A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts

Sushma Jankal Basavarajappa; Radhakrishnan Subramaniyan; Rajeshwari Dabas; Sandeep V Lal; Manasa S Janney

doi:10.4103/idoj.IDOJ_507_20

A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts

Indian Dermatol Online J. 2021 May 12;12(3):412-416. doi: 10.4103/idoj.IDOJ_507_20. eCollection 2021 May-Jun.

Authors

Sushma Jankal Basavarajappa¹, Radhakrishnan Subramaniyan², Rajeshwari Dabas³, Sandeep V Lal⁴, Manasa S Janney⁵

Affiliations

¹ Department of Dermatology, Siddaganga Hospital Research Centre, Tumkur, Karnataka, India.
² Professor Dermatology, Command Hospital (Central Command), Lucknow, Uttar Pradesh, India.
³ Department of Dermatology, Command Hospital, Udhampur, J & K, Kollam, Kerala, India.
⁴ Department of Dermatology, Victoria (Women and Child) Hospital, Kollam, Kerala, India.
⁵ Department of Dermatology, Military Hospital, Dimapur, Nagaland, India.

Abstract

Background: Warts are benign proliferations of keratinocytes caused by Human Papilloma Virus (HPV). Plantar warts are caused by HPV types 1, 2, 4, 27 and 57. It is challenging to treat them due to frequent recurrences.

Aim: To compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with needling versus 30% Trichloroacetic acid (TCA) with needling in the treatment of plantar warts.

Materials and methods: Sixty consecutive patients of plantar warts were randomly allocated into two groups of 30 each and treated with either 30% TCA with needling or 5% 5-FU with needling once in four weeks, until complete clearance of warts or for a maximum of three sessions. Baseline clinical photographs were taken and subjective response at the end of treatment was recorded. Objective assessment at 4, 8, and 12 weeks was carried out and outcome was evaluated by reduction in number and size of warts. Adverse effects of each group were noted and compared. Follow-up of patients was done at 6 months for clinical assessment of results and to study recurrence.

Results: Out of 30 patients in 30% TCA group, 28 patients (93.33%) had complete response and 02 patients (6.66%) had partial response at the end of 12 weeks. In 5-FU group, 26 patients (86.66%) showed complete response, 02 patients (6.66%) had partial response, and 02 patients (6.66%) had no response to treatment. The mean reduction in size and number of warts was better in the TCA group and was significant at 4^th week of follow up while at the end of 8^th week and 12^th week, the response was identical. There was no recurrence of warts in the complete responders at the end of 6 months. The main adverse effect seen in both groups was pain at the needling site.

Conclusion: Needling with both topical 5% 5-FU and 30% TCA are highly effective in clearing plantar warts. However, 30% TCA has the advantage of early action and complete clearance of plantar warts with fewer adverse effects.

Keywords: 30% Trichloroacetic acid; 5% 5-Fluorouracil; needling; plantar warts.