Topical 5-fluorouracil has no additional benefit in treating common warts with cryotherapy: a single-centre, double-blind, randomized, placebo-controlled trial. Modern treatment of warts: cure rates at 3 and 6 months. The treatment of plantar warts with 5-fluorouracil. Treatment of skin papillomas with topical alpha-lactalbumin-oleic acid. Photodynamic therapy with 5-aminolaevulinic acid or placebo for recalcitrant foot and hand warts: randomised double-blind trial. Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial. Efficacy of 80% phenol solution in comparison with cryotherapy in the treatment of common warts of hands. [Double-blind randomized clinical study on treatment of warts with a fluorouracil-containing topical preparation (author's transl)]. [Cutaneous cryosurgery in family medicine: dimethyl ether-propane spray versus liquid nitrogen]. Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Effects of interferon-alpha on human warts. Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study. [Plantar warts. Occurrence and cryosurgical treatment]. Treatment of verrucae vulgaris with alpha 2 interferon. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine. Photodynamic therapy (PDT) and waterfiltered infrared A (wIRA) in patients with recalcitrant common hand and foot warts. Cryotherapy of common viral warts at intervals of 1, 2 and 3 weeks. Reduced dose of bleomycin in the treatment of recalcitrant warts. Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: a single-blinded, randomized, and controlled trial. Photodynamic inactivation of virus warts: a controlled clinical trial. Photodynamic inactivation of verrucae vulgares. II. Locally injected bleomycin in the treatment of warts. An assessment of methods of treating viral warts by comparative treatment trials based on a standard design. Local hyperthermia at 44 degrees C for the treatment of plantar warts: a randomized, patient-blinded, placebo-controlled trial. Value of a second freeze-thaw cycle in cryotherapy of common warts. Liquid nitrogen and salicylic/lactic acid paint in the treatment of cutaneous warts in general practice. Pulsed-dye laser versus conventional therapy in the treatment of warts: a prospective randomized trial. Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts. Efficacy of silver nitrate pencils in the treatment of common warts. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. Salicylic acid in karaya gum patch as a treatment for verruca vulgaris. A comparison of acyclovir cream versus placebo cream versus liquid nitrogen in the treatment of viral plantar warts. Effects of hypnotic, placebo, and salicylic acid treatments on wart regression. Paring and intense pulsed light versus paring alone for recalcitrant hand and foot warts: a randomized clinical trial with blinded outcome evaluation. Intralesional bleomycin in the treatment of cutaneous warts: a randomized clinical trial comparing it with cryotherapy. A double-blind, randomized trial of local formic acid puncture technique in the treatment of common warts. [Treatment of warts of the hands and feet with Verucid]. Efficacy of duct tape vs placebo in the treatment of verruca vulgaris (warts) in primary school children. Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study. Smoke from leaves of Populus euphratica Olivier vs. conventional cryotherapy for the treatment of cutaneous warts: a pilot, randomized, single-blind, prospective study. A controlled trial on the use of topical 5-fluorouracil on viral warts. Monochloroacetic acid and 60% salicylic acid as a treatment for simple plantar warts: effectiveness and mode of action. The treatment of resistant warts with intralesional bleomycin: a controlled clinical trial. Application of beta-interferon in virus-induced papillomas. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial. Wart treatment with anthralin. Intralesional recombinant alpha-2 interferon for the treatment of patients with condyloma acuminatum or verruca plantaris. The treatment of plantar warts in the home. A critical appraisal of a new preparation. Clinical observation on the therapeutic effects of Qu You Ding on flat wart. [595 nm pulse dye laser therapy for viral warts: a single-blind randomized comparative study versus placebo]. The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart). Recalcitrant hand and foot warts successfully treated with photodynamic therapy with topical 5-aminolaevulinic acid: a pilot study. Topical zinc sulphate solution for treatment of viral warts.
The role of topical 5-fluorouracil (5-FU) in treating common warts is not well defined. We tried to evaluate the efficacy and adverse effects of combination cryotherapy and topical 5% 5-FU ointment in the treatment of common warts. The study was a single-centre, double-blind randomized placebo-controlled trial. In the study, 80 patients with common warts were randomized into two groups and underwent two 10-second freeze/thaw cycles of cryotherapy with liquid nitrogen once every three weeks for a maximum of five treatments. Between treatments, patients applied either topical 5% 5-FU ointment (group A) or placebo aqueous cream (group B) twice daily. The mean +/- SD reduction in wart area was 58.57 +/- 0.06% in group A and 65.29 +/- 0.06% in group B. In total, 19 patients in group A and 24 patients in group B had wart size reduced by 75% or more (P = 0.50), while 12 patients in group A and 17 patients in group B had clearance of their warts (P = 0.245). Logistic regression with age, sex, smoking status, immune status, site, duration and number of warty lesions, history of previous treatment, and treatment group found that only a history of previous treatment and acral lesions were significant adverse predictors of improvement. There was no significant difference in the number of adverse events between the two groups, although there was a trend towards more pain and blistering associated with topical 5-FU. We concluded that topical 5-FU has no added benefit in treating common warts with cryotherapy. Four-hundred consecutive referrals with viral warts of the hands and/or feet were investigated to determine the cure rate from a combination of cryotherapy, keratolytic wart paint and paring. For treatment failures after 3 months, the value of continuing cryotherapy and of additional treatment with the immunomodulator inosine pranobex were assessed. Subjects were treated for 3 months with wart paint and cryotherapy and were randomized to receive, or not, paring in addition. Those who did not respond by 3 months were randomized to receive, or not, 3 months further cryotherapy, and to receive inosine pranobex 60 mg/kg/day for 1 week each month, or matching placebo. Fifty-two per cent of subjects were cured by 3 months. The chance of cure was inversely related both to the length of history and to the diameter of the largest wart. Paring improved the cure rate for plantar warts but not for hand warts. During the second 3 months the cure rate fell to 41%. Neither cryotherapy nor inosine pranobex significantly improved this response. nan We studied the effect on skin papillomas of topical application of a complex of alpha-lactalbumin and oleic acid (often referred to as human alpha-lactalbumin made lethal to tumor cells [HAMLET]) to establish proof of the principle that alpha-lactalbumin-oleic acid kills transformed cells but not healthy, differentiated cells.
                Forty patients with cutaneous papillomas that were resistant to conventional treatment were enrolled in a randomized, placebo-controlled, double-blind study, in which alpha-lactalbumin-oleic acid or saline placebo was applied daily for three weeks and the change in the volume of each lesion was recorded. After this first phase of the study, 34 patients participated in the second phase, an open-label trial of a three-week course of alpha-lactalbumin-oleic acid. Approximately two years after the end of the open-label phase of the study, 38 of the original 40 patients were examined, and long-term follow-up data were obtained.
