Clearance of plantar wart was defined as the restoration of normal skin on close inspection. Bring a list of all medications you take regularly including nonprescription medications and dietary supplements and the daily dosage of each. These models are used to estimate the number of occurrences of an event when the event has Poisson variation with over-dispersion. There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). The findings from the adjusted analysis were similar to those of the unadjusted analysis (odds ratio 1.17 (0.62 to 2.21), P=0.62). Randomisation was performed by a member of the research team either telephoning an independent, secure, remote, telephone randomisation service (York Trials Unit) or accessing a secure online web randomisation programme, thereby concealing treatment allocation until the moment of randomisation. The Cochrane systematic review found only one small trial directly comparing the effectiveness of a chemical treatment, salicylic acid, with cryotherapy in patients with warts on their feet alone.6 This poor quality study found a 58% cure rate among the patients allocated to cryotherapy, compared with 41% among those treated with salicylic acid. You may also want to list questions for your health care provider, such as: Your health care provider may ask you questions such as: If you're sure you have a plantar wart, you may try nonprescription remedies or alternative medicine approaches. 
SC and KH were the trial coordinators, and GT was the trial support officer. Or your health care provider might cut off a small section of the growth and send it to a lab for testing. information submitted for this request. Eligible participants gave written informed consent. Table 4 summarises the treatment details for the salicylic acid group. 
Hands. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm381429.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. The Cochrane systematic review further highlighted the lack of good quality evidence on which to inform clinical decision making. The figure shows the flow of participants through the trial, and table 1 summarises their baseline characteristics. These manufacturers had no role in the design of the trial or in the collection, analysis, and interpretation of data. If the first treatment doesn't work, what will we try next? Cohens measure of inter-rater agreement was used to assess agreement between the two assessors of the photographs for clearance. Most plantar warts are harmless and go away without treatment, though it may take a year or two in children, and even longer in adults. Contributors: DT and Jill Hall wrote the original protocol. You may opt-out of email communications at any time by clicking on Accessed Feb. 9, 2022. Accessed Feb. 10, 2022. The overall cure rates from this study are smaller than those observed in two placebo controlled trials of salicylic acid, both of which reported cure rates of 85% for active treatment, possibly because more resistant verrucae were included in the study comparing cryotherapy with salicylic acid. privacy practices. It might take weeks to remove the wart using this method. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Department of Health. If neither of these were available for a participant, the patients self reported outcome recorded in the week 12 patient questionnaire or on the Verrucae gone form was used. information highlighted below and resubmit the form. Participants were excluded from the study if they had impaired healing (such as from diabetes or peripheral vascular disease); were immunosuppressed (such as agammaglobulinaemia) or were taking immunosuppressant drugs (such as oral corticosteroids); had neuropathy; were receiving renal dialysis; had cold intolerance (such as Raynauds syndrome or cold urticaria); had any of the following conditions (blood dyscrasias of unknown origin, cryoglobulinaemia, cryofibrinogenaemia, collagen or autoimmune disease); were unable to give informed consent; or were currently in a trial evaluating other treatments for their plantar wart. 13th ed. We compared the time to clearance of the plantar warts between the two groups adjusting for the same covariates as above (age, previous treatment, and type of wart). Accessed March 2, 2017. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. At week 3, more patients were unhappy with salicylic acid than with cryotherapy (none), and more patients were very happy with cryotherapy than salicylic acid. The complete clearance of all plantar warts at six months was analysed in the same way as the primary outcome with adjustments for the same covariates. Accessed Feb. 9, 2022. Copyright 2022 BMJ Publishing Group Ltd, , professor, director of York Trials Unit. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. In order to give 80% power (5% two sided significance) to show a difference in cure rates of 70% for salicylic acid versus 85% for cryotherapy at 12 weeks, a sample size of 120 patients in each treatment group was required, or 133 patients in each group after allowing for 10% attrition (266 patients in total). Nor did we evaluate the effectiveness of salicylic acid treatment if delivered by a healthcare professional. There was also a difference in the age of the populations. Main outcome measures Complete clearance of all plantar warts at 12 weeks. SJ and ARK conducted the clinical analysis. We found no evidence that cryotherapy is more effective than patient self treatment with 50% salicylic acid for the treatment of plantar warts. American Academy of Dermatology. The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients preferences at baseline. Accessed Feb. 10, 2022. We therefore conducted a randomised controlled trial to compare the clinical and cost effectiveness of 50% salicylic acid and cryotherapy with liquid nitrogen. In: Andrews' Diseases of the Skin: Clinical Dermatology. Do you have diabetes or poor sensation in your feet? The Cox proportional hazard assumption was tested globally by the correlation of Schoenfeld residuals and survival time (or ranked survival time) and separately for each covariate through the correlation of Schoenfeld scaled residuals and survival time (or ranked survival time). You may need to return to the clinic for repeat treatments every 2 to 3 weeks until the wart disappears. GD, CM, FH, SJ, DT, IW, and GT commented on the report. 