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BMJ Clin Evid. 2014; 2014: 1710.
Published online 2014 Jun 12.
PMCID: PMC4054795
PMID: 24921240
Steven King-fan Loo, Consultant Dermatologist# and William Yuk-ming Tang, Dermatologist in private practice#
Author information Copyright and License information PMC Disclaimer
Abstract
Introduction
Warts are caused by the human papillomavirus (HPV), of which there are over 100 types. HPV probably infects the skin via areas of minimal trauma. Risk factors include use of communal showers, occupational handling of meat, and immunosuppression. In immunocompetent people, warts are harmless and resolve as a result of natural immunity within months or years.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for warts (non-genital)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results
We found 17 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions
In this systematic, review we present information relating to the effectiveness and safety of the following interventions: intralesional bleomycin; intralesional candida antigen; contact immunotherapy; cryotherapy; duct tape occlusion; photodynamic treatment; pulsed dye laser; surgical procedures; and topical salicylic acid.
Key Points
Warts are caused by the human papillomavirus (HPV), of which there are over 100 types. HPV probably infects the skin via areas of minimal trauma.
Risk factors include use of communal showers, occupational handling of meat, and immunosuppression.
In immunocompetent people, warts are harmless and resolve as a result of natural immunity within months or years.
For what is such a common condition, there are few large, high-quality RCTs available to inform clinical practice.
Topical salicylic acid increases the cure rate of warts compared with placebo.
Cryotherapy may be as effective at increasing the cure rate of warts as topical salicylic acid, but we don't know about wart recurrence. We found insufficient evidence on the effects of cryotherapy versus placebo.
Contact immunotherapy with dinitrochlorobenzene may increase wart clearance compared with placebo, but it can cause inflammation.
We don't know whether intralesional bleomycin speeds up clearance of warts compared with placebo, as studies have given conflicting results.
We found no systematic reviews or RCTs about the effects of intralesional candida antigens.
We don't know whether duct tape occlusion, pulsed dye laser, photodynamic treatment, or surgery increase cure rates compared with placebo, as few high-quality studies have been found.
We found limited evidence from one small RCT that photodynamic treatment plus topical salicylic acid may increase the proportion of warts cured compared with placebo plus topical salicylic acid; however, it may increase pain or discomfort compared with placebo.
About this condition
Definition
Non-genital warts (verrucas) are an extremely common, benign, and usually a self-limited skin disease. Infection of epidermal cells with the human papillomavirus (HPV) results in cell proliferation and a thickened, warty papule on the skin. There are over 100 different types of HPV. The appearance of warts is determined by the type of virus and the location of the infection. Any area of skin can be infected, but the most common sites are the hands and feet. Genital warts are not covered in this review (see review on Genital warts). We have also excluded RCTs in people with immunosuppression in this review. Common warts are most often seen on the hands and present as skin-coloured papules with a rough 'verrucous' surface. Flat warts are most often seen on the backs of the hands and on the legs. They appear as slightly elevated, small plaques that are skin-coloured or light brown. Plantar warts occur on the soles of the feet and look like very thick callouses.
Incidence/Prevalence
There are few reliable, population-based data on the incidence and prevalence of non-genital warts. Prevalence probably varies widely between different age groups, populations, and periods of time. Two large population-based studies found prevalence rates of 0.84% in the US and 12.9% in Russia. Prevalence is highest in children and young adults, and two studies in school populations have shown prevalence rates of 12% in 4- to 6-year-olds in the UK and 24% in 16- to 18-year-olds in Australia.
Aetiology/Risk factors
Warts are caused by HPV, of which there are over 100 different types. They are most common at sites of trauma, such as the hands and feet, and probably result from inoculation of virus into minimally damaged areas of epithelium. Warts on the feet can be acquired from walking barefoot in areas where other people walk barefoot. One observational study (146 adolescents) found that the prevalence of warts on the feet was 27% in those that used a communal shower room and 1.3% in those that used the locker (changing) room. Warts on the hand are also an occupational risk for butchers and meat handlers. One cross-sectional survey (1086 people) found that the prevalence of warts on the hand was 33% in abattoir workers, 34% in retail butchers, 20% in engineering fitters, and 15% in office workers. Immunosuppression is another important risk factor. One observational study in immunosuppressed renal transplant recipients found that, at 5 years or longer after transplantation, 90% had warts.
Prognosis
Non-genital warts in immunocompetent people are harmless and usually resolve spontaneously as a result of natural immunity within months or years. The rate of resolution is highly variable and probably depends on several factors, including host immunity, age, HPV type, and site of infection. One cohort study (1000 children in long-stay accommodation) found that two-thirds of warts resolved without treatment within a 2-year period.
Aims of intervention
To eliminate warts, with minimal adverse effects.
Outcomes
Wart clearance (generally accepted as complete eradication of warts from the treated area); reduction in number of warts (if wart clearance not reported); wart recurrence; and adverse effects of treatment.