                In the first phase of the study, the lesion volume was reduced by 75 percent or more in all 20 patients in the alpha-lactalbumin-oleic acid group, and in 88 of 92 papillomas; in the placebo group, a similar effect was evident in only 3 of 20 patients (15 of 74 papillomas) (P<0.001). After the patients in the initial placebo group had been treated with alpha-lactalbumin-oleic acid in the second phase of the study, a median reduction of 82 percent in lesion volume was observed. At follow-up two years after the end of the second phase, all lesions had completely resolved in 83 percent of the patients treated with alpha-lactalbumin-oleic acid, and the time to resolution was shorter in the group originally assigned to receive alpha-lactalbumin-oleic acid than among patients originally in the placebo group (2.4 vs. 9.9 months; P<0.01). No adverse reactions were reported, and there was no difference in the outcomes of treatment between immunocompetent and immunosuppressed patients.
                Treatment with topical alpha-lactalbumin-oleic acid has a beneficial and lasting effect on skin papillomas.
                Copyright 2004 Massachusetts Medical Society Photodynamic therapy (PDT) with topical 5-aminolaevulinic acid (ALA) followed by irradiation with incoherent light (ALA-PDT) for recalcitrant warts have had beneficial results. Therefore, we undertook a randomised, parallel, double-blind clinical trial of ALA-PDT versus placeboPDT for recalcitrant foot and hand warts.
                Recalcitrant foot and hand warts were randomly assigned to six repetitive ALA-PDT or placebo-PDT interventions combined with standard treatment encompassing paring followed by a keratolytic (Verucid). Standardised photographs of each wart were taken before, during (week 7) and after treatment (weeks 14 and 18). The area of each wart compared with entry area was the primary outcome variable, measured from photographs by an evaluator unaware of treatment allocation for intervention. Pain intensity immediately and 24 h after each intervention was assessed by a five-point scale.
                A total of 232 foot and hand warts in 45 patients were entered into the trial: 117 warts were allocated to ALA-PDT and 115 warts to placebo-PDT. In week 14, the median relative reduction in wart area was 98% in the ALA-PDT group (interquartile range 100%, 55%) versus 52% (100%, 0) in the placebo group (p=0.0006). In week 18, the median relative reduction in wart area was 100% in the ALA-PDT group (100%, 57%) versus 71% (100%, 0) in the placebo-PDT arm (p=0.008). Both the number of vanishing warts and the difference in relative wart area of persisting warts at week 14 and 18 were significant (p<0.05) in favour of ALA-PDT. Significantly more ALA-PDT warts were graded at a higher pain intensity after treatment than placebo-PDT warts.
                ALA-PDT is superior to placebo-PDT when both wart area and number of vanishing warts are considered. 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts.
                The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts.
                Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection.
                Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo (p<.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups.
                The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate. The common wart is a common infectious disease caused by human papilloma virus. A variety of therapeutic modalities are available. Cryotherapy (liquid nitrogen) is one of the most common treatment forms. It freezes the tissue and destroys warts. Phenol is a caustic agent. Our purpose was to evaluate and compare the efficacy of cryotherapy and 80 percent phenol solution on common warts of hands.
                This single-blinded clinical trial study was performed on 60 patients with common warts referred to the dermatology clinic of Ghaem Hospital Mashhad, Iran, in 2002. Patients were randomly divided into two groups; 30 patients were treated with cryotherapy and 30 patients were treated with 80 percent phenol, on a once-weekly basis until complete clearance of the lesions or a maximum duration of six weeks.
                Complete clearance of warts after six weeks was observed in 70 percent of patients who were treated with cryotherapy, and 82.6 percent of patients in the 80 percent phenol group; there was no statistically significant difference between the two methods (p-value is 0.014).
                Our data indicates that 80 percent phenol and cryotherapy are effective and simple treatments for common warts of hands, and patients do not experience any pain during the treatment. In a double blind trial 60 patients were treated with a salicylic acid-containing product against warts (Verrumal) on basis fluorouracil in comparison to placebo. The trial demonstrated a statistically significantly better result for the verum preparation than for the placebo without fluorouracil and without salicylic acid. This product against warts is, therefore, indicated if operative methods are not applicable or refused by the patient. To compare the efficacy, tolerance and safety of two types of cryotherapy, performed by family physicians, for benign cutaneous lesions: low freezing (-59 degrees C) with dimethyl either-propane cryogenic spray (DMEP) and intense freezing (196 degrees C) with conventional liquid nitrogen (LN).
                A randomised, multi-centered, controlled clinical trial, with single-blind assessment.
                Three primary care teaching teams in the Community of Madrid.
                Ten MIR from family & community medicine intervened. There were 124 patients, who had 174 benign cutaneous lesions, suitable for cryotherapy. There were 3 voluntary withdrawals, none because of an adverse reaction. Interventions, in each case there was local application for a standard time of the randomised agent. Control-group intervention, 81 cases: swab soaked in LN. Study-group intervention, 93 cases: swab saturated with DMEP spray. Maximum of three freezings per case, at weekly intervals.
                A doctor made a blind assessment of the results (elimination, adverse reaction, aesthetic result) 15 days after treatment.
                No clinically relevant differences between the efficacy, tolerance and safety of the two cryogenic agents used in primary care were found. The low freezing of DMEP was sufficient for the cryotherapy of benign lesions. To evaluate the efficacy of duct tape occlusion therapy for the treatment of common warts in adults.
                Double-blind controlled clinical intervention trial.
                Veterans Affairs medical center.
                A total of 90 immunocompetent adult volunteers with at least 1 wart measuring 2 to 15 mm were enrolled between October 1, 2004, and July 31, 2005. Eighty patients completed the study.
                Patients were randomized by a computer-generated code to receive pads consisting of either moleskin with transparent duct tape (treatment group) or moleskin alone (control group). Patients were instructed to wear the pads for 7 consecutive days and leave the pad off on the seventh evening. This process was repeated for 2 months or until the wart resolved, whichever occurred first. Follow-up visits occurred at 1 and 2 months.
                Complete resolution of the target wart. Secondary outcomes included change in size of the target wart and recurrence rates at 6 months for warts with complete resolution.
                There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group). Of patients with complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month.
                We found no statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population. Two patients with extensive warts which were stable for two years or more were treated with human interferon-alpha to assess the ability of interferon to affect this benign tumor of viral etiology. Intramuscular administration of 96.6 and 135 million units over 12-15 weeks produced softening and decreased scaling of each patient's warts. Double blind, placebo-controlled intralesional injections resulted in progressive disappearance of interferon treated warts. A dose response relationship was shown in eight warts. The minimum effective dose was 1.2 x 10(6) units injected over 15.5 weeks. The treatment of viral warts remains challenging. A variety of treatment modalities have been used with a range of success. Fluorouracil has been shown to be effective in treating warts but the method of its delivery directly onto the affected tissue has been of little efficacy. We evaluated the safety and efficacy of intralesional 5-fluorouracil in the treatment of verrucae.
