Comparison of 40% trichloroacetic acid and cryotherapy for the treatment of plantar warts: A single‐blind,randomized clinical trial

Plantar warts can cause pain near the toes and the sole of the foot and may result in referral for treatment. This study was aimed at comparing 40% trichloroacetic acid (TCA) and cryotherapy (Cryo) for the treatment of plantar warts. This single‐blind, randomized clinical trial was performed on 60 subjects presenting with plantar wart in Sabzevar, Iran in 2018. The first intervention group was treated with 40% TCA in four sessions within 4 weeks. The second intervention group was treated with Cryo using liquid nitrogen in four sessions within 8 weeks. The mean (SD) age of subjects was 20.16 ± 5.96 years and 68.33% (n = 41) were male. Although the resolution rate of warts in the TCA 40% group was greater than the Cryo group, there was no statistical association found between the two groups by adjusting age, sex, and basal time (P = .648). Findings suggest that although 40% TCA was almost as effective as Cryo in the treatment of plantar warts, considering the lower adverse effects of TCA 40% group as compared to the Cryo group, it could be a proper alternative.     

Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study.

OBJECTIVE--To compare patient tolerance and treatment efficacy of subcutaneous interferon (IFN) alpha 2a plus cryotherapy versus cryotherapy alone in treatment of primary anogenital (AG) warts. DESIGN--Randomised placebo controlled observer blind study. Statistical analysis was by chi square and Mann Whitney U tests. PATIENTS--60 patients with newly diagnosed AG warts. INTERVENTION--29 and 31 patients were treated with subcutaneous IFN alpha 2a plus cryotherapy or placebo injections plus cryotherapy, respectively. MAIN OUTCOME MEASURES--Clinical presence or absence of AG warts. Patients wart-free at 8 weeks were asked to re-attend at 12 weeks; those with persistent warts at 8 weeks were withdrawn from the study. RESULTS--At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not significant); corresponding figures at 12 week review were 29.6% (8/27 patients) and 40% (10/25 patients) respectively (not significant). There was no difference in treatment response between males and females. Recurrence of warts at three month review, in patients cleared of warts at 8 weeks, was seen in 50% (8/16) and 37.5% (6/16) of patients in the IFN and placebo groups respectively (not significant). Multiple warts and the presence of perianal/anal canal warts, either alone or concurrent with warts on the genitalia, at first clinic attendance, were adverse prognostic indicators (p less than 0.001, and p = 0.05 respectively). Cervical human papilloma virus (HPV) infection, exophytic or subclinical, was present in 58.3% and 77.2% of females in the IFN and placebo groups respectively, at trial entry. Although these lesions were not directly treated, colposcopic resolution was seen in 12.5% of affected women, in both treatment groups, by the end of the 7 week treatment period. Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p less than 0.01). Severe influenza like symptoms occurred, after the first three injections only, in one patient treated with IFN; all other reported side effects were mild. CONCLUSIONS--Subcutaneous IFN alpha 2a combined with cryotherapy is no more effective than cryotherapy alone in the treatment of primary AG warts. The presence of multiple warts and perianal/anal canal warts are adverse prognostic indicators.     

Silver duct tape occlusion in treatment of plantar warts in adults: Is it effective?

Duct tape occlusive therapy may represent a convenient alternative to the standard wart therapies. The objective of the current study is to assess the therapeutic effect of duct tape occlusion in comparison to cryotherapy in treatment of plantar warts in adults, in a prospective comparative randomized non‐inferiority design. A total of 100 patients presenting with plantar warts were divided into two equal groups. First group was treated with silver duct tape occlusion for up to 8 weeks or disappearance of warts, whichever occurred first. Second group was treated with cryotherapy every 2 to 3 weeks for a maximum of four sessions or disappearance of warts. There was a statistically significant lower rate of complete resolution in duct tape than cryotherapy group (20% vs 58%, P = .0001, respectively). Degree of response to treatment in the duct tape and cryotherapy groups was not correlated to patients' age (P = .361 and .334, respectively) or disease duration (P = .266 and .285, respectively), while there was a statistically significant inverse relationship between the number (P = .0032 and .001, respectively) and diameter of warts (P = .013 and .003, respectively) and the degree of response in the two studied groups. Cryotherapy has higher efficacy than duct tape in the treatment of plantar warts in adults; however, duct tape may represent a practical and convenient alternative to cryotherapy in certain circumstances.     