6th ed. Cochrane Database of Systematic Reviews. ES designed and undertook the economic analysis. More recently, a head to head trial compared salicylic acid and cryotherapy in a primary care setting in the Netherlands. The median number of plantar warts at 12 weeks in the salicylic acid group was two (range 020) and in the cryotherapy group was one (040), and no significant difference between the two groups (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). Finally, participants allocated to the salicylic acid group were advised to self treat for a maximum of eight weeks, but we collected patient self reported data on adherence to treatment only at one and three weeks after randomisation. (Values are numbers (percentages) unless stated otherwise), Details of self treatment with salicylic acid by 108 patients for treatment of plantar warts. Further research assessing the effectiveness of these treatments is required in order to inform future practice. Elsevier; 2021. https://www.clinicalkey.com. The remaining 27 were assessed as non-serious, 13 of which were in the salicylic acid group and 14 in the cryotherapy group. The proportional hazard assumption was tested and not violated, either separately for each covariate (cryotherapy v salicylic acid (P=0.3107), age (P=0.9508), type of plantar wart (P=0.7024), previous treatment (P=0.4456)) or globally (P=0.8208). Firstly, our sample size was powered to show a 15% difference in effectiveness, with cure rates of 70% for the salicylic acid treatment and 85% for the cryotherapy. In: Taylor and Kelly's Dermatology for Skin of Color. The assessors disagreed in 51 cases: in three cases the disagreement was between whether the plantar wart was cleared or not cleared, in five cases it was between cleared and unable to assess, and in the remaining 43 cases it was between not cleared and unable to assess. This might lead to an underestimation of the clearance rate, but as the assessment was blind to treatment allocation it is unlikely to lead to a difference between the two treatments groups. Using one or more of the following treatments may help: Freezing medicine (cryotherapy). Non-significant correlation indicates that there is not enough evidence that the proportional hazard assumption has been violated. The participants had longstanding plantar warts, most of which had been self treated. If salicylic acid and freezing medicine don't work, your health care provider may suggest one or more of the following treatments: If a plantar wart goes away after treatment and another wart grows, it could be because the area was exposed again to HPV. Some wart removers are flammable. This trial was a superiority study of cryotherapy compared with salicylic acid and was powered to show a 15% difference in effectiveness. Participants applied salicylic acid on a mean of 6.3 days in week 1 and 5.4 days in week 3. This method can be painful, so your health care provider may numb the area first. Details of cryotherapy received by 109 patients for treatment of plantar warts. NEW The Essential Diabetes Book - Mayo Clinic Press, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. If you are unable to import citations, please contact
2nd ed. McGraw Hill; 2016. https://accessmedicine.mhmedical.com. Typically, first line treatments in the UK are weaker preparations of 15%26% salicylic acid. The dots are tiny clotted blood vessels. This is not expected if satisfaction with treatment was independent of treatment randomised. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference 3.15% (16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). At week 1, more patients were happy with salicylic acid than cryotherapy but also more patients were very happy with cryotherapy than salicylic acid. the unsubscribe link in the e-mail. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. A total of 28 adverse events were reported in 19 participants. Participants were recruited between November 2006 and January 2010 (end of extended recruitment period) from university podiatry school clinics, NHS podiatry clinics, and primary care. Cover the wart to help prevent it from spreading to other parts of the body or to other people. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. In this study neither treatment was very effective with only 17/119 (14%) in the salicylic acid group and 15/110 (14%) in the cryotherapy group having complete clearance of plantar warts at 12 weeks, but the lack of a no treatment arm in this study means we cannot compare these cure rates with the natural resolution rate. This content does not have an English version. At week 12, more patients were unhappy with salicylic acid than with cryotherapy, and more were very happy with cryotherapy than with salicylic acid. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. Prescription-strength wart medications with salicylic acid work by removing a wart a layer at a time. Analyses were conducted in SAS version 9.2 (SAS Institute, NC, USA) and SPSS version 17.0.2 (SPSS) using two sided significance tests at the 5% significance level for the primary outcome measure and 1% significance level for secondary outcome measures. Randomisation was simple (that is, it was not restricted in any way such as by stratification or blocked allocation with the allocation sequence being computer generated).