                Seventy-six patients with a total 315 verrucae were randomized to receive either a 5-fluorouracil, lidocaine and epinephrine (5-FU + LE) mixture or serum saline injection into the paired verrucae in the same patient. The mixture of 5-FU (4 cm(3), 50 mg/mL), lidocaine (1 cm(3), 20 mg/mL) and epinephrine (0.0125 mg/mL) was injected into the base of the wart using a mantoux needle. Each lesion was infiltrated with either of the solutions once a week for up to a maximum of 4 weeks, and the patients were followed up for 6 months.
                Complete response was noted in an average of 70% of the verrucae treated with the 5-FU + LE mixture and in 29% of those in the placebo group (P < 0.001). No clinically significant systemic and local adverse effects occurred. Pain and burning were noted as an immediate injection pain. Recurrence rates were evaluated and no statistically significant difference between the two groups was found.
                The results demonstrate that treatment of verrucae with 5-FU + LE mixture is safe and effective. nan nan To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts.
                A multicentre, open, two arm randomised controlled trial.
                University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland.
                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.
                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.
                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.
                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).
                Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts.
                Current Controlled Trials ISRCTN18994246, National Research Register N0484189151. Despite numerous therapeutic modalities reported in the literature, treatment of common warts remains a continuing challenge and there is no universal consensus about optimal treatment. Recently, intralesional immunotherapy by different antigens has proved efficacy in the treatment of different types of warts.
                To evaluate the efficacy and safety of intralesional mumps, measles and rubella (MMR) vaccine in the treatment of common warts.
                The study included 135 patients with single or multiple recalcitrant or non-recalcitrant common warts. They were randomly assigned to two groups; the first group (85 patients) received intralesional MMR vaccine, and the second group (50 patients) received intralesional saline as a control group. Both treatments were injected into single lesions or largest wart in case of multiple lesions at 2-week intervals until complete clearance or for a maximum of five treatments. Follow-up was made every 2 months for 6 months to detect any recurrence.
                A highly significant difference was found between the therapeutic response of common warts to MMR vaccine and saline control group (P < 0.001). In the MMR group, complete response was achieved in 80% and 84.6% of patients presenting with recalcitrant and multiple warts respectively. No recurrence was observed in the MMR group and side effects included pain during injection and flu-like symptoms.
                Intralesional immunotherapy by MMR vaccine is a promising effective and safe treatment modality for common warts, particularly the multiple ones.
                © 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology. Common warts (verrucae vulgares) are human papilloma virus (HPV) infections with a high incidence and prevalence, most often affecting hands and feet, being able to impair quality of life. About 30 different therapeutic regimens described in literature reveal a lack of a single striking strategy. Recent publications showed positive results of photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) in the treatment of HPV-induced skin diseases, especially warts, using visible light (VIS) to stimulate an absorption band of endogenously formed protoporphyrin IX. Additional experiences adding waterfiltered infrared A (wIRA) during 5-ALA-PDT revealed positive effects.
                First prospective randomised controlled blind study including PDT and wIRA in the treatment of recalcitrant common hand and foot warts. Comparison of "5-ALA cream (ALA) vs. placebo cream (PLC)" and "irradiation with visible light and wIRA (VIS+wIRA) vs. irradiation with visible light alone (VIS)".
                Pre-treatment with keratolysis (salicylic acid) and curettage. PDT treatment: topical application of 5-ALA (Medac) in "unguentum emulsificans aquosum" vs. placebo; irradiation: combination of VIS and a large amount of wIRA (Hydrosun) radiator type 501, 4 mm water cuvette, waterfiltered spectrum 590-1400 nm, contact-free, typically painless) vs. VIS alone. Post-treatment with retinoic acid ointment. One to three therapy cycles every 3 weeks. Main variable of interest: "Percent change of total wart area of each patient over the time" (18 weeks). Global judgement by patient and by physician and subjective rating of feeling/pain (visual analogue scales). 80 patients with therapy-resistant common hand and foot warts were assigned randomly into one of the four therapy groups with comparable numbers of warts at comparable sites in all groups.
                The individual total wart area decreased during 18 weeks in group 1 (ALA+VIS+wIRA) and in group 2 (PLC+VIS+wIRA) significantly more than in both groups without wIRA (group 3 (ALA+VIS) and 4 (PLC+VIS)): medians and interquartile ranges: -94% (-100%/-84%) vs. -99% (-100%/-71%) vs. -47% (-75%/0%) vs. -73% (-92%/-27%). After 18 weeks the two groups with wIRA differed remarkably from the two groups without wIRA: 42% vs. 7% completely cured patients; 72% vs. 34% vanished warts. Global judgement by patient and by physician and subjective rating of feeling was much better in the two groups with wIRA than in the two groups without wIRA.
                The above described complete treatment scheme of hand and foot warts (keratolysis, curettage, PDT treatment, irradiation with VIS+wIRA, retinoic acid ointment; three therapy cycles every 3 weeks) proved to be effective. Within this treatment scheme wIRA as non-invasive and painless treatment modality revealed to be an important, effective factor, while photodynamic therapy with 5-ALA in the described form did not contribute recognisably - neither alone (without wIRA) nor in combination with wIRA - to a clinical improvement. For future treatment of warts an even improved scheme is proposed: one treatment cycle (keratolysis, curettage, wIRA, without PDT) once a week for six to nine weeks. We studied the efficacy, and time to clearance, of more frequent cryotherapy of viral warts, by randomizing 225 patients to receive treatment at 1-, 2- or 3-weekly intervals. The mean times to clearance of warts in each group were 5.5, 9.5 and 15 weeks in the weekly, 2-weekly and 3-weekly groups, respectively (P < 0.01). Cure rates after 3 months correlated with frequency of treatment (P < 0.05). After 3 months, 43% (66% of non-defaulters) had cleared in the group treated weekly, 37% (47%) of the group treated every 2 weeks, and 26% (30%) of those treated every 3 weeks. The mean numbers of treatments needed to achieve clearance were similar in each group (5.5, 4.75 and 5 treatments). After 12 treatments, cure rates were similar for all three groups: 43% for the weekly-treated group (3 months), 48% for the 2-weekly group (6 months), and 44% for the 3-weekly group (9 months). Percentage cure is related to the number of treatments received, and independent of the interval between treatments. A more rapid cure may, therefore, be achieved by more frequent treatment. The effectiveness of intralesional bleomycin (1 U/ml) in the treatment of warts refractory to conventional methods of treatment has been shown in well-controlled studies. We have now evaluated more dilute concentrations of bleomycin in the treatment of recalcitrant warts. Warts were assigned for therapy with intralesional bleomycin at a concentration of 0.25 U/ml, 0.5 U/ml, or 1 U/ml at 3-week intervals. If warts persisted after three injections or had recurred by 3 months' follow-up, treatment was considered a failure. Twenty-six patients whose warts had persisted after conventional treatment entered the study. Three patients had spontaneous regression of untreated warts during therapy and were not included in the results. Of seventy-nine warts treated with intralesional bleomycin, sixty-two (78%) were cured after one to three injections. Responding warts showed a hemorrhagic eschar even with the lower bleomycin concentrations and healed without complication. Almost all treated warts responded, although not all were cured. Treatment with bleomycin at 0.5 U/ml was as effective as treatment with 1 U/ml. Bleomycin at 0.25 U/ml is effective therapy but not enough warts were treated to permit a conclusion when compared with higher concentrations. Warts occur commonly in humans. Destructive modalities are generally the first physician-administered therapy. Other treatment options include immunotherapy. Intralesional immunotherapy using mumps, Candida, or Trichophyton skin test antigens has proved efficacy in the treatment of warts.
