Warts are common, non-cancerous growths on the skin caused by infection with the human papillomavirus (HPV). The virus enters the skin through small breaks, causing an overgrowth of cells that results in a rough bump. While many people seek a simple pill, true oral medications are generally not the standard first-line treatment for common warts. Therapy usually focuses on localized approaches that directly target the infected skin tissue.
The Localized Nature of Wart Infections
The reason oral medication is uncommon lies in the biological nature of the HPV infection. The virus specifically targets epithelial cells found only in the top layers of the skin (the epidermis). HPV does not typically enter the bloodstream or spread throughout the body in healthy individuals.
Since the infection is confined to the skin’s surface, it is considered a localized condition. This localization means that a systemic treatment, like a pill, is often less efficient than a treatment applied directly to the site of infection. Topical and procedural methods are designed to physically destroy the infected cells or stimulate a local immune response.
Systemic Medications and Off-Label Use
Despite not being a primary treatment, oral medications have been studied for specific, difficult cases. Systemic therapy is reserved for severe, widespread, or recalcitrant warts that failed to respond to standard localized treatments, or for patients with compromised immune systems. These oral agents often function as immunomodulators, aiming to boost the patient’s immune response against the HPV infection.
One medication studied is Cimetidine, an H2-receptor antagonist commonly used to treat ulcers, which has immunomodulatory effects at high doses. Results on its effectiveness for common warts have been mixed, with some studies showing no superiority over a placebo. Oral zinc sulfate has also shown promise, particularly in patients with a zinc deficiency that affects their immune function.
Oral retinoids, such as isotretinoin or acitretin, have also been used in severe or treatment-resistant cases because they help regulate skin cell proliferation. None of these oral medications are specifically approved as a standard treatment for common warts; their use is considered “off-label.” This requires strict physician supervision due to potential side effects. The evidence supporting their routine use is insufficient, meaning they are a secondary option when established treatments have failed.
Effective Topical and Procedural Alternatives
Because warts are localized, the most common and effective treatments directly address the infected tissue. Over-the-counter (OTC) options typically use salicylic acid, a keratolytic agent that gradually dissolves the layers of the wart. Salicylic acid products are available in various concentrations and formulations, such as liquids, gels, or patches. They have reported cure rates between 50% and 70% with consistent use.
Professional treatments administered by a healthcare provider are stronger and faster-acting. These include:
Procedural Interventions
Cryotherapy involves applying liquid nitrogen to freeze and destroy the tissue, causing a blister to form and the wart to peel off. Other interventions include electrosurgery, which uses heat to burn away the wart, or curettage, where the wart is scraped off.
Prescription Topicals
Prescription topical treatments, such as the immunomodulator Imiquimod or chemical agents like cantharidin, can be utilized. These stimulate the immune system or create a localized chemical burn to eliminate the lesion.