The treatment was delivered according to the sites usual practice (such as debridement before treatment, masking of the surrounding area, and padding after treatment). Mayo Clinic is a not-for-profit organization. Secondly, it has been suggested that a six month follow-up is a more realistic time point at which to assess the success of treatments of cutaneous warts than shorter time frames.6 Assessment at six months not only allows for the fact that the human papilloma virus may remain dormant within epithelial cells without visible disease but would also allow time for any response mediated by the immune system to be observed. Of these, one event (a ruptured Achilles tendon requiring hospitalisation) was classed as serious and unrelated to the trial treatment (salicylic acid). All analyses were conducted on an intention to treat basis, including all patients in the groups to which they were randomised. HPV vaccine for treatment of recalcitrant cutaneous warts in adults: A retrospective cohort study. Design A multicentre, open, two arm randomised controlled trial.
Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. For some deep seated plantar warts, this might not have been sufficient to clear the wart. Have you tried any home remedies? (Values are numbers (percentages) unless stated otherwise). 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). A health care provider usually diagnoses a plantar wart by looking at it or cutting off the top layer with a scalpel and checking for dots. Make a donation. Ethical approval: This study was approved by Trent Multicentre Research Ethics Committee, Galway Research Ethics Committee, and local ethics committees, Medicines and Healthcare products Regulatory Agency, Irish Medicines Board, and local research and development trusts. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The EVerT collaborators (current and past) are Peter Arthur, Lucy Bellas, Beverly Brown, Lynne Bryan, Amanda Clark, Andrew Clarke, Michael Concannon, Beryl Cooling, Dawn Curruthers, Chris Davies, Gary Denby, Sean Dinneen, Diane Exley, Lisa Farndon, Simon Gazeley, Elizabeth Green, Stephanie Haughy, Julia Haswell, Christine Hearmon, Christine Howell, Arthur Kangombe, Jamil Karolia, Susan Kitchener, Phillip LeDune, Susan Lightfoot, Maria Madigan, Julie Mandehzadeh, Rina Miah, Caroline McIntosh, Christine Northern, Frances Price, Julie Poland, Ilan Rajap, Jayne Robinson, Julie Robinson, Raymond Skinner, Deborah Turner, Susan Walton, Linda White, Catriona Williams, who were members of the research team at each site and recruited participants to the study; Fiona Aitken and Helen Hill from the Medicines for Children Local Research Network; and Kate Biscomb and Kate Wyer from the Primary Care Research Network. SC, MC, FH, NM, DT, and KT were co-applicants on the application to Health Technology Assessment Programme and refined the protocol. Studies that have examined the prevalence of warts or verrucae have produced a wide range of estimatesfrom 0.84% in the US,1 3.3% to 4.7% in the UK,2 3 and up to 24% in 1618 year olds in Australia.4 Although most plantar warts will spontaneously disappear without treatment,5 6 many patients seek treatment for a variety of reasons, including discomfort or because they are prevented from doing sports and other activities of daily living. Overall, 32 of the 229 (14%) had complete clearance of all plantar warts at 12 weeks, corresponding to 17/119 (14%) patients in the salicylic acid group and 15/110 (14%) patients in the cryotherapy group, with no significant difference between the two groups (difference 0.65% (95% confidence interval 8.33 to 9.63), P=0.89). This concentration of salicylic acid is similar to that often used by podiatrists to treat plantar warts and is often viewed as a second line treatment. Elsevier; 2020. https://www.clinicalkey.com.