                To determine rates of wart resolution in response to injection of antigen alone, antigen plus interferon alfa-2b, interferon alfa-2b alone, and normal saline; and to compare response according to viral type, major histocompatibility complex antigens, and peripheral blood mononuclear cell proliferation to autologous human papillomavirus antigen before and after injection.
                Randomized, single-blinded, placebo-controlled, clinical trial.
                Medical school-based dermatology department.
                Two hundred thirty-three patients clinically diagnosed as having 1 or more warts. Main Outcome Measure Clinical resolution of warts in response to intralesional immunotherapy.
                Responders were observed in all treatment arms, but were significantly more likely to have received antigen (P<.001). Resolution of distant untreated warts was observed, and was significantly more likely in subjects receiving antigen (P<.001). Interferon did not significantly enhance the response rate (P = .20) and did not differ from normal saline (P = .65). No viral type or major histocompatibility complex antigen correlated with response or lack of response (P>.99 and P = .86, respectively). A positive peripheral blood mononuclear cell proliferation assay result (2 times pretreatment levels) was significantly more likely among responders (P = .002). While there was no significant difference in response based on sex (P = .56), older subjects (>40 years) were less likely to respond (P = .01).
                Intralesional immunotherapy using injection of Candida, mumps, or Trichophyton skin test antigens is an effective treatment for warts, as indicated by significantly higher response rates and distant response rates in subjects receiving antigen. Viral type and major histocompatibility complex antigens did not seem to influence treatment response. Response is accompanied by proliferation of peripheral blood mononuclear cells to human papillomavirus antigens, suggesting that a human papillomavirus-directed cell-mediated immune response plays a role in wart resolution. nan Photodynamic inactivation therapy, consisting of a double-blind, paired comparison treatment schedule, was used in treating 56 patients for recalcitrant, symmetrical verrucae vulgares. 0.1% proflavine in 100% dimethylsulphoxide (DMSO) and 0.1% neutral red in 100% DMSO were used as active dyes, and 1% picric acid in 100% DMSO and 1% color ruber in 100% DMSO and 1% color ruber in 100% DMSO served as corresponding placebos. A Westinghouse sunlamp and black light were used to irradiate the warts dyed with proflavine and its placebo, and the warts dyed with neutral red and its placebo were irradiated with an ordinary light bulb (Osram 588597). 50 patients completed the treatment. 10 of the 27 patients treated with proflavine and 10 of the 23 patients treated with neutral red were cured by the end of an 8 week period, with the warts disappearing simultaneously from the actively as well as the placebo-treated side. Complement fixing antibodies against wart virus were detected in one of the cured patients and 2 who were treatment failures. To evaluate the clinical effectiveness of intradermally injected bleomycin in saline and oil versus placebo, a double-blind study of 62 patients with 108 warts was made. Although bleomycin has been recommended in previous reports, we found no difference between the group treated with bleomycin and the placebo group. A series of eleven comparative wart treatment trials undertaken between 1969 and 1975 and involving 1802 patients is described. A method of coding provided groups of patients matched for age, type, number and duration of warts, within which treatments could be randomized. The variation in response to treatment was shown to be influenced significantly by these factors and the level of cure to depend on the proportions of the various response groups within the population under consideration. These proportions were found to vary geographically and at different periods. In all the trials the results were assessed at 12 weeks. In the treatment of hand warts, the percentage cure of patients treated with liquid nitrogen fell significantly from 75 to 40% when the interval between freezings was increased from 3 to 4 weeks. The average number of freezings required for a cure was 3-1 amongst all patients cured by 6 or less freezings at intervals of 2 or 3 weeks. In a two-centre trial there was no significant difference between the percentage cure of patients with hand warts treated with liquid nitrogen (69%) and of those applying a paint containing salicylic and lactic acids (SAL) (67%). Patients receiving both treatments concurrently did better (78%) but the difference was not found to be statistically significant. In the treatment of simple plantar warts the percentage cure for the SAL paint (84%) was found to compare favourably with that for a podophyllin treatment (81%). Only one of the patients cured by the paint in that trial was found to have had a recurrence after 6 months. The paint was found to be satisfactory for use under general practice conditions. Additions to the formula did not alter its effectiveness. In the treatment of mosaic plantar warts the overall percentage cure for the SAL paint in a series of comparative trials (1969-75) was 45%. In these trials it was compared directly with one or more other preparations. No differences were found between its efficacy and that of 10% buffered gluteraldehyde (47%), 40% benzalkonium chloride dibromide (Callusolve 40) (30%) and 5% 5-fluorouracil in dimethyl sulphoxide (53%). Only 25% of thirty-six patients treated with 5% idoxuridine in dimethylsulphoxide were cured. Throughout the trials approximately 30% of patients with hand warts, 20% of those with simple plantar warts and 50% of those with mosaic plantar warts were found to be resistant to treatment. The adoption of treatment with SAL paint for hand warts and simple plantar warts by the general practitioners in the Edinburgh area has proved satisfactory. Only resistant cases are now referred to hospital and these can be treated within a few weeks instead of 4-5 months as was the case in 1969. There have been anecdotal reports that local hyperthermia was effective in the treatment of viral warts. We conducted a randomized, patient-blinded, placebo-controlled trial to test the effect of local hyperthermia (44 degrees C for 30 min a day for 3 consecutive days plus 2 additional days 2 weeks later) on plantar warts. By the end of 3 months, 53.57% of patients (15/28) in the treatment group and 11.54% of patients (3/26) in the control group were cured (P < .01). The effect was not influenced by patient age, duration of disease, or number or size of lesions. A study of open, randomized, parallel-group design was performed to investigate the impact of a second freeze-thaw cycle on the cure rate, at 3 months, from cryotherapy of common warts on the hands and feet. Cryotherapy was performed at 3-week intervals, and subjects were randomized to receive either one or two freeze-thaw cycles. In addition, all subjects used keratolytic wart paints throughout the study, and plantar warts were pared prior to freezing. Three hundred subjects were recruited. At 3 months, 124 were cured, 83 were not cured, and 93 had defaulted. Among those who did not default the cure rate was 57% from the single freeze technique, and 62% from the double freeze technique, a difference of 5% (P = 0.53, 95% CI-8.1-18.6). Separate analyses for subjects with warts on the hands and on the feet demonstrated no effect of double freezing on hand warts. In contrast, for plantar warts, the cure rate was 41% from single freezing and 65% for double freezing, a difference of 24% (P = 0.04, 95% CI 2.9-44.4). The use of a double freeze-thaw cycle confers little or no advantage over a single freeze in the treatment of hand warts, but may be considerably more effective for plantar warts. Patients with common hand warts and simple plantar warts attending a general practice wart clinic in Northern Ireland were assigned to one of three treatment groups - liquid nitrogen applied weekly, daily application of wart paint (lactic acid one part, salicylic acid one part, collodion four parts), or a combination of the two. Combination therapy cured 87% of common hand warts over a six week period, and was significantly more effective than either agent used separately (P<0.05). The results for simple plantar warts were disappointing and no treatment regimen proved to be significantly better than any other. These treatments were cheap, compliance and tolerance were good, and the six month recurrence rate was minimal. Given the likelihood that warts will multiply if left untreated we would recommend early active treatment for this condition. The clinical management of verrucae vulgaris is often challenging, and no ideal treatment currently exists. Early studies suggested that pulsed-dye laser (PDL) therapy might be highly effective in the treatment of verrucae, although more recent reports have been less optimistic. Previous studies have been retrospective or have consisted of a series of patients treated with PDL alone.
