Clinical reports: Cryotherapy most effective for common warts

Cryotherapy may be more effective than salicylic acid or a wait and see approach, based on a RCT reported online September 13 in the Canadian Medical Association Journal.

Highlights of the study from Medscape CME dermatology article (free registration required):

• Randomized controlled trial at 30 primary care practices in the Netherlands between May 1, 2006, and January 26, 2007
• Two hundren and fifty consecutive (250) eligible patients (4 - 79 years) with new cutaneous warts.
• Fourty-nine percent (122) were common warts and 51% (128) were plantar warts.
• Treatment groups
• cryotherapy with liquid nitrogen every 2 weeks
• daily self-application of salicylic acid
• wait-and-see approach.
• Overall cure rate at 13 weeks
• 39% with cryotherapy (95% CI, 29% - 51%)
• 24% with salicylic acid (95% CI, 16% - 35%)
• 16% (95% CI, 9.5% - 25%) with the wait-and-see approach.
• Cure rate for common warts at 13 weeks
• 49% with cryotherapy (95% CI, 34% - 64%)
• 15% with salicylic acid (95% CI, 7% - 30%)
• 8% with the wait-and-see approach.
• For plantar warts, no significant differences in cure rates.
• Children with plantar warts had relatively high cure rates of approximately 50% regardless of treatment. 
• Adolescents and adults had cure rates of only approximately 5%.
• Compared with topical salicylic acid, cryotherapy was associated with more frequent and more severe adverse effects

CMAJ. Published online September 13, 2010