Jornal de Pesquisa em Dermatologia Clínica e Experimental
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Sequential Therapy of Common and Plantar Warts with Salicylic Acid after Cryotherapy versus Cryotherapy Alone: A Case-Control Study in 42 Subjects

Federico Diotallevi, Massimo Milani*, Anna Maria Offidani

Background: Common Wart (CW; Verruca vulgaris) is a benign cutaneous virus infection caused by human papilloma virus commonly located in the palmar and plantar regions. Warts, especially located at pressure points, could be painful, but in general they are asymptomatic. Treatment is not always necessary but when multiple lesions, pain, immunosuppression and discomfort are present therapeutic intervention could be mandatory. Chemical or physical destructions are commonly used for the treatment of CW. Cryotherapy with liquid nitrogen is a common clinician-administered treatment. The most relevant drawbacks of this procedure are the pain associated with treatment, the need of several sessions and the recurrence of new lesion. Salicylic Acid (SA) applied under tape occlusion is a convenient, effective and safe therapy of CW, even if no effective as cryotherapy. So far, there are few data regarding the efficacy and safety of the sequential treatment of CW with cryotherapy followed by a 10-day treatment course with SA.

Study Design: We evaluated in a case-control study the clinical efficacy of cryotherapy alone and cryotherapy with SA in adult immunocompetent subjects with common or plantar warts.

Subjects and Methods: We evaluated a total of forty-two men and women, mean age 33 ± 13 years, with CW located in the palm (30% of the lesions) and plantar (70%) regions. Twenty subjects (mean CW lesion number: 2.2 ± 0.7) represented the cases group and twenty-two the control group. The cases subjects were treated with a cryotherapy session and after 3 days topical SA patch was applied for additional 10 consecutive days. The control group, after the initial cryotherapy session, was followed clinically to evaluate the need of new cryotherapy procedures. After the last cryotherapy, all subjects underwent to a follow up evaluation of three months.

Results: In the case group the sequential therapy was very effective with disappearance of the treated lesion. After the first cryotherapy session and the sequential SA treatment, the additional cryotherapy treatments were on average, mean ± SD, 1.4 ± 0.6 (range 1-3). In the control group, in order to obtain a complete cure of CW, the additional cryotherapy treatments were 3.4 ± 0.7 (range 1-5). This difference was statistically significant (p=0.0001) in favour of the cases vs. control subjects. Only two subjects (both in the control group) suffered from recurrences in the follow up.

Conclusion: In subjects with CW, the sequential therapy with cryotherapy and topical salicylic acid is an effective strategy able to reduce significantly the need of additional cryotherapy procedures therefore reducing the procedureassociated discomfort. Furthermore, this sequential therapeutic strategy could offer additional benefits in term of cost-saving.