Positive results from studies looking at pipeline treatments for common warts might give pediatricians hope that something simple and nondestructive would magically make warts disappear—never to return.
In June, for example, Verrica Pharmaceuticals (West Chester, Pennsylvania) announced Phase 2 trial results showing 51% of subjects achieved complete clearance of common warts when treated with VP-102, a topical solution of 0.7% cantharidin in a single-use applicator.1
Although the trial suggests VP-102 was well tolerated with no serious adverse events, treating warts with cantharidin and other options brings up the old wart conundrum: Is treating warts worth the risk when most will vanish on their own and most treatments are only temporary? This is according to Bernard A. Cohen, MD, professor of Pediatrics and Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Cohen and coauthors did a retrospective chart review of pediatric patients with common warts in an outpatient setting, published in 2015 in Pediatric Dermatology. Most of the 214 patients surveyed received some form of therapy, but it wasn’t clear that any form of treatment altered the course of their warts. The researchers found that warts resolved in 65% of children by age 2 years and in 80% by age 4 years, regardless of treatment.2
The findings suggest that counseling without aggressive destructive treatment is reasonable for managing warts in most children, the authors concluded.2
“The bottom line is we didn’t find anything that worked better than placebo,” Cohen says. “I think it’s very important for pediatricians to know that still, at this point, it is unclear if anything works better than placebo to make warts go away permanently.”
To best guide patients and families about whether to treat or not to treat warts, pediatricians should know about the natural history of common warts, according to Cohen.
Most important: Risk of serious complications from warts in otherwise healthy kids is negligible. Yet many treatments for warts are destructive and painful and are more likely to cause complications than the warts themselves, he says.
1. Verrica Pharmaceuticals. Verrica Pharmaceuticals achieves positive topline results in Phase 2 clinical study of VP-102 in patients with common warts [press release]. Available at: https://investors.verrica.com/news-releases/news-release-details/verrica-pharmaceuticalsachieves-positive-topline-results-phase. Published June 26, 2019. Accessed August 12, 2019.
2. Kuwabara AM, Rainer BM, Basdag H, Cohen BA. Children with warts: a retrospective study in an outpatient setting. Pediatr Dermatol. 2015;32(5):679-683.
3. Moresi JM, Herbert CR, Cohen BA. Treatment of anogenital warts in children with topical 0.05% podofilox gel and 5% imiquimod cream. Pediatr Dermatol. 2001;18(5):448-450; discussion 452.