Papers

Local treatments for cutaneous warts: systematic review

Sam Gibbs, consultant, ^a Ian Harvey, professor of epidemiology and public health, ^b Jane Sterling, honorary consultant, ^c Rosemary Stark, library and information services manager. ^d

^a Department of Dermatology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD, ^b School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, ^c Department of Dermatology, Addenbrooke's NHS Trust, Cambridge CB2 2QQ, ^d Department of Service Development, Finance and Information, Norfolk Health Authority, Norwich NR7 0HT

Correspondence to: S Gibbs sgibbs{at}fish.co.uk

Objective: To assess the evidence for the efficacy of local treatments for cutaneous warts.
Methods: Systematic review of randomised controlled trials.
Main outcomes measures: Total clearance of warts and adverse effects such as irritation, pain, and blistering.
Study selection: Randomised controlled trials of any local treatment for uncomplicated cutaneous warts. All published and unpublished material was considered, with no restriction on date or language.
Results: 50 included trials provided generally weak evidence because of poor methods and reporting. The best evidence was for topical treatments containing salicylic acid. Data pooled from six placebo controlled trials showed a cure rate of 75% (144 of 191) in cases compared with 48% (89 of 185) in controls (odds ratio 3.91, 95% confidence interval 2.40 to 6.36). Some evidence for the efficacy of contact immunotherapy was provided by two small trials comparing dinitrochlorobenzene with placebo. Evidence for the efficacy of cryotherapy was limited. No consistent evidence was found for the efficacy of intralesional bleomycin, and only limited evidence was found for the efficacy of topical fluorouracil, intralesional interferons, photodynamic therapy, and pulsed dye laser.
Conclusions: Reviewed trials of local treatments for cutaneous warts were highly variable in methods and quality, and there was a paucity of evidence from randomised, placebo controlled trials on which to base the rational use of the treatments. There is good evidence that topical treatments containing salicylic acid have a therapeutic effect and some evidence for the efficacy of dinitrochlorobenzene. Less evidence was found for the efficacy of all the other treatments reviewed, including cryotherapy.

What is already known on this topic A wide range of local treatments is available for treating warts No one treatment is strikingly effective and little is known about the absolute and relative efficacy of these treatments What this study adds High quality research on the efficacy of various local treatments for warts is lacking Evidence, which is generally of a poor quality, shows a beneficial effect of topical salicylic acid and contact immunotherapy with dinitrochlorobenzene Little evidence exists for the efficacy of cryotherapy and no consistent evidence for the efficacy of all the other treatments reviewed