Methods
Clinical Evidence search and appraisal October 2013. The following databases were used to identify studies for this systematic review: Medline 1966 to October 2013, Embase 1980 to October 2013, and The Cochrane Database of Systematic Reviews 2013, issue 9 (1966 to date of issue). Additional searches were carried out in the Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment (HTA) Database. We also searched for retractions of studies included in the review. Titles and abstracts identified by the initial search, run by an information specialist, were first assessed against predefined criteria by an evidence scanner. Full texts for potentially relevant studies were then assessed against predefined criteria by an evidence analyst. Studies selected for inclusion were discussed with an expert contributor. All data relevant to the review were then extracted by an evidence analyst. Study design criteria for inclusion in this review were: published systematic reviews and RCTs in the English language, blinded or open label trials, studies of any size of which more than 80% of participants were followed up. There was a minimum follow-up of 4 weeks. We included RCTs and systematic reviews of RCTs where harms of an included intervention were assessed, applying the same study design criteria for inclusion as we did for benefits. In addition, we use a regular surveillance protocol to capture harms alerts from organisations such as the FDA and the MHRA, which are added to the reviews as required. To aid readability of the numerical data in our reviews, we round many percentages to the nearest whole number. Readers should be aware of this when relating percentages to summary statistics such as relative risks (RRs) and odds ratios (ORs). We have performed a GRADE evaluation of the quality of evidence for interventions included in this review (see table). The categorisation of the quality of the evidence (high, moderate, low, or very low) reflects the quality of evidence available for our chosen outcomes in our defined populations of interest. These categorisations are not necessarily a reflection of the overall methodological quality of any individual study, because the Clinical Evidence population and outcome of choice may represent only a small subset of the total outcomes reported, and population included, in any individual trial. For further details of how we perform the GRADE evaluation and the scoring system we use, please see our website (www.clinicalevidence.com).
Table
GRADE Evaluation of interventions for Warts (non-genital).
| Important outcomes | Wart clearance, Wart recurrence | ||||||||
| Studies (Participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of treatments for warts (non-genital)? | |||||||||
| 6 (486) | Wart clearance | Topical salicylic acid versus placebo or no treatment | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for weak methods; directness points deducted for inclusion of co-interventions and trial heterogeneity |
| 2 (80) | Wart clearance | Contact immunotherapy (dinitrochlorobenzene) versus placebo or no treatment | 4 | –2 | 0 | –1 | +1 | Low | Quality points deducted for sparse data and inclusion of abstract in analysis; directness point deducted for unclear length of follow-up in 1 RCT; effect-size point added for RR >2 |
| 4 (247) | Wart clearance | Cryotherapy versus placebo or no treatment | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for weak methods; directness points deducted for no statistical analyses between groups in 1 RCT and for unclear length of follow-up in 1 RCT |
| 2 (42) | Wart clearance | Cryotherapy versus photodynamic treatment | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results; directness point deducted for inclusion of co-interventions |
| 5 (900) | Wart clearance | Cryotherapy versus topical salicylic acid | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for weak methods |
| 1 (240) | Wart recurrence | Cryotherapy versus topical salicylic acid | 4 | 0 | 0 | –2 | 0 | Low | Directness points deducted for no statistical analysis between groups and for inclusion of plantar warts only |
| 2 (318) | Wart clearance | Cryotherapy plus salicylic acid versus salicylic acid alone | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for unspecified blinding in 1 RCT; directness point deducted for inclusion of hand warts only in 1 RCT |
| 2 (328) | Wart clearance | Cryotherapy plus salicylic acid versus cryotherapy alone | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for unspecified blinding in 1 RCT; directness point deducted for inclusion of hand warts only in 1 RCT |
| 4 (592) | Wart clearance | Aggressive versus gentle cryotherapy | 4 | –1 | 0 | –2 | 0 | Very low | Quality point deducted for weak methods; directness points deducted for different definitions of aggressive and gentle between RCTs, and inclusion of co-interventions |
| 3 (313) | Wart clearance | Interval between cryotherapy | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for weak methods; directness point deducted for differences in populations |
| 2 (57) | Wart clearance | Photodynamic treatment versus placebo photodynamic treatment | 4 | –2 | 0 | –1 | 0 | Very low | Quality point deducted for sparse data and incomplete reporting of results; directness point deducted for inclusion of co-interventions |
| 1 (56) | Wart clearance | Different types of photodynamic treatment versus each other | 4 | –2 | 0 | –1 | 0 | Very low | Quality points deducted for sparse data and incomplete reporting of results; directness point deducted for no statistical analysis between groups |
| 4 (133) | Wart clearance | Intralesional bleomycin versus placebo | 4 | –1 | –1 | –2 | 0 | Very low | Quality point deducted for sparse data; consistency point deducted for conflicting results; directness points deducted for combined control group, and randomising by people but analysing by warts |
| 1 (26) | Wart clearance | Different concentrations of intralesional bleomycin | 4 | –3 | 0 | 0 | 0 | Very low | Quality points deducted for sparse data, exclusion of warts that spontaneously regressed from the analysis, and a high withdrawal rate in people receiving intralesional bleomycin 0.25% |
| 2 (117) | Wart clearance | Intralesional bleomycin versus cryotherapy | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data; directness point deducted for no statistical analysis between groups in 1 RCT |
| 2 (193) | Wart clearance | Duct tape occlusion versus placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data; directness point deducted for age differences between populations |
| 1 (17) | Wart recurrence | Duct tape occlusion versus placebo | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for sparse data; directness point deducted for subgroup analysis |
| 1 (61) | Wart clearance | Duct tape occlusion versus cryotherapy | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and poor outcome assessment |
| 1 (37) | Wart clearance | Pulsed dye laser versus placebo | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and not specifying number of warts per treatment group at baseline |
We initially allocate 4 points to evidence from RCTs, and 2 points to evidence from observational studies. To attain the final GRADE score for a given comparison, points are deducted or added from this initial score based on preset criteria relating to the categories of quality, directness, consistency, and effect size. Quality: based on issues affecting methodological rigour (e.g., incomplete reporting of results, quasi-randomisation, sparse data [<200 people in the analysis]). Consistency: based on similarity of results across studies. Directness: based on generalisability of population or outcomes. Effect size: based on magnitude of effect as measured by statistics such as relative risk, odds ratio, or hazard ratio.