                Our objective was to prospectively evaluate the efficacy of PDL therapy versus conventional therapy with liquid nitrogen cryotherapy or cantharidin in the treatment of warts.
                Forty healthy adult patients with verrucae were randomized to receive either PDL (585 nm) therapy or conventional therapy. All enrollees also performed home therapy. Patients were eligible for up to 4 treatment sessions at 1-month intervals. Warts were individually counted and measured at the time of each treatment session. Complete response was defined as complete absence of verrucae with the presence of dermatoglyphics, and partial response was defined as a 50% or greater reduction in wart size.
                A total of 194 warts were evaluated by the conclusion of the study. Complete response was noted in an average of 70% of the warts treated with conventional therapy and in 66% of those in the PDL group; this was statistically insignificant. Partial response was observed in an average of 82% of the warts in patients treated with conventional therapy and 87% in the PDL group. Verruca vulgaris responded more readily than verruca plantaris in both treatment groups. The mean number of treatments to achieve success was similar in both groups.
                The PDL is an efficacious form of therapy for verrucae, as is conventional therapy. PDL therapy should be considered among the better established approaches in the treatment of warts, although data from this trial suggest that this approach is probably not superior. Warts are a common dermatologic problem. Treatment is painful, prolonged, and can cause scarring.
                To evaluate topical zinc oxide for the treatment of warts.
                This was a randomized, double-blind controlled trial of 44 patients. Twenty-two patients were given topical zinc oxide 20% ointment, and the other 22 received salicylic acid 15% + lactic acid 15% ointment twice daily. All patients were followed up for 3 months or until cure, whichever occurred first. All patients were observed for side-effects.
                Sixteen patients in the zinc group and 19 in the salicylic acid-lactic acid group completed the study. In the zinc oxide-treated group, 50% of the patients showed complete cure and 18.7% failed to respond, compared with 42% and 26%, respectively, in the salicylic acid-lactic acid-treated group. No patients developed serious side-effects.
                Topical zinc oxide is an efficacious, painless, and safe therapeutic option for wart treatment. Common warts are an important issue, especially in children and young adults. The methods proposed for common wart treatment are painful, destructive, and require special experience and devices. The chemical cauterization effect of silver nitrate on warts is noted in the classical pharmaceutical textbooks. In order to test this effect for this purpose, a placebo controlled clinical study was performed on 70 patients. On 35 randomly selected patients, a silver nitrate stick was used, and, on the other 35 patients, black ink was used. At the end of this study, of the patients treated with the silver nitrate stick, 15 (43%) were completely healed, 9 (26%) were partially healed, and 11 (31%) were not healed. Of the patients treated with black ink, 4 (11%) were completely healed, 5 (14%) were partially healed, and 26 (74%) patients were not affected. Thus the silver nitrate stick affected the warts of 24 (69%) patients. Therefore, this method appears to be an effective, economic, and easily applicable treatment for common warts. Cryotherapy is widely used for the treatment of cutaneous warts in primary care. However, evidence favours salicylic acid application. We compared the effectiveness of these treatments as well as a wait-and-see approach.
                Consecutive patients with new cutaneous warts were recruited in 30 primary care practices in the Netherlands between May 1, 2006, and Jan. 26, 2007. We randomly allocated eligible patients to one of three groups: cryotherapy with liquid nitrogen every two weeks, self-application of salicylic acid daily or a wait-and-see approach. The primary outcome was the proportion of participants whose warts were all cured at 13 weeks. Analysis was on an intention-to-treat basis. Secondary outcomes included treatment adherence, side effects and treatment satisfaction. Research nurses assessed outcomes during home visits at 4, 13 and 26 weeks.
                Of the 250 participants (age 4 to 79 years), 240 were included in the analysis at 13 weeks (loss to follow-up 4%). Cure rates were 39% (95% confidence interval [CI] 29%-51%) in the cryotherapy group, 24% (95% CI 16%-35%) in the salicylic acid group and 16% (95% CI 9.5%-25%) in the wait-and-see group. Differences in effectiveness were most pronounced among participants with common warts (n = 116): cure rates were 49% (95% CI 34%-64%) in the cryotherapy group, 15% (95% CI 7%-30%) in the salicylic acid group and 8% (95% CI 3%-21%) in the wait-and-see group. Cure rates among the participants with plantar warts (n = 124) did not differ significantly between treatment groups.
