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Evidence summaries

Local Treatments for Cutaneous Warts

Topical treatments containing salicylic acid are effective for cutaneous warts. Evidence on other forms of treatment is limited. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 85 studies with a total of 8 815 subjects. Salicylic acid (SA) compared with placebo significantly increased the chance of clearance of warts at all sites (RR 1.56, 95% CI 1.20 to 2.03; 6 studies, n=486). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01; 2 studies, n=120) and feet (RR 1.29, 95% CI 1.07 to 1.55; 2 studies, n=139), suggested it might be more effective for hands than feet.

A meta-analysis of cryotherapy versus placebo for warts at all sites favoured neither intervention nor control (RR 1.45, 95% CI 0.65 to 3.23; 3 studies, n=227). One trial showed cryotherapy to be better than both placebo and SA, but only for hand warts. There was no significant difference in cure rates between cryotherapy at 2-, 3-, and 4-weekly intervals. Aggressive cryotherapy appeared more effective than gentle cryotherapy (RR 1.90, 95% CI 1.15 to 3.15), but with increased adverse effects. Meta-analysis did not demonstrate a significant difference in effectiveness between cryotherapy and SA at all sites (RR 1.23, 95% CI 0.88 to 1.71; 4 studies, n=707) or in subgroup analyses for hands and feet. Two trials (n= 328) showed that SA and cryotherapy combined appeared more effective than SA alone (RR 1.24, 95% CI 1.07 to 1.43).

The benefit of intralesional bleomycin remains uncertain as the evidence was inconsistent. The most informative trial with 31 participants showed no significant difference in cure rate between bleomycin and saline injections (RR 1.28, 95% CI 0.92 to 1.78). Dinitrochlorobenzene was more than twice as effective as placebo in 2 trials with 80 participants (RR 2.12, 95% CI 1.38 to 3.26). Two trials of clear duct tape with 193 participants demonstrated no advantage over placebo (RR 1.43, 95% CI 0.51 to 4.05).

It was not possible to combine data from trials of the following treatments: intralesional 5-fluorouracil, topical zinc, silver nitrate (which demonstrated possible beneficial effects), topical 5-fluorouracil, pulsed dye laser, photodynamic therapy, 80% phenol, 5% imiquimod cream, intralesional antigen, and topical alpha-lactalbumin-oleic acid (which showed no advantage over placebo). No RCTs evaluating surgery (curettage, excision), formaldehyde, podophyllotoxin, cantharidin, diphencyprone, or squaric acid dibutylester were identified.

    References

    • Kwok CS, Gibbs S, Bennett C et al. Topical treatments for cutaneous warts. Cochrane Database Syst Rev 2012;(9):CD001781. [PubMed]

Primary/Secondary Keywords