Glossary
| Contact immunotherapy | Contact sensitisers such as dinitrochlorobenzene, diphencyprone, and squaric acid dibutyl ester result in allergic dermatitis, which stimulates an immune reaction in close proximity to the wart. |
| Cryotherapy | A destructive treatment based on the targeted freezing of tissue using liquid nitrogen, dimethyl ether propane, or carbon dioxide snow. Liquid nitrogen achieves the lowest temperatures and is now the most commonly used agent. |
| Low-quality evidence | Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. |
| Moderate-quality evidence | Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. |
| Photodynamic treatment | Combines the application of a photosensitising substance (usually aminolaevulinic acid) to the wart and subsequent irradiation with wavelengths of light that are absorbed by the photosensitising substance and lead to destruction of the target tissue. |
| Very low-quality evidence | Any estimate of effect is very uncertain. |
Notes
Disclaimer
The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients. To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.
Notes
Genital warts
Contributor Information
Steven King-fan Loo, Hong Kong Adventist Hospital, , Hong Kong SAR.
William Yuk-ming Tang, , , Hong Kong SAR.
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- BMJ Clin Evid. 2014; 2014: 1710. »
- Salicylic acid (topical)
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
Topical salicylic acid increases the cure rate of warts compared with placebo.
Benefits and harms
Topical salicylic acid versus placebo or no treatment:
We found one systematic review (search date 2011), which identified six RCTs (486 people) comparing topical salicylic acid with placebo or no treatment.
Wart clearance
Topical salicylic acid compared with placebo or no treatment Topical salicylic acid may be more effective than placebo at increasing the cure rate of warts (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 486 people with warts 6 RCTs in this analysis | Cure ratetimeframe unclear 137/242 (57%) with topical salicylic acid 91/244 (37%) with placebo | RR 1.56 95% CI 1.20 to 2.03 P<0.001 Results should be interpreted with caution; see Further information on studies | Small effect size | topical salicylic acid |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
Systematic review | People with warts (number not clear) | Adverse effects with topical salicylic acid with placebo or no treatment |
Topical salicylic acid versus cryotherapy:
See option on Cryotherapy.
Further information on studies
One of the five RCTs included in the meta-analysis compared topical salicylic acid plus lactic acid versus placebo, and one compared topical salicylic acid plus monochloroacetic acid crystals versus placebo. The RCTs varied in their study design and methodology, and only one RCT was classified as having a high methodological quality. Trial heterogeneity and poor quality of the RCTs included in the review mean that the pooled results should be treated with caution.
None.
Substantive changes
Topical salicylic acid One systematic review updated. Categorisation unchanged (beneficial).
- BMJ Clin Evid. 2014; 2014: 1710. »
- Contact immunotherapy (dinitrochlorobenzene)
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
Contact immunotherapy with dinitrochlorobenzene may increase wart clearance compared with placebo, but it can cause inflammation.
Benefits and harms
Contact immunotherapy (dinitrochlorobenzene) versus placebo or no treatment:
We found one systematic review (search date 2011), which identified two RCTs (80 people) comparing contact immunotherapy (dinitrochlorobenzene) versus placebo.
Wart clearance
Contact immunotherapy compared with placebo or no treatment Contact immunotherapy using dinitrochlorobenzene may be more effective at increasing the proportion of people with wart clearance (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 80 people 2 RCTs in this analysis | Proportion of people with wart clearanceend of trial 32/40 (80%) with contact immunotherapy (dinitrochlorobenzene 2% solution followed by 1% solution) 15/50 (38%) with placebo or no treatment | RR 2.12 95% CI 1.38 to 3.26 NNT 2 95% CI 2 to 4 1 RCT included in the meta-analysis was published in only abstract form | Moderate effect size | contact immunotherapy |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | People with warts In review | Adverse effects with contact immunotherapy (dinitrochlorobenzene) with placebo or no treatment |
We found one systematic review that identified one RCT comparing dinitrochlorobenzene with cryotherapy; however, the data were published in only abstract form, which does not meet our reporting criteria and so is not discussed further.
Substantive changes
Contact immunotherapy (dinitrochlorobenzene) One systematic review updated. Categorisation unchanged (likely to be beneficial).
- BMJ Clin Evid. 2014; 2014: 1710. »
- Cryotherapy
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
Cryotherapy may be as effective at increasing the cure rate of warts as topical salicylic acid, but we don't know about wart recurrence.
We found insufficient evidence on the effects of cryotherapy versus placebo.
Benefits and harms
Cryotherapy versus placebo or no treatment:
We found one systematic review (search date 2011), which identified three RCTs (227 people), and one subsequent RCT comparing cryotherapy versus topical placebo cream or no treatment.
