Two Cases of Childhood Recalcitrant Warts Successfully Treated with Topical Trichloroacetic Acid

Abstract

Topical trichloroacetic acid (TCA) is a well-known treatment for genital warts, condyloma acuminatum. However, there have been few reports dealing with its use for warts other than genital warts, such as common or plantar warts. In two Japanese children, topical 45％ TCA application successfully cured multifocal recalcitrant warts on the fingers and toes that were resistant to conventional treatments such as cryotherapy, topical salicylic acid, topical glutaraldehyde, topical vitamin D₃, or systemic coix seed extract. No adverse events were observed. Cryotherapy with liquid nitrogen is currently the most popular therapy for common and plantar warts. However, severe pain associated with cryotherapy often reduces patients' adherence to the treatment. Based on our experience of these two cases, topical 45％ TCA therapy may be superior to cryotherapy with a much better adherence and clinical effectiveness. Further investigation is warranted to determine the safety, effectiveness, and suitable concentrations of TCA for the treatment of intractable warts.