Treatment Options for Cutaneous Viral Warts in Children

Therapy options for children with cutaneous viral warts was summarized in literature review data published in Dermatologic Therapy.

Although many publications have described cutaneous wart treatment in adults, few studies assess efficacy and safety of treatments in children. Investigators conducted a review of PubMed, EMBASE, and Web of Science for English-language studies published from 1961 through 2020 that assessed treatment options for children or adolescents younger than age 21 years with cutaneous viral warts. Eligible studies either exclusively reported on effects in pediatric and adolescent populations or conducted separate analyses for adults and children. Letters, case reports, and case studies were excluded.

A total of 38 studies were reviewed. Investigators identified 7 categories of cutaneous wart treatment: (1) no intervention; (2) cryotherapy; (3) salicylic acid monotherapy and combination therapies; (4) other topical therapies; (5) immunotherapy; (6) mechanical destructive therapy; and (7) alternative treatments. In studies that reported the effects of watchful nonintervention, 63.6% of children experienced spontaneous wart resolution within 2 years. Overall, cryotherapy and salicylic acid emerged as the most efficacious treatment options. Reported clearance rates with cryotherapy ranged from 51.6% over 13 weeks to 68.2% over 3 months. Clearance rates with salicylic acid monotherapy ranged from 18% over 6 months to 100% at 2 years. Cryotherapy was associated with pain and blistering, which may be less tolerable for children compared with adults. Salicylic acid monotherapy was not associated with significant adverse events, although skin irritation was reported by some. In 1 study, the combination of salicylic acid with cryotherapy was effective and appeared to reduce the painful adverse events of cryotherapy.

Limited data were available on the efficacy of other topical therapies in children. Studied agents included formalin, nitric-zinc complex solution, pyruvic acid, promicid gel with or without occlusion, monochloroacetic acid, silver nitrate, retinoids, and cantharidin. Clearance rates ranged from 99% with formalin to 22.2% with cantharidin. Adverse eventsvaried; pain and blistering were common with monochloroacetic acid, and stinging was reported by a third of patients using promicid gel.

Both topical and intralesional immunotherapy displayed efficacy in children. The greatest clearance rates were observed for topical diphenylcyclopropenone (88.3%) and intralesional candida (70.9-87.3%). However, many studies failed to report the adverse events of immunotherapies in children. These therapies should be limited to children with recalcitrant or problematic warts, investigators wrote, due to their immunomodulatory effects.

Excluding cryotherapy, other mechanical therapies that have been studied in children include curettage, electrocautery, carbon dioxide laser, pulsed dye laser, and superficial radiotherapy. Although clearance rates were high for these methods, they were associated with substantial pain, which may make them unsuitable for younger patients. Mild hyperpigmentation and erythema were also observed. Overnight occlusion of warts was associated with 66.7% clearance rate over 2 years, with very minoradverse events. The length of time required for clearance, however, may be unacceptable to some patients.

A total of 4 studies examined alternative therapies for warts in children. The study cohorts were small, limiting generalizability. Methods of interest included homeopathy, relaxation mental imagery, and transfer factor therapy.

These summary data describe the efficacy and safety of myriad therapies for cutaneous warts in children. The most efficacious methods were cryotherapy and salicylic acid, although the former was associated with pain and blistering, which may limit tolerability in younger patients. The combination of salicylic acid with other modalities—such as other keratolytics or cryotherapy—may improve its efficacy. For children with recalcitrant warts, immunotherapy and other mechanical therapies may be considered. “We recommend further randomized trials to evaluate these [less common] treatment modalities, comparing [them] with the more established options of cryotherapy and salicylic acid,” investigators wrote.

Reference

Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: a review [published online July 19, 2020]. Dermatol Ther. doi: 10.1111/dth.14034