous warts: An evidence-based approach to therapy. American Family Physician Journal (2005).
HAMADEH G. N. & al. Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts. International Journal of Dermatology (2007).
EEKHOF J. A. H. & al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ (2010).
SÁNCHEZ-BLANCO E. & al. Glycolic acid 15% plus salicylic acid 2%: a new therapeutic pearl for facial flat warts. Journal of Clinical and Aesthetic Dermatology (2011).
WATT I. & al. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. BMJ (2011).
ABBOTT R. & al. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews (2012).
EEKHOF J. A. H. & al. HPV type in plantar warts influences natural course and treatment response: secondary analysis of a randomised controlled trial. Journal of Clinical Virology (2013).
HOSSEINI S. M. & al. Topical pyruvic acid (70%) versus topical salicylic acid (16.7%) compound in treatment of plantar warts: A randomized controlled trial. Advanced Biomedical Research (2015).
SÁNCHEZ G. & al. Safety and effectiveness of cantharidin- podophylotoxin-salicylic acid in the treatment of recalcitrant plantar warts. Dermatologic Therapy (2015).
HEIRAN A. & al. Comparison of the efficacy of topical 85% formic acid versus a combination of topical salicylic acid and lactic acid in the treatment of warts: A randomized, triple-blind, controlled trial. Iranian Journal of Dermatology (2016).
OCKENFELS H. M. Therapeutic management of cutaneous and genital warts. Journal of the German Society of Dermatology (2016).
BOONSARN N. & al. Cryotherapy versus salicylic acid for treating plantar warts: a systematic review. The Clinical Academia (2019).
KÖRVER J. E. M. & al. Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution. Dermatologic Therapy (2019).
BOGERS J. P. & al. Efficacy of AV2-Salicylic acid combination therapy for cutaneous warts: Study protocol for a single-center randomized controlled trial. Contemporary Clinical Trials Communications (2020).
YOON H-S. & al. Effectiveness of new 5-fluorouracil/salicylic acid application method for periungual warts: A descriptive study. Annals of Dermatology (2020).
MARTÍNEZ J. L. L. & al. Topical treatment for plantar warts: A systematic review. Dermatologic Therapy (2021).
ABOELDAHAB S. & al. A case of resistant multiple plantar warts cured with combined autologous platelet-rich plasma injection and topical salicylic acid 30. Journal of Cosmetic Dermatology (2022).
DRAGO F. & al. 5-Fluorouracil 0.5%/salicylic acid 10% solution in the treatment of ano-genital warts. Dermatologic Therapy (2022).
SRIVASTAVA A. & al. Podophyllin and salicylic acid combination along with paring for treatment of cutaneous warts. Journal of Dermatological Treatment (2022).
ELETHAWI A. M. D. & al. The efficacy and safety of superficial chemical peel in the treatment of plane wart. Advanced Medical Journal (2023).
