Potent preparations, such as 40 percent plasters (Mediplast or Duofilm patch), usually are reserved

for thicker areas (eg, palms, soles, extremities); they are particularly useful for plantar warts. The
plaster is best applied to the wart and a few millimeters of surrounding skin, taped into place with
duct or athletic tape and kept dry for 48 to 72 hours. The patch is then removed, the wart pared
down, and the process repeated. The patch must be taped securely in place because it destroys all
skin it contacts. If it gets wet, it must be reapplied.
Lesser strength preparations are used for the digits of young children and for thinner warts in adults.
Two liquid forms, salicylic acid 17 percent (Occlusal HP, Duoplant, Compound W, Duofilm, Wartoff) and salicylic acid 27.5 percent in a film-forming base (Virasal) allow easy application to
multiple areas and are useful for common, plantar, palmar, and flat warts. Salicylic acid may also be
combined with other agents to attempt to achieve synergistic therapeutic results. For example,
salicylic acid 16.7 percent plus lactic acid 17.7 percent (Viranol) and salicylic acid 17 percent
premixed with 2 percent 5-fluorouracil (WartPeel) are available for topical treatment of warts.
Patients generally should be advised to apply the patch or liquid at bedtime after soaking the
affected area in warm water for 10 to 20 minutes.
Adequate paring of hyperkeratosis is an essential component of successful treatment. Paring is done
with a nail file (included with some patches) or pumice stone by the patient in between treatments,
and/or with a scalpel blade in the office immediately before cryotherapy or application of topical
agents.
The response to therapy is assessed after two to three weeks. Treatment is often continued for one to
two weeks after clinical removal of the verruca to help reduce recurrence.

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