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Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae)

Discussion in 'General Issues and Discussion Forum' started by NewsBot, Jun 10, 2011.

  1. NewsBot

    NewsBot The Admin that posts the news.


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    Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial.
    Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang'ombe AR, Stamuli E, Turner G, Thomas K, Curran M, Denby G, Hashmi F, McIntosh C, McLarnon N, Torgerson D, Watt I; on behalf of the EVerT Team.
    BMJ. 2011 Jun 7;342:d3271. doi: 10.1136/bmj.d3271.
  2. Admin2

    Admin2 Administrator Staff Member

    Related threads:
    Other threads tagged with verruca
  3. dragon_v723

    dragon_v723 Active Member

    is there another study that investigates if there is any difference in recurrence rate from using the s.acid and cryo?
  4. carolethecatlover

    carolethecatlover Active Member

    What about the needling?
  5. Now that would be the study

    Bel et al paper number 2

    Cryo v´s Salicylic acid v´s needling v´s control group.

    6 days
    6 weeks
    6 months

  6. carolethecatlover

    carolethecatlover Active Member

    Well Mark, I'lll do it with you, but when I graduate, I want to do a paper on Dyshidrosis. But I do love verrucae too.
  7. Carole its Mike

    and Im not your guy on this one for so many reasons which is why I suggested to someone else.

    Goodluck with the exams etc etc
  8. David Smith

    David Smith Well-Known Member

    This is what you realy need, TERASIL - see how the blue granules attack the virus:wacko::dizzy:


    Apparently this product contains no harsh chemicals - No, the activated minerals Gently Kill the virus so that's good eh? Just smother them while they sleep with a nice soft downy pillow aaahh sweet and gently DIE!

  9. blinda

    blinda MVP

    It`s in the pipeline. Ethical approval has been problematic as I no longer work for the NHS....but we`re getting there :drinks
  10. David Smith

    David Smith Well-Known Member

    I was suprised that they used the best type of freezing i.e. liquid nitrogen applied by the best method i.e. a podiatrist and then strangely say they only used a gentle freeze! what does that mean? does it mean that the tissues are not effectively frozen so as to avoid secondary trauma??? Then yet the acid was not the highest concentrate and applied by the patient i.e. highly unreliable. If the objective of this research was an exercise in statistics then they did a good job but for me its a surprisingly pointless exercise if they really wished to discover the best treatment method between acid and cryo.

    Here's an analogy. Who can run 200m the fastest men or women?
    Use elite male athletes but put a sharp stone in one of each of their shoes and female accountants who occasionally run for fitness but allow them to enter their own times to complete the distance, with no one watching to check (and then put in the shortcomings that you expect they under estimated their times since 21.2 seconds seems a little fast for non elite athletes??) . Then do an in depth five page statistical study of the results to discover the difference between the two cohorts. Does it answer the original question no not really no matter how clever the statistics were.

  11. Heather J Bassett

    Heather J Bassett Well-Known Member

    WOW terrasil sounds like a wonder drug?!? :)

    On that note I will hit the soft downy pillow! But not to Die?!?!

    Sorry folks past my bedtime!!

  12. mokgatle

    mokgatle Member

    Has anyone ever tried a combitation therapy of salicylic acid (50%) & phenol(80%) for the treatment of warts.

    I once tried this method and it worked like a bomb, fast & effective.Done on 2 pts
    method: 1st week 50% s-acid for 7days,
    day 7, expose the verruca by removing masceration tissue
    draw 0.2ml of phenol, slightly prick & inject phenol with every location pricked,
    cover with strapping & tcb 5-7days,
    after week 2 or 3 the verucca may be clear.
    3-4 weeks of patient's time was saved

    Researchers, you may try this to establish an extra clinical wart removing technique.
  13. NewsBot

    NewsBot The Admin that posts the news.

    EVerT: cryotherapy versus salicylic acid for the treatment of verrucae - a randomised controlled trial.
    Cockayne E, Curran M, Denby G, Hashmi F, Hewitt C, Hicks K, et al.
    Health Technol Assess 2011;15(32).
  14. NewsBot

    NewsBot The Admin that posts the news.

    Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)
    Eugena Stamuli, Sarah Cockayne, Catherine Hewitt, Kate Hicks, Shalmini Jayakody, Arthur Ricky Kang'ombe, Gwen Turner, Kim Thomas, Mike Curran, Farina Hashmi, Caroline McIntosh, Nichola McLarnon, David J Torgerson and Ian Watt
    Journal of Foot and Ankle Research 2012,
  15. Jvm620

    Jvm620 Member

    Hi everyone Re: cryo vs salacylic acid for verrucas - no one has discussed the issue of scarring after cryotherapy.
    I have several patients whose verrucas were treated successfully (& unsuccessfully) with cryo only to have residual scarring for ever, causing more painful lesions than the original warts! My treatment philosophy is not to treat unless causing pain or disability, & then advise pts in first instance to self treat with sal acid, cover, & return for debridement if necessary. If still resistant then progressing to further treatment if necessary. I think it is also important that patients are fully informed of likely outcomes etc with all treatment options, otherwise are they able to give informed consent?
  16. NewsBot

    NewsBot The Admin that posts the news.

    The effect of patients' preference on outcome in the EVerT cryotherapy versus salicylic acid for the treatment of plantar warts (verruca) trial
    Sarah Cockayne, Kate Hicks, Arthur R Kangombe, Catherine Hewitt, Michael Concannon, Kim Thomas, Farina Hashmi, Caroline McIntosh, Gwen Brierley, David Torgerson and Ian Watt
    Journal of Foot and Ankle Research 2012, 5:28 doi:10.1186/1757-1146-5-28 Published: 12 November 2012
  17. NewsBot

    NewsBot The Admin that posts the news.

    A Double-Blind, Randomised, Placebo-Controlled Trial of EMLA® Cream (Eutectic Lidocaine/Prilocaine Cream) for Analgesia Prior to Cryotherapy of Plantar Warts in Adults.
    Lee SH, Pakdeethai J, Toh MP, Aw DC.
    Ann Acad Med Singapore. 2014 Oct;43(10):511-4.
  18. NewsBot

    NewsBot The Admin that posts the news.

    Implementation of blinded outcome assessment in the Effective Verruca Treatments trial (EverT) – lessons learned
    Sarah Cockayne, Catherine Hewitt, Farina Hashmi, Kate Hicks, Michael Concannon, Caroline McIntosh, Kim Thomas, Jill Hall, Judith Watson, David Torgerson and Ian Watt
    Journal of Foot and Ankle Research20169:21
  19. NewsBot

    NewsBot The Admin that posts the news.

    Efficacy of Two Different Liquid Nitrogen Cryotherapy Regimes in the Treatment of Plantar Viral Warts: A Prospective Comparative Study
    Leow, Mabel Qi He; Tan, Eugene Sern-Ting
    Journal of the Dermatology Nurses' Association: July/August 2017 - Volume 9 - Issue 4 - p E1–E5
  20. blinda

    blinda MVP


    It was a privilege it was to be invited to act on the steering and ethics committee for the above valuable trial. Dr Farina Hashmi (and many others, including myself) was keen to obtain ethical approval for a good quality RCT on verrucae needling, to add to the growing body of evidence for this treatment. To date, there has been scant research on this method – apart from a few papers suggesting that a cell-mediated immune response, could be induced by `pinpoint`, or capillary bleeding – until the first RCT was conducted by our Australian colleagues (Cunningham et al, 2014) in JAPMA “Needling Versus Liquid Nitrogen Cryotherapy for the Treatment of Pedal Warts. A Randomized Controlled Pilot Study.” The Results of this study, (where MORE THAN ONE NEEDLING SESSION WAS SOMETIMES UNDERTAKEN) were: “Of 37 patients enrolled in the study, 18 were allocated to receive needling and 19 to receive liquid nitrogen cryotherapy. Regression of the primary pedal wart occurred in 64.7% of the needling group (11 of 17) and in 6.2% of the liquid nitrogen cryotherapy group (1 of 16)....There was no significant difference in pain, satisfaction, or cosmesis between the two groups. Conclusions: The regression rate of the primary pedal wart was significantly higher in the needling group compared with the liquid nitrogen cryotherapy group.”

