#173 Acid, freeze, or duct tape: What works best for common warts?

CLINICAL QUESTION

QUESTION CLINIQUE

What is the efficacy of commonly used treatments for non-genital warts?

BOTTOM LINE

RÉSULTAT FINAL

Highest quality primary care evidence finds warts resolve with cryotherapy (39%) and salicylic acid (24%) more than no treatment (16%) at 13 weeks. Cryotherapy has more pain and blistering (up to ~80%), but greater patient satisfaction (~70%). Evidence for duct tape is limited and inconsistent.

Reading Tools for Practice Article can earn you MainPro+ Credits

La lecture d'articles d'outils de pratique peut vous permettre de gagner des crédits MainPro+

Join Now S’inscrire maintenant

Already a CFPCLearn Member? Log in

Déjà abonné à CMFCApprendre? Ouvrir une session

EVIDENCE

DONNÉES PROBANTES

Highest-quality primary care Randomized Controlled Trial (RCT):¹ 240 children and adults, new warts, cryotherapy (2-10 seconds via cotton applicator three times every two weeks), daily 40% salicylic acid (SA), or no treatment. Cure at 13 weeks:
- All warts: Cryotherapy 39%, SA 24%, no treatment 16%.
  - Versus no treatment: SA Number Needed to Treat (NNT)=13, cryotherapy NNT=5.
- Plantar warts: Cryotherapy 30%, SA 33%, no treatment 23% (none statistically significant):
  - No patient >12 years old had spontaneous resolution of plantar warts.
- Other outcomes cryotherapy versus SA:
  - Patient satisfaction: 69% versus 24%, NNT=3.
  - Adverse effects:
    - Pain: 81% versus 12%, Number Needed to Harm (NNH)=2.
    - Blistering: 51% versus 9%, NNH=3.
High quality primary/secondary care RCT:² 229 patients >12 years old, mostly recalcitrant plantar warts (median duration >1 year), randomized to cryotherapy (~10 seconds via spray or probe, every 2-3 weeks) or daily 50% SA. At 12 weeks, cryotherapy versus SA:
- Cure: No difference (both 14%).
- Patient satisfaction: 62% versus 41% SA, NNT=5.
  - Blistering: 2% versus 0.

Systematic review of RCTs.³
- Limitations: Small heterogeneous studies, incomplete reporting, high risk of bias
- Cryotherapy not significantly better than placebo (three RCTs, 227 patients) but equivalent to SA (four RCTs, 707 patients) which is superior to placebo with NNT=6, (six RCTs, 486 patients)
Duct tape: Inconsistent RCT findings.^4-6
- Cure: 17% versus 12% placebo (not statistically significant).
- Limitations: Short follow-up (six weeks),⁴ added clear duct tape to moleskin5 and no evidence of blinding or intention-to-treat.⁶

Context:

Warts affect up to 1/3 of school-aged children⁷
- Transmission appears increased:
  - When family member or classmates have warts.⁸
  - With communal shower use (plantar warts).⁹
Spontaneous resolution occurs in ~50% at ~1 year10 and appears greater in:
- Younger children.^1,10
- Non-plantar warts.¹