What are the best treatment options for filiform warts?

Generally speaking, there is no such thing as "the best treatment for filiform warts." Treatments for filiform warts mainly include daily care with adjunctive therapy, physical therapy, drug therapy, surgical therapy, and traditional Chinese medicine (TCM) therapy. A detailed analysis is as follows:

1. Daily Care with Adjunctive Therapy

Daily care cannot directly remove warts, but it can help control the condition and prevent its spread. Patients should keep the affected area clean and dry, avoiding scratching that could damage the warts; personal items such as clothing and towels should be washed and disinfected separately to prevent viral transmission; at the same time, attention should be paid to regular rest and consumption of vitamin-rich foods to enhance physical immunity, thus creating favorable conditions for wart removal.

2. Physical Therapy

Physical therapy removes the affected tissue directly by acting on the warts. Common methods include cryotherapy, laser therapy, and electrocautery. Cryotherapy uses liquid nitrogen to freeze the warts, causing them to necrose and fall off, and is simple to perform. Laser therapy destroys the wart tissue with high-energy heat and offers high precision. Electrocautery removes warts using high-frequency electric current and is suitable for smaller warts. These methods can quickly eliminate warts and reduce the risk of viral spread, making them common clinical treatments.

3. Drug Therapy

Drug therapy can inhibit viral replication and promote wart removal through topical medications. Patients may use medications such as imiquimod cream, fluorouracil ointment, and tretinoin cream under medical guidance to improve symptoms. Imiquimod cream can regulate local immunity and enhance the body's ability to eliminate the virus. Fluorouracil ointment inhibits the proliferation of wart cells, causing the warts to necrose. Tretinoin cream promotes epidermal cell renewal and helps warts fall off; it should be used according to the prescribed guidelines.

4. Surgical Therapy

For larger warts, fewer in number, or when physical or drug treatments are ineffective, surgical therapy can be used, commonly known as wart excision. Surgery directly removes the warts through surgical methods, rapidly eliminating the diseased tissue and reducing the possibility of further viral spread. However, postoperative wound care is important to avoid secondary infection, so the procedure should be performed at a professional medical institution.

5. Traditional Chinese Medicine (TCM) Therapy

TCM believes that filiform warts are related to damp-heat accumulation and blood stasis. Treatment often uses heat-clearing and detoxifying herbs, as well as blood-activating and stasis-resolving herbs, such as Portulaca mixture and Taohong Siwu Decoction. In addition, external herbal washes, such as washing the affected area with a solution boiled from ingredients like Isatis root, Chinese indigo leaf, and Equisetum hyemale, can also help remove warts. Acupuncture can also regulate the body's qi and blood and may alleviate local discomfort caused by filiform warts; it should be performed under the guidance of a professional TCM practitioner.

In addition, patients should follow medical advice for standardized treatment and regular follow-ups during treatment, avoiding self-medication or handling warts on their own. If abnormalities such as redness, swelling, or increased pain at the wound site occur after treatment, timely medical attention should be sought. Patients with hyperthyroidism or hypothyroidism should inform their doctor of their condition before treatment to allow for adjustment of the treatment plan.