Comparison of 40% trichloroacetic acid and cryotherapy for the treatment of plantar warts: A single‐blind, randomized clinical trial

Abstract

Plantar warts can cause pain near the toes and the sole of the foot and may result in referral for treatment. This study was aimed at comparing 40% trichloroacetic acid (TCA) and cryotherapy (Cryo) for the treatment of plantar warts. This single‐blind, randomized clinical trial was performed on 60 subjects presenting with plantar wart in Sabzevar, Iran in 2018. The first intervention group was treated with 40% TCA in four sessions within 4 weeks. The second intervention group was treated with Cryo using liquid nitrogen in four sessions within 8 weeks. The mean (SD) age of subjects was 20.16 ± 5.96 years and 68.33% (n = 41) were male. Although the resolution rate of warts in the TCA 40% group was greater than the Cryo group, there was no statistical association found between the two groups by adjusting age, sex, and basal time (P = .648). Findings suggest that although 40% TCA was almost as effective as Cryo in the treatment of plantar warts, considering the lower adverse effects of TCA 40% group as compared to the Cryo group, it could be a proper alternative.

Efficacy of cryotherapy for plantar warts: A systematic review and meta‐analysis

“…Subsequently, a second analysis by subgroups was performed with low heterogeneity ( x 2 = 4.18, df = 3, p = 0.24, I 2 = 28.2%). Five studies included 403 patients compared the effects of cryotherapy versus keratolytic agents (daily patient self‐treatment with 50% salicylic acid, 40% trichloroacetic acid, and 10% formaldehyde and topical CPS) 6,9,18,22,24 . Meta‐analysis of this data estimated the pooled OR at 0.48 (95% CI 0.18–1.32) with substantial heterogeneity ( x 2 = 8.72, df = 4, p = 0.07, I 2 = 54%).…”

“…Cryotherapy was compared with 40% trichloroacetic acid solution (TCA) 9 , 18 or laser 19 , 20 in two trials, duct tape, 8 intralesional bleomycin, 21 topical 10% formaldehyde soaks, 22 adapalene 0.1% gel, 23 CPS formulation, 24 radiofrequency ablation, 25 salicylic acid, 6 acyclovir cream, 26 or placebo 26 in one trial. In addition, studies carried out by Albalat et al 11 and Leow et al 27 compared the efficacy of two modalities of cryotherapy.…”

“…A first meta‐analysis with 12 studies including 927 patients compared the effects of cryotherapy versus other treatments 6 , 8 , 9 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 (Figure 4 ). Meta‐analysis of this data estimated the pooled odds ratio (OR) at 0.31 (95% confidence interval [CI] 0.12–0.78) with substantial heterogeneity ( x 2 = 60.85, df = 12, p = 0.01, I 2 = 80%).…”

“…2,4,6,7 Cryotherapy is considered by most of healthcare providing facilities as the treatment of choice in common wart management. 8 It is the most common method for treating warts 9 and it is based on the destruction of infected tissue by the application of liquid nitrogeninduced cold, producing a sharp, localized freezing, followed by a slow thawing. 9,10 The advantages of using cryotherapy are rapid application and cost-effectiveness 9 although pain, dyspigmentation, scar formation, delayed healing, and/or relapses are potential side effects.…”

“…8 It is the most common method for treating warts 9 and it is based on the destruction of infected tissue by the application of liquid nitrogeninduced cold, producing a sharp, localized freezing, followed by a slow thawing. 9,10 The advantages of using cryotherapy are rapid application and cost-effectiveness 9 although pain, dyspigmentation, scar formation, delayed healing, and/or relapses are potential side effects. 11 Recent systematic reviews of the range of treatments for plantar warts continue to consider cryotherapy together with salicylic acid as one of the treatments of choice.…”