The liquid nitrogen was applied with a spray (method of choice if available) or a probe. High WA, et al., eds. Our overall cure rate was 14% (32/229), whereas cure rates in the earlier studies ranged from about 30%9 to 68%,11 at least twice the rate we observed. Avoid wearing uncomfortable shoes. We do not capture any email address. It is therefore possible that cryotherapy is a superior treatment against lower concentrations of salicylic acid. Of the 13 non-serious adverse events in the salicylic acid group, nine were unrelated to the trial treatment and four were unlikely to be related to the treatment. We thank the participants for taking part in the trial; the podiatrists, general practitioners, and practice nurses for recruiting participants to the study and completing the trial documentation; the principal investigators at each site for coordinating participant recruitment; members of the trial steering committee (Sam Gibbs (independent chair), Jill Mollison, Elaine Thomas, and Wesley Vernon); and members of the data monitoring and ethics committee (Anne-Maree Keenan (independent chair), Matthew Hankins, and Katharine Speaks for overseeing the study. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SC, KH, SJ, GT, KT, MC, FH, NM, and DT received proportions of their salaries from the Health Technology Assessment grant in order to conduct the study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. Mayo Clinic.
The strengths of this study include adequate randomisation, allocation concealment, blinded outcome assessment, and intention to treat analysis, all of which minimises the risk of bias. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. These preparations were significantly better than placebo. All rights reserved. The Cochrane systematic review identified only one trial that compared two different concentrations of salicylic acid.6 This trial found no evidence of a difference in the cure rates between the two treatments, but, as this trial was assessed as being of low quality, we cannot rule out the possibility that different cure rates might be achieved with different strengths of acid. We also extended the primary outcome model to explore the effect of patient preferences by including preference and an interaction term between preferred treatment and randomised treatment. Many people have removed warts with these self-care tips: In general, no matter which treatment you try, do these two things: You'll likely start by seeing your primary care provider, who may then refer you to a specialist in disorders of the skin (dermatologist) or feet (podiatrist). This difference in cure rate could be attributed to different populations recruited to the study. William Ransom and Son supplied the 50% salicylic acid (Verrugon) at no cost, and BOC provided one site with liquid nitrogen storage equipment at reduced cost.
SC and KH were the trial coordinators, and GT was the trial support officer. Or your health care provider might cut off a small section of the growth and send it to a lab for testing. information submitted for this request. Eligible participants gave written informed consent. Table 4 summarises the treatment details for the salicylic acid group. Hands. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm381429.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery. The Cochrane systematic review further highlighted the lack of good quality evidence on which to inform clinical decision making. The figure shows the flow of participants through the trial, and table 1 summarises their baseline characteristics. These manufacturers had no role in the design of the trial or in the collection, analysis, and interpretation of data. If the first treatment doesn't work, what will we try next? Cohens measure of inter-rater agreement was used to assess agreement between the two assessors of the photographs for clearance. Most plantar warts are harmless and go away without treatment, though it may take a year or two in children, and even longer in adults. Contributors: DT and Jill Hall wrote the original protocol. You may opt-out of email communications at any time by clicking on Accessed Feb. 9, 2022. Accessed Feb. 10, 2022. The overall cure rates from this study are smaller than those observed in two placebo controlled trials of salicylic acid, both of which reported cure rates of 85% for active treatment, possibly because more resistant verrucae were included in the study comparing cryotherapy with salicylic acid. privacy practices. It might take weeks to remove the wart using this method. The views and opinions expressed are those of the authors and do not necessarily reflect those of the Department of Health. If neither of these were available for a participant, the patients self reported