    In 2013, Dr Ivan Bristow and I published a review of practice; “The Treatment of Verrucae Pedis Using Falknor’s Needling: A Review of 46 Cases”. We reported a 69% success rate in total clearance of verrucae WITH A MAXIMUM OF 2 NEEDLING SESSIONS. We also reported a significant improvement in pain outcomes amongst those who were not included in the 69% because the lesions had either reduced in number or size, thus the pt experienced less pain. Whilst not counted as complete resolution, this reduction of viral load can be regarded as a positive outcome. However, the case series was biased due to lack of a control and the placebo effect could not be determined. Thus, it was intended to act as a catalyst for further research in the form RCT`s so that we may gain a better understanding of 1) How HPV evades innate & adaptive immune responses 2) whether needling is an effective treatment for eradication or reduction of viral load.

    So, Farina and her colleagues obtained ethical approval for A SINGLE NEEDLING SESSION to compare against sharp debridement (It`s a shame it isn`t open access, but that`s an altogether different debate to be had). The study was carried out without adverse events and the results are very interesting indeed. On the face of it, it would appear that needling works no better than debridement. However, this trial did not allow for subsequent treatments (even if the participant requested it, due to the positive result experienced) and was limited by the time scale dictated by the strict ethics criteria – and rightly so; the patients` welfare ALWAYS comes first. Thus, when any participant contacted the university to say the lesion(s) had resolved outside the timescale of 24 weeks, this could not be included in the study results. Yes, after that period, it would be difficult to attribute the needling for the later resolution as we know spontaneous regression does occur…particularly after an episode of inflammation, but this global inflammatory response varies greatly from one individual to another.

    The majority of verruca trials look at cryotherapy and/or SalA and THE most robust trial was also carried out by the same EVerT team that Farina was part of., which is posted on this thread by Newsbot. They interestingly reported just a 14% success rate of lesion resolution for both therapies at 12 weeks, which is a far lower percentage than that reported by most other studies, according to the Cochrane – but this is a seminal piece of research in the world of VP`s, see link below.

    What can we learn from Farina`s excellent study? Quite a few things actually.
    1) It demonstrates that more than one needling is sometimes required (as is the case with ALL verrucae treatments, including the SWIFT device).
    2) That patients often want further needling sessions as they can see and feel the benefit in the reduction of viral load.
    3) Strict protocol, dictated by ethical criteria, can limit an RCTs application in clinical practice. Hence the requirement for using meta-analysis reviews (such as the Cochrane), which include both case studies and RCTs for an overall evaluation.
    4) Further research is (of course) required.

    Talking of further research....I`m selling up and moving on. Wish me luck!
  21. NewsBot

    NewsBot The Admin that posts the news.

    Efficacy and Safety of Three Cryotherapy Devices for Wart Treatment: A Randomized, Controlled, Investigator-Blinded, Comparative Study
    Imko WalczukFrank Eertmans et al
    Dermatology and Therapy 06 December 2017
  22. vuye

    vuye Member

    Scarring only happens if cryo done excessively penetrating deep into dermis in my opinion hence why I think in the study they wrote gently used.
  23. NewsBot

    NewsBot The Admin that posts the news.

    Efficacy of cryotherapy for plantar warts: a systematic review and meta-analysis
    Sara García-Oreja et al
    Dermatol Ther. 2022 Apr 1
  24. NewsBot

    NewsBot The Admin that posts the news.

    Cryotherapy versus topical nitric-zinc complex solution for the treatment of plantar warts: A randomized controlled trial
    Sara García-Oreja et al
    Med Virol. 2023 Nov;95(11):e29212

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