Wart Stick - Drug Monograph

Introduction

Wart Stick is an over-the-counter topical medication primarily used for the treatment of common warts and plantar warts. It contains salicylic acid as its active ingredient, typically in concentrations ranging from 12-17%, formulated in a solid base for precise application. This monograph provides comprehensive information about Wart Stick's pharmacological properties, clinical applications, and safety considerations.

Mechanism of Action

Salicylic acid, the active component of Wart Stick, exerts its therapeutic effect through keratolytic action. It promotes desquamation by dissolving the intercellular cement that binds corneocytes in the stratum corneum. This process softens and breaks down the hyperkeratotic tissue characteristic of warts, allowing for gradual debridement of the lesion. Additionally, salicylic acid may stimulate an inflammatory response that helps the immune system recognize and eliminate human papillomavirus (HPV)-infected cells.

Indications

Wart Stick is indicated for the topical treatment of:

• Common warts (verruca vulgaris)
• Plantar warts (verruca plantaris)
• Other benign epithelial hyperkeratotic lesions

Dosage and Administration

• Hold applicator vertically and twist base to advance medication
• Apply directly to wart, avoiding surrounding healthy skin
• Cover treated area with bandage or tape if recommended

• Pediatric patients: Use under adult supervision
• Geriatric patients: Use with caution due to potential skin fragility
• Diabetic patients: Consult healthcare provider before use

Pharmacokinetics

Contraindications

• Hypersensitivity to salicylic acid or any component of the formulation
• Diabetes mellitus with peripheral vascular disease
• Peripheral arterial disease
• Use on moles, birthmarks, or unusual warts with hair growth
• Application to irritated, infected, or broken skin
• Use on facial warts or genital warts
• Children under 2 years of age

Warnings and Precautions

• Avoid contact with eyes, mucous membranes, and normal skin surrounding wart
• Discontinue use if excessive irritation, redness, or swelling occurs
• Use with caution in patients with impaired renal function
• Monitor for signs of salicylism if applied to large areas or under occlusive dressings
• Not for use by multiple persons to prevent cross-contamination
• Consult healthcare provider if wart persists beyond 12 weeks of treatment
• Use caution in patients taking anticoagulants due to potential increased bleeding risk

Drug Interactions

• Oral anticoagulants (warfarin): Potential increased anticoagulant effect
• Oral hypoglycemics: Potential enhanced hypoglycemic effect
• Methotrexate: Possible increased methotrexate toxicity
• Other topical medications: Potential increased irritation or altered absorption
• Systemic NSAIDs: Potential additive effects and increased risk of adverse reactions

Adverse Effects

• Local irritation, redness, and burning at application site
• Skin peeling and dryness
• Mild stinging sensation

• Severe local inflammation
• Allergic contact dermatitis
• Signs of systemic salicylism (tinnitus, nausea, dizziness)
• Chemical burns with improper application

Monitoring Parameters

• Visual inspection of treatment area for signs of excessive irritation
• Assessment of wart size and appearance at weekly intervals
• Monitoring for signs of infection at treatment site
• Evaluation for systemic symptoms if applied to large areas
• Assessment of treatment efficacy after 4-6 weeks of use

Patient Education

• Use exactly as directed; more frequent application will not improve results
• Protect surrounding healthy skin with petroleum jelly before application
• Do not share medication with other family members
• Soak wart in warm water before application to enhance penetration
• Use emery board or pumice stone to remove dead tissue between applications
• Wash hands thoroughly after application
• Store at room temperature away from moisture and heat
• Seek medical attention if no improvement after 12 weeks or if condition worsens
• Avoid shaving over treated areas
• Do not use on sunburned, windburned, or irritated skin

References

1. Sterling JC, Gibbs S, Haque Hussain SS, et al. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol. 2014;171(4):696-712. 2. Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2006;4(4):273-293. 3. FDA Monograph for OTC Corn and Callus Remover Drug Products. Federal Register. 1993;58(1