outcome recorded in the week 12 patient questionnaire or on the Verrucae gone form was used. information highlighted below and resubmit the form. Participants were excluded from the study if they had impaired healing (such as from diabetes or peripheral vascular disease); were immunosuppressed (such as agammaglobulinaemia) or were taking immunosuppressant drugs (such as oral corticosteroids); had neuropathy; were receiving renal dialysis; had cold intolerance (such as Raynauds syndrome or cold urticaria); had any of the following conditions (blood dyscrasias of unknown origin, cryoglobulinaemia, cryofibrinogenaemia, collagen or autoimmune disease); were unable to give informed consent; or were currently in a trial evaluating other treatments for their plantar wart. 13th ed. We compared the time to clearance of the plantar warts between the two groups adjusting for the same covariates as above (age, previous treatment, and type of wart). Accessed March 2, 2017. In: Clinical Dermatology: A Color Guide to Diagnosis and Therapy. At week 3, more patients were unhappy with salicylic acid than with cryotherapy (none), and more patients were very happy with cryotherapy than salicylic acid. The complete clearance of all plantar warts at six months was analysed in the same way as the primary outcome with adjustments for the same covariates. Accessed Feb. 9, 2022. Copyright 2022 BMJ Publishing Group Ltd, , professor, director of York Trials Unit. Participants 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. In order to give 80% power (5% two sided significance) to show a difference in cure rates of 70% for salicylic acid versus 85% for cryotherapy at 12 weeks, a sample size of 120 patients in each treatment group was required, or 133 patients in each group after allowing for 10% attrition (266 patients in total). Nor did we evaluate the effectiveness of salicylic acid treatment if delivered by a healthcare professional. There was also a difference in the age of the populations. Main outcome measures Complete clearance of all plantar warts at 12 weeks. SJ and ARK conducted the clinical analysis. We found no evidence that cryotherapy is more effective than patient self treatment with 50% salicylic acid for the treatment of plantar warts. American Academy of Dermatology. The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients preferences at baseline. Accessed Feb. 10, 2022. We therefore conducted a randomised controlled trial to compare the clinical and cost effectiveness of 50% salicylic acid and cryotherapy with liquid nitrogen. In: Andrews' Diseases of the Skin: Clinical Dermatology. Do you have diabetes or poor sensation in your feet? The Cox proportional hazard assumption was tested globally by the correlation of Schoenfeld residuals and survival time (or ranked survival time) and separately for each covariate through the correlation of Schoenfeld scaled residuals and survival time (or ranked survival time). You may need to return to the clinic for repeat treatments every 2 to 3 weeks until the wart disappears. GD, CM, FH, SJ, DT, IW, and GT commented on the report. 6th ed. Cochrane Database of Systematic Reviews. ES designed and undertook the economic analysis. More recently, a head to head trial compared salicylic acid and cryotherapy in a primary care setting in the Netherlands. The median number of plantar warts at 12 weeks in the salicylic acid group was two (range 020) and in the cryotherapy group was one (040), and no significant difference between the two groups (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). Finally, participants allocated to the salicylic acid group were advised to self treat for a maximum of eight weeks, but we collected patient self reported data on adherence to treatment only at one and three weeks after randomisation. (Values are numbers (percentages) unless stated otherwise), Details of self treatment with salicylic acid by 108 patients for treatment of plantar warts. Further research assessing the effectiveness of these treatments is required in order to inform future practice. Elsevier; 2021. https://www.clinicalkey.com. The remaining 27 were assessed as non-serious, 13 of which were in the salicylic acid group and 14 in the cryotherapy group. The proportional hazard assumption was tested and not violated, either separately for each covariate (cryotherapy v salicylic acid (P=0.3107), age (P=0.9508), type of plantar wart (P=0.7024), previous treatment (P=0.4456)) or globally (P=0.8208). Firstly, our sample size was powered to show a 15% difference in effectiveness, with cure rates of 70% for the salicylic acid treatment and 85% for the cryotherapy. In: Taylor and Kelly's Dermatology for Skin of Color. The assessors disagreed in 51 cases: in three cases the