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Randomized Controlled Trial
. 2011 Jun 7:342:d3271.
doi: 10.1136/bmj.d3271.

Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial

Sarah Cockayne  1 , Catherine Hewitt, Kate Hicks, Shalmini Jayakody, Arthur Ricky Kang'ombe, Eugena Stamuli, Gwen Turner, Kim Thomas, Mike Curran, Gary Denby, Farina Hashmi, Caroline McIntosh, Nichola McLarnon, David Torgerson, Ian Watt; EVerT Team
Affiliations
Randomized Controlled Trial

Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial

Sarah Cockayne et al. BMJ. .

Abstract

Objective: To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts.

Design: A multicentre, open, two arm randomised controlled trial.

Setting: University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland.

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.

Interventions: Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks.

Main outcome measures: Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment.

Results: There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI -8.33 to 9.63), P=0.89). 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. 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). 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).

Conclusions: Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts.

Trial registration: Current Controlled Trials ISRCTN18994246, National Research Register N0484189151.

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Conflict of interest statement

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.

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Flow of participants through the EVerT trial
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