Local creams effectively treat warts

Topical salicylic acid is an effective and safe treatment for warts, but there is no clear evidence that any other treatments have a particular advantage of either higher cure rates or fewer side effects. Viral warts caused by the human papillomavirus (HPV) represents one of the most common diseases of the skin. Any area of skin can be affected although the hands and feet are by far the commonest sites. A very wide range of local treatments is available. To assess the effects of different local treatments for cutaneous, non-genital warts in healthy people this study was carried out. Researchers from the Department of Dermatology, Ipswich Hospital, Ipswich, UK reviewed randomised controlled trials of any local treatment for uncomplicated cutaneous warts. All published and unpublished material was considered, with no restriction on date or language. They conducted a systematic review of local treatments. Fifty trials provided generally weak evidence because of poor methods and reporting. The best evidence was for topical treatments containing salicylic acid. Data pooled from six placebo-controlled trials showed a cure rate of 75% (144 of 191) in cases compared with 48% (89 of 185) in controls. Some evidence for the efficacy of contact immunotherapy was provided by two small trials comparing dinitrochlorobenzene with placebo. Evidence for the efficacy of cryotherapy (a freezing procedure that destroys abnormal cells) was limited. Pooled data from two small trials that included cryotherapy and placebo or no treatment, showed no significant difference in cure rates. In two other trials comparing cryotherapy with salicylic acid no significant difference in efficacy was demonstrated and there was no consistent evidence for the effectiveness of intralesional bleomycin. There was some evidence for the efficacy of dinitrochlorobenzene, a potent contact sensitizer and only limited evidence was found for the efficacy of topical fluorouracil, intralesional interferons, photodynamic therapy, and pulsed dye laser. Overall, it was found that trials of local treatments for cutaneous warts were highly variable in methods and quality, and there was a paucity of evidence from randomised, placebo-controlled trials on which to base the rational use of the treatments. There is good evidence that topical treatments containing salicylic acid have a therapeutic effect and some evidence for the efficacy of dinitrochlorobenzene. Less evidence was found for the efficacy of all the other treatments reviewed, including cryotherapy. Only 12 of 50 trials were found to be of high quality and photodynamic therapy and pulsed dye lasers may hold promise for the future.