disagreement was between whether the plantar wart was cleared or not cleared, in five cases it was between cleared and unable to assess, and in the remaining 43 cases it was between not cleared and unable to assess. This might lead to an underestimation of the clearance rate, but as the assessment was blind to treatment allocation it is unlikely to lead to a difference between the two treatments groups. Using one or more of the following treatments may help: Freezing medicine (cryotherapy). Non-significant correlation indicates that there is not enough evidence that the proportional hazard assumption has been violated. The participants had longstanding plantar warts, most of which had been self treated. If salicylic acid and freezing medicine don't work, your health care provider may suggest one or more of the following treatments: If a plantar wart goes away after treatment and another wart grows, it could be because the area was exposed again to HPV. Some wart removers are flammable. This trial was a superiority study of cryotherapy compared with salicylic acid and was powered to show a 15% difference in effectiveness. Participants applied salicylic acid on a mean of 6.3 days in week 1 and 5.4 days in week 3. This method can be painful, so your health care provider may numb the area first. Details of cryotherapy received by 109 patients for treatment of plantar warts. NEW The Essential Diabetes Book - Mayo Clinic Press, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education. If you are unable to import citations, please contact 2nd ed. McGraw Hill; 2016. https://accessmedicine.mhmedical.com. Typically, first line treatments in the UK are weaker preparations of 15%26% salicylic acid. The dots are tiny clotted blood vessels. This is not expected if satisfaction with treatment was independent of treatment randomised. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference 3.15% (16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). At week 1, more patients were happy with salicylic acid than cryotherapy but also more patients were very happy with cryotherapy than salicylic acid. the unsubscribe link in the e-mail. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. A total of 28 adverse events were reported in 19 participants. Participants were recruited between November 2006 and January 2010 (end of extended recruitment period) from university podiatry school clinics, NHS podiatry clinics, and primary care. Cover the wart to help prevent it from spreading to other parts of the body or to other people. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. In this study neither treatment was very effective with only 17/119 (14%) in the salicylic acid group and 15/110 (14%) in the cryotherapy group having complete clearance of plantar warts at 12 weeks, but the lack of a no treatment arm in this study means we cannot compare these cure rates with the natural resolution rate. This content does not have an English version. At week 12, more patients were unhappy with salicylic acid than with cryotherapy, and more were very happy with cryotherapy than with salicylic acid. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. Prescription-strength wart medications with salicylic acid work by removing a wart a layer at a time. Analyses were conducted in SAS version 9.2 (SAS Institute, NC, USA) and SPSS version 17.0.2 (SPSS) using two sided significance tests at the 5% significance level for the primary outcome measure and 1% significance level for secondary outcome measures. Randomisation was simple (that is, it was not restricted in any way such as by stratification or blocked allocation with the allocation sequence being computer generated).
The treatment was delivered according to the sites usual practice (such as debridement before treatment, masking of the surrounding area, and padding after treatment). Mayo Clinic is a not-for-profit organization. Secondly, it has been suggested that a six month follow-up is a more realistic time point at which to assess the success of treatments of cutaneous warts than shorter time frames.6 Assessment at six months not only allows for the fact that the human papilloma virus may remain dormant within epithelial cells without visible disease but would also allow time for any response mediated by the immune system to be observed. Of these, one event (a ruptured Achilles tendon requiring hospitalisation) was classed as serious and unrelated to the trial treatment (salicylic acid). All analyses were conducted on an intention to treat basis, including all patients in the groups to which they were randomised. HPV vaccine for treatment of recalcitrant cutaneous warts in adults: A retrospective cohort study. Design A multicentre, open, two arm randomised controlled trial.