Wart clearance
Cryotherapy compared with placebo or no treatment We don't know whether cryotherapy is more effective than placebo at increasing the cure rate of warts after 2 to 4 months (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 227 people 3 RCTs in this analysis | Cure rate2 to 4 months 41/107 (38%) with cryotherapy 26/120 (22%) with placebo | RR 1.45 95% CI 0.65 to 3.23 P=0.36 | Not significant | |
RCT 3-armed trial | 12 people; 2 warts each treated | Cure ratetimeframe unclear 2/12 (17%) with cryotherapy 3/8 (38%) with placebo | Significance not assessed |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
No data from the following reference on this outcome.
Cryotherapy versus photodynamic treatment:
We found one systematic review (search date 2011), which identified one RCT (30 people) and one subsequent RCT comparing cryotherapy versus photodynamic treatment.
Wart clearance
Cryotherapy compared with photodynamic treatment Cryotherapy may be less effective than photodynamic treatment at reducing the number of warts after 4 to 6 weeks in people who also used topical salicylic acid plus lactic acid; however, evidence was weak. We don't know about wart clearance (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT 5-armed trial | 30 adults with recalcitrant hand and foot warts of different sizes and categories In review | % reduction in number of warts4 to 6 weeks 20% with cryotherapy 73% with 3 episodes of white light photodynamic treatment Absolute numbers not reported | P<0.01 | Effect size not calculated | white light photodynamic treatment |
RCT 5-armed trial | 30 adults with recalcitrant hand and foot warts of different sizes and categories In review | % reduction in number of warts4 to 6 weeks 20% with cryotherapy 71% with 1 episode of white light photodynamic treatment Absolute numbers not reported | Reported as significant; P value not reported | Effect size not calculated | white light photodynamic treatment |
RCT 5-armed trial | 30 adults with recalcitrant hand and foot warts of different sizes and categories In review | % reduction in number of warts4 to 6 weeks 20% with cryotherapy 42% with 3 episodes of red light photodynamic treatment Absolute numbers not reported | P=0.03 | Effect size not calculated | red light photodynamic treatment |
RCT 5-armed trial | 30 adults with recalcitrant hand and foot warts of different sizes and categories In review | % reduction in number of warts4 to 6 weeks 20% with cryotherapy 28% with 3 episodes of blue light photodynamic treatment Absolute numbers not reported | P=0.03 | Effect size not calculated | blue light photodynamic treatment |
RCT 3-armed trial | 12 people; 2 warts each treated | Cure ratetimeframe unclear 1/4 (25%) with aminolaevulinic acid plus blue light (5 treatments at 2–4 week intervals) 2/12 (17%) with cryotherapy | Significance not assessed |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT 5-armed trial | 30 adults with recalcitrant hand and foot warts of different sizes and categories In review | Adverse effects with cryotherapy with 3 episodes of white light photodynamic treatment with 1 episode of white light photodynamic treatment with 3 episodes of red light photodynamic treatment with 3 episodes of blue light photodynamic treatment |
No data from the following reference on this outcome.
Cryotherapy versus intralesional bleomycin:
See option on Intralesional bleomycin.
Cryotherapy versus topical salicylic acid:
We found one systematic review (search date 2011), which identified four RCTs (707 people), and one subsequent RCT comparing cryotherapy versus topical salicylic acid.
Wart clearance
Cryotherapy compared with topical salicylic acid Cryotherapy and topical salicylic acid seem to be equally effective at increasing wart cure rate at 3 to 6 months (moderate-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 707 people 4 RCTs in this analysis | Cure rate3 to 6 months 153/351 (44%) with cryotherapy 126/356 (35%) with topical salicylic acid | RR 1.23 95% CI 0.88 to 1.71 P=0.22 | Not significant | |
RCT | 193 people aged 12 years and over with warts | Cure rateat 6 months 33/98 (34%) with cryotherapy 29/95 (31%) with salicylic acid | Difference –3.1% 95% CI –10% to +16.3% P=0.64 | Not significant |
Wart recurrence
Cryotherapy compared with topical salicylic acid We don't know how effective cryotherapy is compared with salicylic acid at reducing the recurrence of warts at 6 months in people who had previously had complete wart clearance with either cryotherapy or salicylic acid (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart recurrence | |||||
RCT | 240 people, aged 12 years and over, with warts who had previously had complete wart clearance | Recurrenceat 6 months 15/110 (13.6%) cleared at 12 weeks with cryotherapy; 2 recurred at 6 months 17/119 (14.3%) cleared at 12 weeks with salicylic acid; 2 recurred at 6 months | Significance not assessed |
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 240 people aged 12 years and over with warts | Treatment-related adverse events 2/110 (2%) blisters larger than expected with cryotherapy 0/119 with salicylic acid | Significance not assessed | ||
RCT | 75 people with common warts | Pain 29/37 (78%) with cryotherapy 5/38 (13%) with salicylic acid | P<0.001 | Effect size not calculated | salicylic acid |
RCT | 77 people with plantar warts | Pain 31/37 (84%) with cryotherapy 4/40 (10%) with salicylic acid | P<0.001 | Effect size not calculated | salicylic acid |
RCT | 75 people with common warts | Blisters 22/37 (59%) with cryotherapy 2/38 (5%) with salicylic acid | P<0.001 | Effect size not calculated | salicylic acid |
RCT | 77 people with plantar warts | Blisters 16/37 (43%) with cryotherapy 5/40 (13%) with salicylic acid | P=0.003 | Effect size not calculated | salicylic acid |
No data from the following reference on this outcome.