Imiquimod cream 5% for recalcitrant cutaneous warts in immunosuppressed individuals

BACKGROUND: Viral warts may cause significant morbidity in individuals unable to mount an adequate T-helper 1 cell-mediated immune response to human papillomavirus. Imiquimod is a potent inducer of antiviral cytokine activity which has shown significant efficacy in the treatment of genital warts. Similar efficacy in cutaneous warts is not yet established. OBJECTIVES: To assess the response of persistent cutaneous warts to 5% imiquimod cream in immunosuppressed individuals. METHODS: Fifteen immunosuppressed patients with warts on the hands and/or feet present for more than 18 months, which had failed to respond to a minimum of 12 weeks of topical salicylic acid and four cycles of cryotherapy, were recruited. Imiquimod 5% cream was applied in an open label, right vs. left comparison study for 24 weeks (three times weekly for 8 weeks, daily for 8 weeks, then daily with occlusion for 8 weeks). RESULTS: Twelve (80%) patients completed the study protocol. Benefit was seen in five patients [36% in the intent-to-treat analysis (14 patients)], including more than 30% clearance of warts in three patients and reduction in overall size of warts in two further cases. Local skin reactions occurred in four (29%) patients and were usually mild. A transient rise in creatinine (11-29% above baseline) was measured in three renal transplant recipients, but we did not consider that this was related to imiquimod exposure. CONCLUSIONS: This is the first controlled study to assess therapeutic efficacy of topical 5% imiquimod cream in persistent warts associated with immunosuppression. It provides preliminary evidence that topical imiquimod may benefit a subgroup of immunosuppressed patients with recalcitrant cutaneous warts.     

Cantharidin–podophylotoxin–salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study

Background Plantar warts are refractory to any form of treatment. High cure rates have been reported with a topical proprietary formulation consisting of 1% cantharidin, 5% podophyllotoxin and 30% salicylic acid (CPS). However, no data exists comparing the efficacy of this formulation with another treatment. Cryotherapy is a method that is also widely used in the treatment of plantar warts. Likewise, there is no evidence that it is more effective than any topical treatment. Objective We aim to compare the efficacy of topical CPS and cryotherapy in the treatment of plantar warts. Methods Patients with plantar warts were consecutively treated with either cryotherapy or topical CPS. Both treatments were performed every 2 weeks for up to five sessions. In patients without complete clearance, the therapy was switched to the other treatment option. Results Twenty‐six patients with a total of 134 warts were included. Fourteen patients were completely cleared of their warts with topical CPS, whereas only in five of 12 patients (41.7%) warts were completely cleared with cryotherapy (P = 0.001). In seven patients without complete clearance, the therapy was switched to CPS. Four of these patients missed the follow‐up. While the two of the remaining three patients were cleared of their warts, one patient’s warts still failed to clear. Conclusion Topical CPS is more effective than cryotherapy in the treatment of plantar warts.     

Comparative study of autoimplantation therapy and intralesional injection of MMR vaccine in warts treatment

Autoimplantation is a simple technique and considered as a novel method of immunotherapy in treating warts. Intralesional immunotherapy by mumps, measles, and rubella (MMR) vaccine is also a promising treatment modality for multiple warts. To compare the efficacy and safety of both the methods in treating multiple warts, the study included 80 patients divided into two groups (Group A and Group B), each containing 40 patients. Informed consent was taken from each patient before enrollment into the study. Group A patients were treated by autoimplantation technique every 2 weeks for a maximum of four treatments. Similarly, Group B patients received MMR intralesional injection at a dose of 0.5 ml every 2 weeks for a maximum of four treatments. Complete clearance of the donor wart was observed in 60% patients in Group A, whereas complete clearance in the Group B injected by MMR was 72.5%. On the other hand, a significant difference (p < .05) was found in the therapeutic response among nonmanipulated warts in both groups, where complete clearance was observed in 47.5% of Group A patients versus 20% of Group B patients. Autoimplantation is a suitable approach for patients with multiple warts associated with distant lesions, while MMR injection is ideal for a single or fewer number of warts.     

