Salicylic acid serves as a key agent in the therapeutic management of cutaneous and genital warts, primarily inducing chemical ablation and irritation of human papillomavirus (HPV)-induced hyperkeratoses while potentially activating the local immune response. Clinically controlled trials comparing salicylic acid to a placebo consistently demonstrated positive therapeutic effects for the former.

Although meta-analysis has shown clearance rates averaged around 50%, the study populations varied in terms of wart location (hands, feet, trunk) and duration (<6 months, >6 months).

The recommended treatment protocol using 17% salicylic acid products involves a warm foot bath for 5 minutes, followed by a careful attempt to remove hyperkeratoses. Applying the salicylic acid product to the wart on a daily basis is advised, continuing the procedure for 12 weeks, with a brief interruption if erythema, pain or bleeding occurs. Mild erythema in the treated area is considered normal.

Importantly, salicylic acid should not be used on the face due to the associated risk of hypo- and hyperpigmentation. This comprehensive approach provides a practical guideline for utilizing salicylic acid to manage cutaneous and genital warts effectively.

Source:Ockenfels HM. JDtsch Dermatol Ges. 2016;14(9):892-9.