Weigh Pros and Cons of Pediatric Wart Therapies

Start use of squaric acid dibutyl ester by applying a 2% solution to a small, quarter-size area of normal skin on the forearm and wait 2 weeks to check for sensitization, she recommended. If none occurs, parents could apply a 0.2% solution to warts 3–7 times per week.

An intralesional immunotherapy, Candida antigen injection, is more painful. The injections are thought to be less painful than cryotherapy but still too painful for young children, Dr. Soohoo said. Some teenagers may tolerate it. It seems to be effective and induces immunity but is expensive and can cause itching as well as pain at the treatment site.

▸ Other off-label therapies. Among other off-label therapies, topical 5-fluorouracil can be applied to warts daily for 6 weeks. “I use it a fair amount in older kids and teens, especially if they're too busy to come back for visits,” Dr. Soohoo said. It is an FDA Pregnancy Category X and is available in compounded formulations by mail order from pharmacies.

Topical retinoic acid has been applied to flat warts on the face for up to 8 weeks of daily treatment but can cause local skin irritation, she said.

A study of pulsed dye laser therapy in 56 children found no support for its use as first-line therapy for pediatric warts (J. Am. Acad. Dermatol. 2007;56:205-10).

Duct tape does not work as monotherapy but may boost the efficacy of other topical therapies when used in combination, she concluded.

Dr. Soohoo reported no conflicts of interest.