Facial Warts

• Commonly known as flat warts (veruca plana) - Smooth, flat-topped, yellow-brown papule
• often located on the face and along scratch marks; common in children, rare in adults

First Line

• tretinoin, imiquimod, or 5-FU as first-line treatments for flat warts on the face
• these topical treatments may cause skin irritation resulting in postinflammatory hyperpigmentation
• Patients with dark skin are at greatest risk for postinflammatory hyperpigmentation

Salicylic Acid

• salicylic acid is usually avoided for facial flat warts because of the absence of significant hyperkeratosis and the potential for excessive skin irritation
• Less common treatments reported effective in small numbers of patients include glycolic acid 15% plus salicylic acid 2%
• Another guideline lists salicylic acid as the first-line therapy for flat warts on the face, plantar warts, and flat and common warts on the hands

Salicylic Acid Application Advice

• Soak your warts and the area surrounding the warts in warm water for 10 to 25 minutes or apply a pad soaked in warm water to your eye for 10 to 25 minutes.
• Apply the salicylic acid. Be careful to keep this solution away from the eyes. This solution can irritate healthy skin surrounding the wart.
• Clear away dead skin after treatment. Use a nail file or pumice stone.
• Repeat this daily for a few weeks until your warts are removed. If the area where you applied the solution is irritated, it means the treatment is working.
• If the wart is in an area in which the salicylic acid would come into contact with the eye, do not pursue this treatment

Duct Tape

• It is not clear how duct tape works or if it is an effective treatment. Some studies have shown success while others have not.
• If you choose to try duct tape, silver duct tape is preferred over clear tape because it sticks to the skin better.
• You should cover the skin wart with tape and leave it in place for six days.
• You then remove the tape, soak the skin in warm water for 10 to 20 minutes, and use and emery board or pumice stone to gently slough off dead skin.
• Leave the skin uncovered for one night, then reapply the tape for another six nights.
• Most people who find duct tape an effective treatment have resolution of their skin warts within four weeks. Warts are unlikely to respond if you do not see any improvement within two weeks

References:

1. www.uptodate.com
2. http://www.aafp.org/afp/2011/0801/p288.html
3. http://www.pcds.org.uk/clinical-guidance/warts
4. http://www.livestrong.com/article/270518-how-to-remove-warts-around-the-eye/