Cryotherapy plus salicylic acid versus salicylic acid alone:
We found one systematic review (search date 2011), which identified two RCTs (318 people) comparing cryotherapy plus salicylic acid versus topical salicylic acid alone.
Wart clearance
Cryotherapy plus salicylic acid compared with topical salicylic acid alone Cryotherapy plus salicylic acid may be more effective than salicylic acid alone at improving wart clearance at 3 to 6 months. However, evidence was weak (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 318 people 2 RCTs in this analysis | Cure rate3 to 6 months 125/163 (77%) with cryotherapy plus salicylic acid 96/155 (62%) with salicylic acid alone | RR 1.24 95% CI 1.07 to 1.43 P=0.0042 | Small effect size | Cryotherapy plus salicylic acid |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
No data from the following reference on this outcome.
Cryotherapy plus salicylic acid versus cryotherapy alone:
We found one systematic review (search date 2011), which identified two RCTs (328 people) comparing cryotherapy plus salicylic acid versus cryotherapy alone.
Wart clearance
Cryotherapy plus salicylic acid compared with cryotherapy alone We don't know whether cryotherapy plus salicylic acid is more effective than cryotherapy alone at improving wart clearance at 3 to 6 months (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 328 people 2 RCTs in this analysis | Cure rate3 to 6 months 125/163 (77%) with cryotherapy plus salicylic acid 107/165 (65%) with cryotherapy alone | RR 1.20 95% CI 0.99 to 1.45 P=0.058 | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
No data from the following reference on this outcome.
Cryotherapy versus duct tape occlusion:
See option on Duct tape occlusion.
Aggressive versus gentle cryotherapy:
We found one systematic review (search date 2011), which identified four RCTs (592 people) comparing aggressive cryotherapy versus gentle cryotherapy.
Wart clearance
Aggressive cryotherapy compared with gentle cryotherapy Aggressive cryotherapy (not further defined) may be more effective than gentle cryotherapy (not further defined) at increasing the proportion of people with wart clearance after 1 to 3 months (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 592 adults 4 RCTs in this analysis | Proportion of people with wart clearance1 to 3 months 159/304 (52%) with aggressive cryotherapy 89/288 (31%) with gentle cryotherapy | RR 1.90 95% CI 1.15 to 3.15 NNT 5 95% CI 3 to 7 For details of methodological limitations, see Further information on studies | Small effect size | aggressive cryotherapy |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 200 people with warts | Pain or blistering 64/100 (64%) with aggressive cryotherapy 44/100 (44%) with gentle cryotherapy | RR 1.45 95% CI 1.12 to 2.31 NNH 5 95% CI 3 to 15 | Small effect size | gentle cryotherapy |
Interval between cryotherapy:
We found one systematic review (search date 2011), which identified three RCTs (313 people) comparing intervals of cryotherapy.
Wart clearance
More frequent cryotherapy compared with less frequent cryotherapy We don't know how cryotherapy given more frequently compares with cryotherapy given less frequently (2 weeks apart v 3 weeks apart) at improving wart clearance after 3 to 8 months (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 313 people 3 RCTs in this analysis | Proportion of people with wart clearance3 to 8 months 77/158 (49%) with 2-week interval between cryotherapy treatments 70/155 (45%) with 3-week interval between cryotherapy treatments | RR 1.03 95% CI 0.77 to 1.37 | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | People with warts In review | Proportion of people with pain, blistering, or both 29% with cryotherapy at 1-weekly intervals 7% with cryotherapy at 2-weekly intervals 0% with at 3-weekly intervals | Significance not assessed |
Further information on studies
Aggressive versus gentle cryotherapy: definitions of 'aggressive' and 'gentle' differed between RCTs in the systematic review, and some RCTs included warts that were resistant to treatment and others did not. In one RCT, all people received topical salicylic acid plus lactic acid and, in another, people in the aggressive treatment group received lactic acid whereas people in the gentle treatment group did not. The review reported that "although these trials were in different populations, on different types of warts and used different definitions of aggressive and gentle, it was felt that the results could be usefully combined for analysis".
The evidence from available RCTs about cryotherapy is both limited and contradictory. Heterogeneity of study design, methodology, and the populations included make it extremely difficult to draw firm conclusions. For example, some RCTs identified by the review included all types of wart on the hands and feet in all age groups, whereas others were more selective and simply looked at hand warts, or excluded certain groups such as mosaic plantar warts or warts that were resistant to treatment. Of particular note is the likelihood that wart-clinic populations used for these RCTs might have had different characteristics in different periods of time. For instance, hospital-based studies carried out in the 1970s in the UK would have included a higher proportion of people with warts that had never been treated before—which have a greater chance of cure, spontaneous resolution, or both. In the 1980s and 1990s, more people with warts were being treated in primary care; consequently, the people included in hospital-based RCTs were more likely to have warts resistant to treatment, with correspondingly lower cure rates. Hence, strong evidence for the beneficial effect of cryotherapy is difficult to establish. However, the review identified evidence that aggressive cryotherapy is beneficial. We found one RCT identified by the systematic review that assessed the effect of duration of cryotherapy; however, it did not meet our reporting criteria and is not discussed further here. See Comment in Contact immunotherapy (dinitrochlorobenzene). The majority of the trials included in the systematic review had unclear or inadequate allocation concealment. The review stated that the beneficial effects of treatment in these trials were likely to have been overstated.