Topical 5-fluorouracil has no additional benefit in treating common warts with cryotherapy: a single-centre, double-blind, randomized, placebo-controlled trial

The role of topical 5-fluorouracil (5-FU) in treating common warts is not well defined. We tried to evaluate the efficacy and adverse effects of combination cryotherapy and topical 5% 5-FU ointment in the treatment of common warts. The study was a single-centre, double-blind randomized placebo-controlled trial. In the study, 80 patients with common warts were randomized into two groups and underwent two 10-second freeze/thaw cycles of cryotherapy with liquid nitrogen once every three weeks for a maximum of five treatments. Between treatments, patients applied either topical 5% 5-FU ointment (group A) or placebo aqueous cream (group B) twice daily. The mean +/- SD reduction in wart area was 58.57 +/- 0.06% in group A and 65.29 +/- 0.06% in group B. In total, 19 patients in group A and 24 patients in group B had wart size reduced by 75% or more (P = 0.50), while 12 patients in group A and 17 patients in group B had clearance of their warts (P = 0.245). Logistic regression with age, sex, smoking status, immune status, site, duration and number of warty lesions, history of previous treatment, and treatment group found that only a history of previous treatment and acral lesions were significant adverse predictors of improvement. There was no significant difference in the number of adverse events between the two groups, although there was a trend towards more pain and blistering associated with topical 5-FU. We concluded that topical 5-FU has no added benefit in treating common warts with cryotherapy.     

Human papillomavirus typing of warts and response to cryotherapy

Background Cutaneous warts are common and caused by a number of different types of human papillomaviruses (HPVs). Objective The aim of this study was to investigate the HPV types causing common warts and to determine any association between the HPV type and the duration of warts and response to cryotherapy. Methods Eighty wart samples from 76 immunocompetent patients were taken from warts by paring prior to cryotherapy and analysed by in situ hybridization (ISH) with HPV probes specific to HPV 1, 2, 3, 4, 7, 10 and 57 and PCR analysis using degenerate cutaneous HPV primers with subsequent DNA sequencing. Each patient's details, including site, duration and response of the wart to cryotherapy were recorded. Cryotherapy was performed at 2 week intervals for a maximum of 12 weeks. Results An HPV type was identified in 65 samples. The majority of warts (58 samples) were typed as HPV 2/27/57 by ISH and/or PCR. Three of the 18 samples that were HPV negative with ISH were HPV positive by PCR. Response to treatment did not correlate with HPV type, duration or location. In the 21 wart parings taken from patients aged 16 and under, response to treatment did not correlate with HPV type but warts of shorter duration were more likely to resolve with cryotherapy treatment than longer standing lesions. Conclusion This study demonstrates that HPV type can be determined from wart parings. HPV‐2 related viruses are the prevalent HPV types causing common warts on the hands and feet in this population.     

Cryotherapy Versus Podophyllin in the Treatment of Genital Warts

572 patients with solitary or multiple genital warts attending the Department of Genitourinary Medicine at the Royal Victoria Hospital, Bournemouth, U.K. between January 1981 and December 1981 were allocated to either podophyllin or cryotherapy for the treatment of their warts. Of 350 patients successfully treated for their warts and returned for a follow-up examination 6 weeks or more after completing their treatment, 206 (139 men and 67 women) were treated with podophyllin, and 144 (86 men and 58 women) with cryotherapy. One hundred five (51%) of those treated with podophyllin and 114 (79%) treated with cryotherapy were free of warts at their follow-up examination. Patients treated with podophyllin required a mean of 6.7 +/- SD 3.5 treatments over a mean of 4.7 +/- SD 2.4 weeks, whereas those receiving cryotherapy required a mean of 2.6 +/- SD 2.0 applications over a mean of 2.3 +/- SD 1.2 weeks.     

