Treatment of warts by keratolysis

 Keratolysis is the removal of dead surface skin cells and is a treatment for several types of wart. The most common keratolytic treatment of warts available over-the-counter involve salicylic acid. These products are readily available at most drugstores and supermarkets. There are typically two types of products: adhesive pads treated with salicylic acid, or a bottle of concentrated salicylic acid. Removing a wart with this method requires a strict regimen of cleaning the area, applying the salicylic acid, and removing the dead skin with a pumice stone or emery board. It may take up to 12 weeks to remove a stubborn wart.

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Formulations

Some formulations are:

• alcoholic solution containing glycerol
• collodion which dries to a celluloid film / Duofilm
• simple ointment
• absorption ointment
• oil in water cream

The amount of salicylic acid reaching the wart varies substantially depending on the formulation used^[1].

Molecular basis of therapeutic effect

• Salicylic acid reaches warts; lactic acid and collodion do not^[2]. Therefore, these additional components have only an indirect role in therapy.
• The molecular structure of the skin is altered at the centre of the wart^[3].
• Experiments indicated that salicylic acid bonding within the human papillomavirus-containing verruca tissue is more likely than simple acid dissociation upon dissolution in water within the tissue^[4].

Complications

Some cases of allergic contact dermatitis have been observed when using collodion formulations^[5]. This was found to be due to colophony in the collodion.

References

1. ^  J Drug Target. 1998;5(5):343-51. PMID 9771616
2. ^  Int J Pharm. 1999 Oct 25;188(2):145-53. PMID 10518670
3. ^  Dermatol Clin. 1990 Jan;8(1):143-6. PMID 2302853