Clinical guide:
Taking these factors into account, cryotherapy is likely to be beneficial for people with non-genital warts where first-line treatment with topical salicylic acid has failed. Depending on the site, size, and status of the person, cryotherapy of different degrees of aggressiveness can be delivered at different time intervals.
Substantive changes
Cryotherapy One systematic review updated, and one subsequent RCT added. Categorisation unchanged (likely to be beneficial).
- BMJ Clin Evid. 2014; 2014: 1710. »
- Photodynamic treatment
2014; 2014: 1710.
Published online 2014 Jun 12.
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Summary
We don't know whether photodynamic treatment is more effective than placebo.
We found limited evidence from one small RCT that photodynamic treatment plus topical salicylic acid may increase the proportion of warts cured compared with placebo plus topical salicylic acid.
Photodynamic treatment may increase pain or discomfort compared with placebo.
Benefits and harms
Photodynamic treatment versus placebo photodynamic treatment:
We found one systematic review (search date 2011) of photodynamic treatment, which identified one RCT (45 people) and one subsequent RCT (12 people) comparing photodynamic treatment versus placebo photodynamic treatment.
Wart clearance
Photodynamic treatment compared with placebo photodynamic treatment We don't know whether photodynamic treatment is more effective than placebo. Aminolaevulinic acid photodynamic treatment plus topical salicylic acid may be more effective than placebo photodynamic treatment plus topical salicylic acid at increasing the proportion of people with wart clearance after 18 weeks in people with warts unsuccessfully treated for over 3 months (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT | 45 adults with warts unsuccessfully treated for >3 months In review | Proportion of warts cured18 weeks 64/114 (56%) with aminolaevulinic acid photodynamic treatment plus topical salicylic acid 47/113 (42%) with placebo photodynamic treatment plus topical salicylic acid | P<0.05 | Effect size not calculated | aminolaevulinic acid photodynamic treatment plus topical salicylic acid |
RCT | 12 people; 2 warts each treated | Cure ratetimeframe unclear 1/4 (25%) with 20% aminolaevulinic acid plus 417nm blue light (5 treatments at 2–4-week intervals) 3/8 (38%) with placebo photodynamic treatment | P=0.2 | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 45 adults with warts unsuccessfully treated for >3 months In review | Painful warts (pain ranging from light to unbearable)immediately after treatment 17% with aminolaevulinic acid photodynamic treatment plus topical salicylic acid 4% with placebo photodynamic treatment plus topical salicylic acid Absolute numbers not reported | Significance not assessed |
No data from the following reference on this outcome.
Different types of photodynamic treatment versus each other:
We found one systematic review (search date 2011), which identified one RCT.
Wart clearance
Different types of photodynamic treatment compared with each other We don't know how proflavine photodynamic treatment and neutral red photodynamic treatment compare at improving wart clearance after 8 weeks (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT 3-armed trial | 56 people In review | Proportion of people with wart clearance8 weeks 10/27 (37%) with proflavine photodynamic treatment 10/23 (43%) with neutral red photodynamic treatment | Significance not assessed |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT 3-armed trial | 56 people In review | Adverse effects with proflavine photodynamic treatment with neutral red photodynamic treatment |
Photodynamic treatment versus cryotherapy:
See option on Cryotherapy.
None.
Substantive changes
Photodynamic treatment One systematic review updated, and one subsequent RCT added. Categorisation changed from likely to be beneficial to unknown effectiveness.
- BMJ Clin Evid. 2014; 2014: 1710. »
- Bleomycin (intralesional)
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
We don't know whether intralesional bleomycin speeds up clearance of warts compared with placebo, as studies have given conflicting results.
Benefits and harms
Intralesional bleomycin versus placebo:
We found one systematic review (search date 2011, 4 RCTs, 133 people) comparing intralesional bleomycin versus placebo. The systematic review did not perform a meta-analysis because of heterogeneity among RCTs.
Wart clearance
Intralesional bleomycin compared with placebo We don't know whether intralesional bleomycin is more effective at increasing the proportion of people with wart clearance, or at increasing the number of warts cured, after 6 weeks to 3 months (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT | 24 adults with warts unsuccessfully treated for >3 months; matched pairs of warts on the left and right side of the body In review | Proportion of people with a more favourable response (not defined)6 weeks 21/24 (88%) with bleomycin 3/24 (13%) with saline placebo | P<0.001 | Effect size not calculated | bleomycin 0.1% |
RCT | 24 adults with warts unsuccessfully treated for >3 months; matched pairs of warts on the left and right side of the body In review | Proportion of warts cured6 weeks 34/59 (58%) with bleomycin 6/59 (10%) with saline placebo | P<0.001 | Effect size not calculated | bleomycin 0.1% |
RCT | 16 people In review | Proportion of warts cured6 weeks 31/38 (82%) with bleomycin 16/46 (34%) with placebo | P<0.001 Results should be interpreted with caution; RCT randomised number of people but analysed number of warts | Effect size not calculated | bleomycin 0.1% |
RCT 4-armed trial | 62 adults In review | Proportion of warts cured3 months 4/22 (18%) with bleomycin in saline 5/22 (23%) with bleomycin in sesame oil 8/19 (42%) with saline placebo 5/11 (46%) with sesame-oil placebo | P=0.018 for combined results for bleomycin v combined results for placebo Results should be interpreted with caution; RCT randomised number of people but analysed number of warts | Effect size not calculated | placebo |
RCT | 31 people In review | Proportion of people with wart clearance30 days 15/16 (94%) with bleomycin 11/15 (73%) with placebo | RR 1.28 95% CI 0.92 to 1.78 P=0.15 | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 24 adults with warts unsuccessfully treated for >3 months; matched pairs of warts on the left and right side of the body In review | Adverse effects with bleomycin with saline placebo | |||
RCT | 16 people In review | Adverse effects with bleomycin with placebo | |||
RCT 4-armed trial | 62 adults In review | Adverse effects with bleomycin in saline with bleomycin in sesame oil with saline placebo with sesame-oil placebo |
No data from the following reference on this outcome.