Efficacy and safety of cryotherapy vs. trichloroacetic acid in the treatment of solar lentigo

Background Solar lentigines are common sun‐induced benign melanocytic proliferation that presents a significant cosmetic worrying for many middle‐aged and elderly patients. Although the newer photoselective lasers have become the mainstay of treatment, cryotherapy and trichloroacetic acid (TCA) solution are inexpensive alternatives in the treatment of solar lentigines. The purpose of this study was to assess the efficacy of cryotherapy compared with TCA 33% on solar lentigines of the back of the hands (SLBH) in patients presenting to dermatologic clinic of our hospital. Methods Each hand of 25 women with SLBH was treated randomly with either cryotherapy or TCA 33% solution. Photographs of the hands were taken prior to and 2 months following the treatment. The response and side‐ effect rate were compared. Results Cryotherapy was more likely to produce substantial lightening of the solar lentigines than TCA 33% solution (P = 0.025) but more painful and took more time to heal. Post‐inflammatory hyperpigmentation (PIH) was almost equal in two types of treatment (P > 0.05). Statistically, the better results were seen in fairer Fitzpatrick's skin types (P = 0.00). Conclusion Cryotherapy shows better results than TCA 33% solution in the treatment of SLBH particularly in lower Fitzpatrick skin types. PIH is the major complication of each type of treatments particularly in darker Fitzpatrick skin types. Generally, the major criterion for treatment of SLBH with cryotherapy or TCA is Fitzpatrick's skin type of patients.     

Cryotherapy Versus Podophyllin in the Treatment of Genital Warts

Abstract: 572 patients with solitary or multiple genital warts attending the Department of Genitourinary Medicine at the Royal Victoria Hospital, Bournemouth, U.K. between lanuary 1981 and December 1981 were allocated to either pedophilic or cryotherapy for the treatment of their warts. Of 350 patients successfully treated for their warts and returned for a follow-up examination 6 weeks or more after completing their treatment, 206 (139 men and 67 women) were treated with pedophilic, and 144 (86 men and 58 women) with cry therapy. One hundred five (51 %) of those treated with pedophilic and 114 (79%) treated with cryotherapy were free of warts at their follow-up examination. Patients treated with podophyllin required a mean of 6,7 SD 3.5 treatments over a mean of 4.7 SD 2.4 weeks, whereas those receiving cryotherapy required a mean of 2.6 SD 2.0 applications over a mean of 2.3 SD 1.2 weeks.     

Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: A randomized controlled trial

The effect of thermotherapy in the treatment of skin warts in comparison to cryotherapy, as the standard conventional method, has remained uncertain. This study aimed to assess the clinical efficacy and safety of thermotherapy and cryotherapy in removing skin warts. This randomized controlled trial was conducted on 52 patients aged 18 years and over with ≤ 10 skin warts. The participants were randomly assigned into two groups to receive cryotherapy (every 2 to 3 weeks up to six sessions if required) or thermotherapy (one session). The patients in both groups were followed every 2 to 3 weeks for the first three months, and then three months after the last treatment session. The clearance rate was 79.2% in the thermotherapy group and 58.3% in the cryotherapy group with no significant difference (p = 0.212). The rate of scarring in the thermotherapy group was 20% (p = .018). A higher clearance rate was achieved in the thermotherapy group. However, this result was not statistically significant. There were some minimal post‐treatment complications. Patients needed only one session of thermotherapy. Due to the risk of scarring, we suggest thermotherapy only as a suitable treatment method for palmoplantar warts.     

OK-432 Therapy for Recalcitrant Warts

Twelve patients with warts recalcitrant to various treatments, including cryotherapy, were treated with OK-432 injection therapy. Six patients received only subcutaneous injection, three received only intralesional injection, and the other three received both subcutaneous and intralesional injections. Complete clearing of the warts occurred in nine (75%) of 12 patients, while the other three patients were not cured. Grouping the patients by the method of injection, the success rate of subcutaneous injection was 5/9 (55.6%), and that of intralesional injection was 4/6 (66.7%). Although five patients complained of mild fever and malaise, these side effects gradually disappeared during the repeated injections. OK-432 injection is considered as a hopeful therapy for recalcitrant warts.     

