Cryotherapy is More Effective than Salicylic Acid for Common Warts

From Journal Watch > Journal Watch (General)

Bruce Soloway, MD

Cutaneous warts are seen often in primary care, particularly among children, but a recent Cochrane review (Cochrane Database Syst Rev 2006; 3:CD001781) was inconclusive on the relative merits of the two most common treatments, salicylic acid and cryotherapy.

Dutch researchers randomized 250 patients (43% were younger than 12 years) who were recruited from 30 primary care practices with one or more new cutaneous warts (<1 cm diameter) to receive cryotherapy with liquid nogen every 2 weeks, daily self-applications of 40% salicylic acid gel, or no treatment for 13 weeks.

Half the patients had predominantly common warts (mainly on the hands), and half had predominantly plantar warts. Among patients with predominantly common warts, warts were significantly more likely to resolve completely with cryotherapy than with salicylic acid or no treatment (49% vs. 15% and 8%, respectively). Patients with predominantly plantar warts had similar cure rates regardless of treatment (30%, 33%, and 23%, respectively) and were more likely to be completely cured if they were younger than 12 years (50% vs. 3%) or if their warts had been present for <6 months (46% vs. 10%). Cryotherapy caused more local side effects than salicylic acid, but more patients who received cryotherapy were satisfied with their treatment.

Comment

This pragmatic primary care–based trial suggests that cryotherapy is the preferred treatment for common warts. Persistent plantar warts in adolescents and adults are unlikely to respond to brief therapy with either cryotherapy or salicylic acid.