Interventions Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. For some deep seated plantar warts, this might not have been sufficient to clear the wart. Have you tried any home remedies? (Values are numbers (percentages) unless stated otherwise). 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). A health care provider usually diagnoses a plantar wart by looking at it or cutting off the top layer with a scalpel and checking for dots. Make a donation. Ethical approval: This study was approved by Trent Multicentre Research Ethics Committee, Galway Research Ethics Committee, and local ethics committees, Medicines and Healthcare products Regulatory Agency, Irish Medicines Board, and local research and development trusts. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. The EVerT collaborators (current and past) are Peter Arthur, Lucy Bellas, Beverly Brown, Lynne Bryan, Amanda Clark, Andrew Clarke, Michael Concannon, Beryl Cooling, Dawn Curruthers, Chris Davies, Gary Denby, Sean Dinneen, Diane Exley, Lisa Farndon, Simon Gazeley, Elizabeth Green, Stephanie Haughy, Julia Haswell, Christine Hearmon, Christine Howell, Arthur Kangombe, Jamil Karolia, Susan Kitchener, Phillip LeDune, Susan Lightfoot, Maria Madigan, Julie Mandehzadeh, Rina Miah, Caroline McIntosh, Christine Northern, Frances Price, Julie Poland, Ilan Rajap, Jayne Robinson, Julie Robinson, Raymond Skinner, Deborah Turner, Susan Walton, Linda White, Catriona Williams, who were members of the research team at each site and recruited participants to the study; Fiona Aitken and Helen Hill from the Medicines for Children Local Research Network; and Kate Biscomb and Kate Wyer from the Primary Care Research Network. SC, MC, FH, NM, DT, and KT were co-applicants on the application to Health Technology Assessment Programme and refined the protocol. Studies that have examined the prevalence of warts or verrucae have produced a wide range of estimatesfrom 0.84% in the US,1 3.3% to 4.7% in the UK,2 3 and up to 24% in 1618 year olds in Australia.4 Although most plantar warts will spontaneously disappear without treatment,5 6 many patients seek treatment for a variety of reasons, including discomfort or because they are prevented from doing sports and other activities of daily living. Overall, 32 of the 229 (14%) had complete clearance of all plantar warts at 12 weeks, corresponding to 17/119 (14%) patients in the salicylic acid group and 15/110 (14%) patients in the cryotherapy group, with no significant difference between the two groups (difference 0.65% (95% confidence interval 8.33 to 9.63), P=0.89). This concentration of salicylic acid is similar to that often used by podiatrists to treat plantar warts and is often viewed as a second line treatment. Elsevier; 2020. https://www.clinicalkey.com.
The liquid nitrogen was applied with a spray (method of choice if available) or a probe. High WA, et al., eds. Our overall cure rate was 14% (32/229), whereas cure rates in the earlier studies ranged from about 30%9 to 68%,11 at least twice the rate we observed. Avoid wearing uncomfortable shoes. We do not capture any email address. It is therefore possible that cryotherapy is a superior treatment against lower concentrations of salicylic acid. Of the 13 non-serious adverse events in the salicylic acid group, nine were unrelated to the trial treatment and four were unlikely to be related to the treatment. We thank the participants for taking part in the trial; the podiatrists, general practitioners, and practice nurses for recruiting participants to the study and completing the trial documentation; the principal investigators at each site for coordinating participant recruitment; members of the trial steering committee (Sam Gibbs (independent chair), Jill Mollison, Elaine Thomas, and Wesley Vernon); and members of the data monitoring and ethics committee (Anne-Maree Keenan (independent chair), Matthew Hankins, and Katharine Speaks for overseeing the study. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: SC, KH, SJ, GT, KT, MC, FH, NM, and DT received proportions of their salaries from the Health Technology Assessment grant in order to conduct the study; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work. Mayo Clinic.
The strengths of this study include adequate randomisation, allocation concealment, blinded outcome assessment, and intention to treat analysis, all of which minimises the risk of bias. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. These preparations were significantly better than placebo. All rights reserved. The Cochrane systematic review identified only one trial that compared two different concentrations of salicylic acid.6 This trial found no evidence of a difference in the cure rates between the two treatments, but, as this trial was assessed as being of low quality, we cannot rule out the possibility that different cure rates might be achieved with different strengths of acid. We also extended the primary outcome model to explore the effect of patient preferences by including preference and an interaction term between preferred treatment and randomised treatment. Many people have removed warts with these self-care tips: In general, no matter which treatment you try, do these two things: You'll likely start by seeing your primary care provider, who may then refer you to a specialist in disorders of the skin (dermatologist) or feet (podiatrist). This difference in cure rate could be attributed to different populations recruited to the study. William Ransom and Son supplied the 50% salicylic acid (Verrugon) at no cost, and BOC provided one site with liquid nitrogen storage equipment at reduced cost.