Effectiveness of intralesional vitamin D3 injection in the treatment of common warts: Single‐blinded placebo‐controlled study

Warts are common viral infection of the skin, usually treated with destructive methods like electrocautery, cryotherapy or laser ablation. Topical vitamin D has been used to treat warts with variable success is to evaluate the efficacy of intralesional vitamin D₃ injection in the treatment of common warts. Fifty patients were divided into two groups: 30 patients as cases group who received intralesional injection of 0.2 mL of vitamin D₃ (300,000 IU) into the base of mother wart for two sessions and another 20 patients as a control group who were injected with normal saline solution. Standardized photographs were taken before the procedure, and 1 month and 3 months after the procedure. The degree of the response was classified into complete, partial, and no response. Complete clearance of the target injected warts occurred in 40% of patients in cases group while it occurred only in 5% of patients in control group (p ≤ .001) that was statistically significant. Intralesional injection of vitamin D₃ may be considered a good and safe modality for the treatment of common warts.     

Cryotherapy as a treatment for psoriasis

There are very few publications on the use of cryotherapy in the treatment of psoriasis. We performed an evaluation to determine its efficacy in small plaque psoriasis. We selected 63 patients who had a clinical diagnosis of chronic plaque-type psoriasis and and for each patient we evaluated two psoriatic plaques of almost the same size and severity on similar areas of the body. One plaque was sprayed with liquid nitrogen every other day for two weeks and the other plaque was untreated as a control. Complete resolution of the plaque occurred in four patients (6.35 %), mild to moderate resolution was evident in 19 cases (30.1 %), and no improvement occurred in 40 patients (63.5 %). Only one complication, superimposed infection, occurred. Cryotherapy may mediates mild resolution of plaques by inducing normal re-epithelization following the physical destruction of the lesions via a reverse Koebner phenomenon. Our findings suggest that cryotherapy is safe to use in the treatment of small-plaque psoriasis but that its efficacy is limited.     

Management of Female Genital Warts with an Analog of Imiquimod 2% in Cream: A Randomized,Double-Blind,Placebo-Controlled Study

The purpose of this randomized, double-blind, placebo-controlled study was to determine the clinical efficacy and tolerability of an analog of imiquimod (2%) in cream to cure genital warts in women. Sixty preselected women, ranging between 18 and 45 years of age (mean 24.3) and having 411 lesions (mean 6.8) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient received a precoded 40-g tube and instructions on how to apply the trial medication to their lesions at home two times daily for five consecutive days per week. The active treatment period was six weeks. Patients were evaluated on a weekly basis. A clinically and PCR established total clearance of target warts was recorded as a cure. By the end of the treatment, 43.3% of patients and 42.8% of warts were cured. Code disclosure revealed that imiquimod cream had cured 83.3% of the treated patients and 84.3% of the treated warts, while the placebo healed one subject and four warts (p<0.0001). Eight patients (13.3%) in the imiquimod group experienced mild to moderate, non-objective, drug-induced symptoms with no dropouts. Among the 26 cured patients, five had a relapse after 11 months. In conclusion, the data presented demonstrate that 2% imiquimod in cream with mild to moderate subjective side effects is significantly more effective than placebo in eliminating genital warts in women.     

