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Salicylic Acid Remains Best Therapy For Cutaneous Warts
British Medical Journal (BMJ)
08/29/2002
By Harvey McConnell
Topical compounds containing salicylic acid remain the most effective method for treating cutaneous warts.
There is no clear evidence that any other treatments for warts are more effective. At the same time, some evidence points towards efficacy of dinitrochlorobenzene, finds Dr. Sam Gibbs, head of the Department of Dermatology, Ipswich Hospital, Ipswich, England.
Dr. Gibbs and colleagues found even less evidence for the efficacy of all the other treatments reviewed, including cryotherapy, in their review of randomised controlled trials of any local treatment for uncomplicated cutaneous warts.
Viral warts are common, benign, and usually self limiting, the clinicians point out, However there is considerable social stigma associated with warts on the face and hands, and they can be painful on the soles of the feet and near the nails.
Many patients request treatment for warts, and while there are a number of treatments, there is a paucity of knowledge on their efficacy.
Dr Gibbs and colleagues found the best evidence was for topical treatments containing salicylic acid. Pooled data from six placebo controlled trials showed a cure rate with salicylic acid in 144 of 191 patients (75 percent) compared with 89 of 185 patients (48 percent) with placebo.
The clinicians said the quality of data was modest at best in most of the trials they reviewed. Simple topical treatments containing salicylic acid seem to be both effective and safe, and there was no clear evidence any of the other treatments have a particular advantage of either higher cure rates or fewer adverse effects.
Although it is widely believed that cryotherapy may succeed when topical salicylic acid has failed, there was no clear evidence to support this, Dr Gibbs and colleagues said. Indeed some evidence shows that at best cryotherapy is only equal in efficacy to topical salicylic acid.
Intralesional bleomycin is popular with some dermatologists, but the study found only limited evidence of efficacy. Topical immunotherapy with agents such as dinitrochlorobenzene, the clinicians feel, is best confined to specialist centers at present in view of its adverse effects.
Photodynamic therapy and the use of pulsed dye lasers may hold promise for the future, they conclude.
BMJ 2002; 325: 461-4
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