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Topical 5-fluorouracil cream or solution and retinoic acid cream or gel are used effectively for flat warts, especially those on the face. With both of these topical agents, patients will probably experience irritation characterized by erythema, scaling, and burning. Patients must be counseled that irritation will occur. Men should switch to an electric razor if they are using warts.

Refractory Warts.

Sublesional bleomycin , diluted to 10 U/mL, has a distinct role in the treatment of refractory warts, both those on the hands and the plantar variety. Usually one or two units injected.

Interferon-alpha (both type 2a and type 2b) has been approved for treatment of refractory genital warts. Lesions are injected intralesionally three times a week for 3 weeks.

Immunostimulation is sometimes tried. Dinitrochlorobenzene (DNCB) sensitization followed by repeated applications of diluted DNCB has been used to treat resistant warts. This form of immunotherapy is sometimes effective, but DNCB has been shown to be a.... Autogenous wart vaccines appear no more effective.

The carbon dioxide laser has become an increasingly popular method for treating warts, although in many instances it is little more than an expensive method of causing tissue destruction. It is best reserved for specialized situations such as extensive vaginal or anal warts or refractory periungual warts.