The SILVER study. Efficacy of topical nitric‐zinc complex solution in the treatment of resistant warts: A postmarketing evaluation

The treatment of cutaneous viral warts caused by human papillomavirus (HPV) infection is often subject to local recurrence and a long clinical and treatment course. Our aim was to analyze real‐life data on the treatment of difficult‐to‐treat warts from a multicenter postmarketing surveillance assessment on the efficacy, tolerability, and safety of a commercially available nitric‐zinc complex solution (NZCS). Dermatologists from 14 Italian centers completed a questionnaire about their clinical experience on treatment of “difficult‐to‐treat” warts, which included warts in the plantar, periungual, anogenital and aesthetically sensitive areas. The questionnaire was designed to obtain detailed information on wart treatment and compare NZCS efficacy with previous treatments. Of 106 questionnaires returned, 83 reported NZCS use; 67 had previous treatments (23 cryotherapy, 2 electrocoagulation, 12 other topical application, and 30 combined treatment, such as laser, cryotherapy, and/or electrocoagulation). NZCS had superior efficacy to that of previous treatments (p < .0001), resulting in 84.1% with a full or partial clearance (vs. 44.8% for previous treatments), and had better local tolerability (p < .0001). NZCS showed better efficacy and tolerability than other previous wart treatments.     

Smoke from leaves of Populus euphratica Olivier vs. conventional cryotherapy for the treatment of cutaneous warts: a pilot, randomized, single-blind, prospective study

Background Populous Euphratica tree which belongs to Salicaceae family is naturally distributed in many parts of the world. Our purpose was to compare the therapeutic effects of smoke of its burnt leaves with conventional cryotherapy in patients with warts. Methods Sixty consecutive wart patients were randomly treated with leaves of Populous Euphratica tree (Group A) or conventional cryotherapy (Group B) and were followed up for 22 weeks. Results The respective end results in group A and group B were; Complete cure rates 66.7% vs. 46.4% (P= NS), partial resolution rates 8.3% vs. 14.3% (P= NS). The recurrence rate however, was 4.2% in group A and 32.2% in group B patients (P= 0.024). Conclusion The smoke of burnt leaves of Populus Euphratica tree can be equally effective for treatment of hand and foot warts as cryotherapy.     

Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial

In spite of many available studies on bleomycin and cryotherapy in treating warts, little head to head research is done to compare efficacy of these treatments. Our aim was to compare the therapeutic effects of intralesional bleomycin and cryotherapy on common warts of the hands and feet. In this clinical trial 44 patients above 12 years of age referred to the dermatology clinic of Bouali University Hospital were enrolled. The patients were required to have warts on at least two symmetric limbs (hands or feet). The warts located on right and left limbs of each patient were examined and counted. Each patient received both cryotherapy and intralesional bleomycin on his or her warts. The two treatment types were randomly allocated to either right sided or left sided warts. Each patient was evaluated at 2 week intervals and retreated if necessary up to three times. Data were analyzed by SPSS 11 and EPI Info 2002 statistical packages. The mean number of warts was 5.2 on upper limbs and 4.6 on lower limbs. In 86.4 percent of the cases all warts on the limb side treated by intralesional bleomycin were cleared compared with 68.2 % for cryotherapy (P<0.05). Relative risk for the effect of bleomycin compared to cryotherapy in this regard was 1.27 (1相似文献   

Intralesional injection of measles,mumps, and rubella vaccine versus cryotherapy in treatment of warts: A randomized controlled trial

Cutaneous warts are benign hyperkeratotic papillomas resulting from infection by human papillomavirus (HPV). Cryotherapy is a known method for warts treatment. Immunotherapy stimulates HPV recognition by the immune system; this helps resolution of warts. To determine the efficacy of intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine versus cryotherapy in the treatment of patients with multiple common and plantar warts. Forty‐eight patients with multiple common and plantar warts were divided into two groups: to undergo either intralesional injection of MMR vaccine (Group A), or cryotherapy (Group B). Forty patients completed the study. In the MMR group, 70% of the patients showed complete response, 5% partial response, and 25% showed no response to treatment. In the CRYO group, 45% of the patients showed complete response, 35% partial response, and 20% showed no response to treatment. The complete response was higher in the MMR group (70%) as compared to the CRYO group (45%), but the difference between the two groups was not statistically significant. Meanwhile, the partial response was significantly higher in the CRYO group. Intralesional MMR injection was a safe and effective treatment for multiple common and plantar warts as compared to cryotherapy.