                For common warts, cryotherapy was the most effective therapy in primary care. For plantar warts, we found no clinically relevant difference in effectiveness between cryotherapy, topical application of salicylic acid or a wait-and-see approach after 13 weeks. (ClinicalTrial.gov registration no. ISRCTN42730629). A clinical study was conducted to evaluate the efficacy of a new delivery system for administering salicylic acid for the treatment of verruca vulgaris. The study compared wart resolution among volunteers who used karaya gum patches. The cure rate was 69% for warts treated with patches containing salicylic acid, which was significantly higher (p less than 0.01) than for warts treated with control patches (35%). 52 patients with a clinical diagnosis of verruca plantaris were entered into a randomised study of acyclovir cream versus placebo cream versus liquid nitrogen. 47 completed the initial 8-week assessment period. At first, liquid nitrogen was used as a positive control but after the entry of 33 patients it was discontinued as an initial therapy in order to obtain maximal numbers of patients on the cream treatments. At the end of the 8-week assessment period 5 of 18 (placebo cream), 7 of 18 (acyclovir cream) and 1 of 11 (liquid nitrogen) patients were completely cleared of their plantar warts. Patients who failed to clear on cream or liquid nitrogen treatments after the initial assessment period but who wished to continue therapy were subsequently treated with liquid nitrogen. Of a total of 27 patients treated vigorously with liquid nitrogen, for periods of time ranging from 2 to 34 weeks, only 11 were completely cleared of their warts at the end of the study. It is concluded that liquid nitrogen should not be considered as a routine treatment for plantar warts and that acyclovir cream is no better than placebo in the treatment of this condition. Subjects with warts on their hands and/or feet were randomly assigned to a hypnotic suggestion, topical salicylic acid, placebo, or no treatment control condition. Subjects in the three treated groups developed equivalent expectations of treatment success. Nevertheless, at the six-week follow-up interval only the hypnotic subjects had lost significantly more warts than the no treatment controls. Theoretical implications are discussed. Treatment of recalcitrant viral warts remains a therapeutic challenge. Intense pulsed light (IPL) has been suggested effective to clear wart tissue. The objective was in a randomized controlled trial to assess the efficacy of paring followed by IPL versus paring alone for recalcitrant hand and foot warts.
                Eighty-nine patients with recalcitrant hand and foot warts were included and randomized (1:1) to three treatments at 3-week intervals with either paring of warts followed by IPL or paring of warts alone. IPL was given with the Ellipse Flex IPL system (Danish Dermatologic Development A/S, Hørsholm, Denmark, 400-950 nm, 5.5 millisecond pulse duration in double pulses with a 2 millisecond interval, 26.0-32.5 J/cm(2) repetitive passes). The primary outcome was complete and partial clearance of warts evaluated by blinded photo assessment at 6 weeks after final treatment. Secondary outcomes were treatment related pain and adverse reactions.
                We found no significant difference in clearance of warts between the two intervention groups (OR 1.64, 95% confidence interval 0.62-4.38). Paring followed by IPL resulted in complete or partial clearance of wart tissue in nine (22%) and five patients (12.2%) versus five (13.5%) and four patients (10.8%) from paring alone. Mostly plantar warts were treated (92.1%). The pain intensity after paring and IPL was moderate and significantly higher than the pain intensity after paring alone (P<0.0005). No adverse reactions were observed from the two interventions.
                Paring followed by IPL did not differ significantly from paring alone in clearance of recalcitrant hand and foot warts but caused significantly more pain. Though not in regular practice, intralesional (IL) bleomycin has been used for the treatment of warts since the 1970s and on the other hand, till now cryotherapy is quite regularly used to treat warts. Aim: Our aim was to assess the evidence for the efficacy of IL bleomycin, in comparison with a control group of similar sample receiving cryotherapy, in the treatment of cutaneous warts.
                Patients were randomized using computer-generated codes to receive either cryotherapy (double freeze-thaw cycle) or IL bleomycin (0.1% solution with concurrent anesthesia) for a maximum of four treatments 3 weeks apart and a maximum of five warts treated in each visit for both groups. Patients had their warts measured at base-line and with each return visit including a post treatment follow-up that was 8 weeks apart from last treatment taken.
                Of the 73 patients completing the study, 39 (53%) were treated with IL bleomycin and 34 (47%) were treated with cryotherapy. Out of 155 treated warts, 87 (56%) were treated with IL beomycin and 68 (44%) were treated with cryotherapy. The clearance rates in context of number of patients and number of warts were 94.9% and 97% for bleomycin and 76.5% and 82% for cryotherapy respectively (P < 0.05 by x(2) analysis and RR = 7.67).
                IL bleomycin injection was significantly more effective than cryotherapy for treatment of cutaneous wart. Viral warts are a common problem especially in young people. They are an important topic as they are transmittable and cause social embarrassment. Though there are several treatments for viral warts, none offer a fast, simple, complete cure by itself. A simple and inexpensive way of treatment would be outstanding, especially in the developing countries. The authors' goal was to determine in patients with warts, the efficacy and safety of topical puncture with 85% formic acid in distilled water solution. A placebo-controlled, clinical trial was performed in patients with common viral warts who were referred to the Khorshid and Beheshti dermatology centers of Isfahan Medical School in 2003 and 2004. A total of 34 patients received 85% formic acid in distilled water solution on their lesion on one side of the body and distilled water as placebo on the other side of the body, every other day, using a needle puncture technique. Follow-up occurred every 2 weeks up to 3 months for all patients. Ninety-one percent of patients who received formic acid application showed complete disappearance of warts after follow-up period, compared to 10% in the placebo (distilled water) group. The results show that the application of 85% formic acid in distilled water solution is a safe and effective treatment for common warts with few side effects and good compliance. nan To determine the efficacy of duct tape compared with placebo in the treatment of verruca vulgaris.
                A randomized placebo-controlled trial in 3 primary schools in Maastricht, the Netherlands.
                One hundred three children aged 4 to 12 years with verruca vulgaris.
                Duct tape applied to the wart or placebo, a corn pad (protection ring for clavi), applied around the wart for 1 night a week. Both treatments were applied for a period of 6 weeks. Patients were blinded to the hypothesis of the study.
                Complete resolution of the treated wart.
                After 6 weeks, the wart had disappeared in 16% of the children in the duct tape group compared with 6% in the placebo group (P = .12). The estimated effect of duct tape compared with placebo on diameter reduction of the treated wart was 1.0 mm (P = .02, 95% confidence interval, -1.7 to -0.1). After 6 weeks, in 7 children (21%) in the duct tape group, a surrounding wart had disappeared compared with 9 children (27%) in the placebo group (P = .79). Fifteen percent of the children in the duct tape group reported adverse effects such as erythema, eczema, and wounds compared with 0 in the placebo group (P = .14).
                In a 6-week trial, duct tape had a modest but nonsignificant effect on wart resolution and diameter reduction when compared with placebo in a cohort of primary school children. Topical 5-fluorouracil (5-FU) is an antineoplastic antimetabolite that inhibits DNA and RNA synthesis, thereby preventing cell replication and proliferation. This mechanism of action may allow topical 5-FU to be utilized in the treatment of human papilloma virus (HPV). We conducted a study comparing 5% 5-FU cream under tape occlusion versus tape occlusion alone in 40 patients presenting with plantar warts. Nineteen out of 20 patients (95%) randomized to 5% 5-FU with tape occlusion had complete eradication of all plantar warts within 12 weeks of treatment. The average time to cure occurred at 9 weeks of treatment. Three patients (15%) had a recurrence at the 6-month follow-up visit; accordingly, an 85% sustained cure rate was observed. It is concluded that use of topical 5% 5-fluorouracil cream for plantar warts is safe, efficacious, and accepted by the patient. Populous euphratica tree which belongs to Salicaceae family is naturally distributed in many parts of the world. Our purpose was to compare the therapeutic effects of smoke of its burnt leaves with conventional cryotherapy in patients with warts.