Different concentrations of intralesional bleomycin:
We found one systematic review (search date 2011), which identified one RCT comparing different concentrations of intralesional bleomycin.
Wart clearance
Different concentrations of intralesional bleomycin versus each other We don't know how different concentrations of intralesional bleomycin compare at improving wart clearance at 3 months (very low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT 3-armed trial | 26 adults In review | Proportion of warts cured (defined as disappearance of warts after 1 to 3 treatments and no recurrence within 3 months after treatment)3 months 11/15 (73%) with bleomycin 0.25% 26/30 (86%) with bleomycin 0.5% | P>0.05 for bleomycin 0.25% v bleomycin 0.5% | Not significant | |
RCT 3-armed trial | 26 adults In review | Proportion of warts cured (defined as disappearance of warts after 1–3 treatments and no recurrence within 3 months after treatment)3 months 11/15 (73%) with bleomycin 0.25% 25/34 (74%) with bleomycin 1.0% | P>0.05 for bleomycin 0.25% v bleomycin 1.0% | Not significant | |
RCT 3-armed trial | 26 adults In review | Proportion of warts cured (defined as disappearance of warts after 1–3 treatments and no recurrence within 3 months after treatment)3 months 26/30 (86%) with bleomycin 0.5% 25/34 (74%) with bleomycin 1.0% | P>0.05 for bleomycin 0.5% v bleomycin 1.0% | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT 3-armed trial | 26 adults In review | Adverse effects with bleomycin 0.25% with bleomycin 0.5% with bleomycin 1.0% |
Intralesional bleomycin versus cryotherapy:
We found one systematic review (search date 2011), which identified two RCTs comparing intralesional bleomycin versus cryotherapy.
Wart clearance
Intralesional bleomycin compared with cryotherapy Intralesional bleomycin may be more effective at increasing the proportion of people with wart clearance after 6 weeks. However, evidence came from one small RCT and evidence was weak (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT | 44 people above 12 years of age with warts on symmetric limbs In review | Proportion of people with wart clearance6 weeks 38/44 (87%) with bleomycin 30/44 (68%) with cryotherapy | RR 1.27 95% CI 1.0 to 1.6 P<0.05 Results should be interpreted with caution; see Further information on studies for full details | Small effect size | bleomycin |
RCT | 73 people In review | Cure8 weeks after last treatment 37/39 (95%) with bleomycin 0.1% 26/34 (77%) with cryotherapy (1–4 sessions) | Significance not assessed Bleomycin reported as more effective but no RR or P value reported |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 44 people above 12 years of age with warts on symmetric limbs | Adverse effects with bleomycin with cryotherapy | |||
RCT | 73 people In review | Pain hampering routine activities(few minutes to 3 days) 2/39 (5%) with bleomycin 4/34 (12%) with cryotherapy | Significance not assessed |
Further information on studies
The disparity in the number of warts assessed in each group could be explained by the exclusion of warts that spontaneously regressed from the analysis, and by a high withdrawal rate in people receiving intralesional bleomycin 0.25%.
The results should be interpreted with caution, as important parameters such as wart size and duration of disease were not mentioned. Furthermore, the clinical importance of the difference between treatments may not have been detected due to the small sample size.
None.
Substantive changes
Intralesional bleomycin One systematic review updated. Categorisation unchanged (unknown effectiveness).
- BMJ Clin Evid. 2014; 2014: 1710. »
- Candida antigen (intralesional)
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
We found no systematic review or RCTs about the effects of intralesional candida antigens.
Benefits and harms
Intralesional candida antigen versus placebo:
We found no systematic review or RCTs.
None.
Substantive changes
Candida antigen (intralesional) New option. Categorised as unknown effectiveness.
- BMJ Clin Evid. 2014; 2014: 1710. »
- Duct tape occlusion
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
We don't know whether duct tape increases cure rates compared with placebo, as few high-quality studies have been found.
Benefits and harms
Duct tape occlusion versus placebo:
We found one systematic review (search date 2011), which identified two RCTs comparing duct tape occlusion with placebo.