                Sixty consecutive wart patients were randomly treated with leaves of Populous euphratica tree (Group A) or conventional cryotherapy (Group B) and were followed up for 22 weeks.
                The respective end results in group A and group B were; Complete cure rates 66.7% vs. 46.4% (P= NS), partial resolution rates 8.3% vs. 14.3% (P= NS). The recurrence rate however, was 4.2% in group A and 32.2% in group B patients (P= 0.024).
                The smoke of burnt leaves of Populus euphratica tree can be equally effective for treatment of hand and foot warts as cryotherapy. A double-blind controlled trial was performed on the use of topical 5% 5-fluorouracil ointment as a treatment for viral warts. The results showed the 5-fluorouracil to be better than the placebo. Monochloroacetic acid crystals and 60% salicylic acid ointment was found to be more effective than placebo as a treatment for simple plantar warts in a double blind study on 57 patients. Nineteen (66%) patients in the active treatment group compared with five (18%) patients in the placebo group were cured after 6 weeks (P = 0.002). The active treatment was associated with a significantly higher cure rate 6 months after entry (P = 0.04). Treatments were well tolerated. IgG or IgM antibodies or both to human papilloma virus (HPV) types 1 or 2 or both were detected significantly more frequently in the actively treated group 6 weeks after entry (P = 0.0005). Twelve (50%) patients considered to be cured had no detectable secondary immune response. Our results suggest that cure does not depend primarily on the humoral system but rather on mechanical destruction of wart tissue, or occurs as a result of cell mediated immunity. A controlled double-blind trial was carried out on fifty-nine matched pairs of hand warts in a group of twenty-four patients, with proven resistance to treatment, to study the effectiveness of the intralesional injection of 0.1% solution of bleomycin sulphate in normal saline, compared with a normal saline placebo injected into the paired warts in the same patient. We found that 87.5% of patients showed a more favourable response to bleomycin (P less than 0.001); 76% of the fifty-nine warts treated with bleomycin were cured by one to three injections of up to 0.2 ml of solution. Subsequently 75% of thirty-two patients with resistant hand warts and 66% of fifteen patients with mosaic plantar warts were cured of all their warts. No patient received more than 4 mg of bleomycin. No toxicity was experienced. Local pain was on the whole well tolerated. This form of treatment for resistant warts is reliable, safe and acceptable to patients. Eighty patients with bilateral common warts of the extremities were treated at weekly intervals with intralesional injections of either human fibroblast interferon or placebo. Lyophilized interferon (3 X 10(6) units) was diluted with 3 ml of normal sterile saline matched with identical vials of placebo. Eighty sets of three vials of human fibroblast interferon or placebo were labeled either A or B by a controller who maintained the code until the experiment was completed. Each patient received 0.1 X 10(6) units of interferon into the warts on one side and placebo injections into those on the matching extremity. Warts were measured each week and the progress or lack thereof was scored on a scale of -1 (worse) to 3 (cured). Therapy continued until either at least one extremity had cleared or the patient had received 10 weekly injections. A final evaluation was scored by measuring the total progress of each patient during the study. Sixty-four patients were treated to completion. More than 81% of the interferon-treated extremities were either cured or responded effectively to therapy. Only 17% of the placebo-treated lesions responded in this fashion. A statistical analysis of these data confirms the effectiveness of intralesional interferon therapy. The average number of interferon injections until cure was 5.9 +/- 1.7. No adverse effects were observed. The applications of interferon in patients with epidermodysplasia verruciformis and flat warts were also studied. Intralesional interferon beta was, to a certain degree, effective for benign lesions of epidermodysplasia verruciformis, but systemic treatments were not effective. Subcutaneous interferon beta was, in an uncontrolled study, effective in 45% of patients with flat warts. In spite of many available studies on bleomycin and cryotherapy in treating warts, little head to head research is done to compare efficacy of these treatments. Our aim was to compare the therapeutic effects of intralesional bleomycin and cryotherapy on common warts of the hands and feet. In this clinical trial 44 patients above 12 years of age referred to the dermatology clinic of Bouali University Hospital were enrolled. The patients were required to have warts on at least two symmetric limbs (hands or feet). The warts located on right and left limbs of each patient were examined and counted. Each patient received both cryotherapy and intralesional bleomycin on his or her warts. The two treatment types were randomly allocated to either right sided or left sided warts. Each patient was evaluated at 2 week intervals and retreated if necessary up to three times. Data were analyzed by SPSS 11 and EPI Info 2002 statistical packages. The mean number of warts was 5.2 on upper limbs and 4.6 on lower limbs. In 86.4 percent of the cases all warts on the limb side treated by intralesional bleomycin were cleared compared with 68.2 % for cryotherapy (P<0.05). Relative risk for the effect of bleomycin compared to cryotherapy in this regard was 1.27 (1<RR<1.6). We found bleomycin to have a clearance rate equal to 87.6 percent of warts, compared to 72.3 percent by cryotherapy. Relative risk for therapeutic effect of bleomycin compared to cryotherapy in this regard was 1.23 (1.11<RR<1.33). Conclusion: Intralesional bleomycin is more effective than cryotherapy in treating warts on hands and feet. In order to investigate the efficacy of anthralin ( Anthraderm ) in the treatment of warts a randomized controlled trial was carried out in 72 patients. During a two-month period of treatment 56% were cured in the group treated with anthralin 2% ( Anthraderm ), evaluated at follow-up 2-9 months after finishing treatment, compared with 26% in the group treated with the comparative drug ( Verucid ). Anthralin 2% ( Anthraderm ) was found to have a significantly better effect, especially in the group of patients with warts solely on the hands. We conducted a multicenter double-blind study comparing human recombinant intralesional alpha-2 interferon (IFN) and placebo in 237 patients with the clinical diagnosis of condyloma acuminatum or verruca plantaris. A single wart on each patient was injected with 0.1 mL containing 10(6) IU of IFN, 10(5) IU of IFN, or placebo three times weekly for three weeks, and the response to treatment was followed up for 12 weeks. Among 91 of the 114 patients with condyloma acuminatum who completed the study, complete clearing of the treated wart occurred in 16 (53%) of 30 patients receiving 10(6) IU of IFN compared with six (19%) of 32 receiving 10(5) IU of IFN and four (14%) of 29 receiving placebo. In the group of 100 patients with plantar warts, there was no apparent benefit associated with interferon administration. Seven patients (3%) had treatment discontinued due to adverse reactions. Intralesional alpha-2 IFN is of benefit in the treatment of a single condyloma; its role in the treatment of multiple lesions remains to be clarified. Its role in the treatment of verruca plantaris, where no response was seen, also remains to be clarified. nan nan Pulse dye laser (PDL) appears an attractive method to treat warts. However, data concerning the efficacy of this approach are based chiefly upon open clinical studies or case reports and results vary widely from one study to another. The purpose of this study was to compare the efficacy and safety of PDL with a placebo in the treatment of a homogeneous group of patients presenting palmoplantar warts.
                This was a randomized, prospective, placebo-controlled, single-blind study conducted between December 2004 and July 2005 in patients consulting for palmoplantar warts at the Dermatology Department of the University Teaching Hospital of Nice. The treatment settings used for the 595-nm PDL were as follows: spot diameter 5 mm, pulse duration 0.45 ms, fluence 9 J/cm2 with 5 passes at a frequency of 1 Hz. Cryogen spray cooling (system incorporated in the machine) was given at a rate of 50 spurts of 40 ms prior to each laser pulse. In patients in the placebo group, cooling pulses alone were given. For the plantar warts (in both groups), hyperkeratosis was removed manually with a scalpel before each session. A maximum of three sessions was administered at 3-week intervals. The type and number of warts was counted and recorded in a treatment schedule before the start of therapy, at each session and 5 weeks after the final session. The global safety of the treatment was evaluated using a visual analog scale between 0 (intolerable) and 10 (completely safe).
                Nineteen patients were included in the laser group and 16 were included in the placebo group. Sixty-four per cent (48/75) of warts in the laser group resolved completely compared with 13% (4/30) in the placebo group (p<0.001). In the PDL group, 6 of 19 patients (31.5%) no longer had warts by the end of the study compared with 3 of 16 patients (18.75%) in the placebo group (p=0.46). The global safety score of the treatment as assessed by the patients themselves was 8.31 in the laser group and 9.81 in the placebo group.
                Pulse dye laser appears to be an effective treatment in palmoplantar warts but the efficacy of this method seems to be only equivalent to that of standard treatments (cryotherapy or salicylic acid preparations). Safety is excellent and constitutes one of the major advantages of this technique. The absence of any proven superiority over the standard treatments in terms of efficacy, coupled with the high costs involved, means that PDL should only be used second-line therapy in patients wishing to avoid constraints affecting their professional activity. To determine if application of duct tape is as effective as cryotherapy in the treatment of common warts.
                A prospective, randomized controlled trial with 2 treatment arms for warts in children.
                The general pediatric and adolescent clinics at a military medical center.
                A total of 61 patients (age range, 3-22 years) were enrolled in the study from October 31, 2000, to July 25, 2001; 51 patients completed the study and were available for analysis.
                Patients were randomized using computer-generated codes to receive either cryotherapy (liquid nitrogen applied to each wart for 10 seconds every 2-3 weeks) for a maximum of 6 treatments or duct tape occlusion (applied directly to the wart) for a maximum of 2 months. Patients had their warts measured at baseline and with return visits.
                Complete resolution of the wart being studied.
                Of the 51 patients completing the study, 26 (51%) were treated with duct tape, and 25 (49%) were treated with cryotherapy. Twenty-two patients (85%) in the duct tape arm vs 15 patients (60%) enrolled in the cryotherapy arm had complete resolution of their warts (P =.05 by chi(2) analysis). The majority of warts that responded to either therapy did so within the first month of treatment.
                Duct tape occlusion therapy was significantly more effective than cryotherapy for treatment of the common wart. The purpose of this pilot study was to determine if photodynamic therapy with topical application of 5-aminolaevulinic acid followed by irradiation with incoherent filtered and unfiltered light (ALA-PDT) is an effective therapy for recalcitrant hand and foot warts. In 30 patients with recalcitrant warts, 49 regions with a total of 250 warts were randomized to one of the following five treatments: (i) ALA-PDT with white light applied three times within 10 days (W3); (ii) ALA-PDT with white light applied once (W1); (iii) ALA-PDT with red light applied three times within 10 days (R3); (iv) ALA-PDT with blue light applied three times within 10 days (B3), and (v) cryotherapy applied up to four times within 2 months (CRYO). The ALA-PDT treatment modality was repeated in case of partially responding warts. Significantly more warts were completely healed after W3 and W1 than after R3, B3 and CRYO (P < 0.01): 73% of the warts treated with W3 were completely healed, 71% after W1, 42% after R3, 23% after B3 and 20% after CRYO. No scars were observed in the ALA-PDT treated areas and patients treated for foot warts were all able to walk after the treatment. No recurrences in completely responding ALA-PDT treated warts were observed after 12 months of follow-up. In conclusion, photodynamic therapy with topical 5-aminolaevulinic acid followed by irradiation with white light is a promising treatment for recalcitrant hand and foot warts. To assess the efficacy and safety of topical zinc sulphate solution in the treatment of plane and common warts.
                This study consisted of a pilot and double blinded clinical trails. This was carried out in the Department of Dermatology and Venereology, Baghdad Teaching Hospital, Baghadad, Iraq during the period from December 2002 to October 2003. Ten patients with plane warts were enrolled in pilot-clinical trial, all patients used 10% w/v zinc sulphate solution topically, 3 times daily for 4 weeks while in the double blind trial, 90 patients were included (50 patients with common warts, 40 patients with plane warts). Patients were randomly used either topical 10% or 5% zinc sulphate solution or distilled water as a control topical therapy 3 times daily for 4 weeks. Full history and close clinical examination were performed to all patients before treatment.
                In the pilot trial, the full response for plane warts was 80%, while the full response for patients with plane warts in double blinded trial was 85.7%, 42.8% and 10% for those using 10% and 5% zinc sulphate solutions and distilled water subsequently. The difference was statistically significant (p<0.008). The full response for patients with common warts were 11%, 5% and 0% for those who used 10% and 5% zinc sulphate solutions and distilled water respectively, the difference was statistically insignificant. No recurrence of warts occurred during follow up that ranged from 2-6 months after therapy.
                Topical 10% zinc sulphate solution was a new effective and safe modality for treatment of plane warts.
Data from two new trials comparing SA and cryotherapy have allowed a better appraisal of their effectiveness. The evidence remains more consistent for SA, but only shows a modest therapeutic effect. Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with SA. Only one trial showed cryotherapy to be better than both SA and placebo, and this was only for hand warts. Adverse effects, such as pain, blistering, and scarring, were not consistently reported but are probably more common with cryotherapy.
None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy. Two trials of clear duct tape demonstrated no advantage over placebo. Dinitrochlorobenzene (and possibly other similar contact sensitisers) may be useful for the treatment of refractory warts.