Wart clearance
Duct tape occlusion compared with placebo We don't know whether duct tape occlusion is more effective than placebo at increasing the proportion of people with wart clearance after 6 to 24 weeks (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
Systematic review | 193 people 2 RCTs in this analysis | Cure rate6 to 24 weeks 16/95 (17%) with duct tape 12/98 (12%) with placebo | RR 1.43 95% CI 0.51 to 4.05 P=0.50 | Not significant |
Wart recurrence
Duct tape occlusion compared with placebo We don't know whether duct tape occlusion is more effective than placebo at reducing the proportion of people with recurrence after 6 months in people who had previously had complete wart clearance with either duct tape occlusion or placebo (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart recurrence | |||||
RCT | 17 adults who had complete wart clearance at 2 months In review Subgroup analysis | Proportion of people with wart recurrence6 months 6/8 (75%) with clear duct tape occlusion 3/9 (33%) with placebo | P=0.15 | Not significant |
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 103 children aged 4–12 years In review | Skin rash 7/47 (15%) with clear duct tape occlusion 0/52 (0%) with placebo | P=0.14 | Not significant | |
RCT | 90 adults In review | Adverse effects with clear duct tape occlusion with placebo |
Duct tape occlusion versus cryotherapy:
We found one systematic review (search date 2005), which identified one RCT.
Wart clearance
Duct tape occlusion compared with cryotherapy We don't know how duct tape occlusion and cryotherapy compare at improving wart clearance after 2 months (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT | 61 people aged 3 to 22 years In review | Proportion of people with complete resolution of warts8 weeks 22/26 (85%) with duct tape occlusion for 6 days a week plus gentle debridement once a week 15/25 (60%) with cryotherapy for 10 seconds every 2 to 3 weeks plus gentle debridement up to 6 treatments | P=0.05 RCT had methodological limitations; see Further information on studies for details | Not significant | |
RCT | 61 people aged 3 to 22 years In review | Proportion of people with complete resolution of warts8 weeks 22/30 (73%) with duct tape occlusion for 6 days a week plus gentle debridement once a week 15/31 (48%) with cryotherapy for 10 seconds every 2 to 3 weeks plus gentle debridement up to 6 treatments | RR 1.52 (calculated by review) 95% CI 0.99 to 2.31 | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 61 people aged 3 to 22 years In review | Adverse effects with duct tape occlusion for 6 days a week plus gentle debridement once a week with cryotherapy for 10 seconds every 2 to 3 weeks plus gentle debridement up to 6 treatments |
Further information on studies
Despite the careful randomisation and blinding in the RCT comparing duct tape occlusion with cryotherapy, the numbers were small. Furthermore, an unspecified number of outcome assessments were carried out over the telephone over the 2 months' follow-up, and it was not entirely clear how long after the treatment period these assessments were done.
There is insufficient evidence to indicate that duct tape occlusion is effective in wart clearance.
Substantive changes
Duct tape occlusion One systematic review updated. Categorisation unchanged (unknown effectiveness).
- BMJ Clin Evid. 2014; 2014: 1710. »
- Pulsed dye laser
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
We don't know whether pulsed dye laser increases cure rates compared with placebo, as few high-quality studies have been found.
Benefits and harms
Pulsed dye laser versus placebo:
We found one systematic review (search date 2011), which identified one RCT of pulsed dye laser. The systematic review found no RCTs comparing pulsed dye laser versus placebo.
Wart clearance
Pulsed dye laser compared with placebo We don't know whether pulsed dye laser is more effective than placebo at increasing the proportion of people with wart clearance after 14 weeks (low-quality evidence).
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Wart clearance | |||||
RCT | 37 people aged 19 to 70 years In review | Proportion of people with complete wart clearance14 weeks 6/19 (32%) with pulsed dye laser at 595nm (spot size 5mm, impulse duration 0.45ms, flux 9J/cm2 with 5 passes at a frequency of 1Hz) 3/16 (19%) with placebo | P=0.46 Results should be interpreted with caution; see Further information on studies for full details | Not significant |
Wart recurrence
No data from the following reference on this outcome.
Adverse effects
| Ref (type) | Population | Outcome, Interventions | Results and statistical analysis | Effect size | Favours |
| Adverse effects | |||||
RCT | 37 people aged 19 to 70 years In review | Incidence of crust and purpura 11% with pulsed dye laser at 595nm (spot size 5mm, impulse duration 0.45ms, flux 9J/cm2 with 5 passes at a frequency of 1Hz) 0% with placebo Absolute numbers not reported | Significance not assessed | ||
RCT | 37 people aged 19 to 70 years In review | Pain levels (measured on a 10-point visual analogue scale) 4.7 with pulsed dye laser at 595nm (spot size 5mm, impulse duration 0.45ms, flux 9J/cm2 with 5 passes at a frequency of 1Hz) 1.5 with placebo | Significance not assessed | ||
RCT | 37 people aged 19 to 70 years In review | Tolerance (measured on a 10-point visual analogue scale) 8.31 with pulsed dye laser at 595nm (spot size 5mm, impulse duration 0.45ms, flux 9J/cm2 with 5 passes at a frequency of 1Hz) 9.81 with placebo | Significance not assessed |
Further information on studies
The results of the RCT should be interpreted with caution, as the clinical importance of the difference between treatments may not be detected owing to the small sample size. Important parameters, such as wart size and duration in each group, were also not mentioned.
None.
Substantive changes
No new evidence
- BMJ Clin Evid. 2014; 2014: 1710. »
- Surgical procedures (cautery and curettage, carbon dioxide laser for cauterisation only)
2014; 2014: 1710.
Published online 2014 Jun 12.
Copyright and License information PMC Disclaimer
Summary
We don't know whether surgery increases cure rates compared with placebo, as no high-quality studies have been found.
Benefits and harms
Surgery:
We found one systematic review (search date 2011), which identified no RCTs.
None.
Substantive changes
No new evidence
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