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PapersLocal treatments for cutaneous warts: systematic reviewCommentary: Systematic reviewers face challenges from varied study designs

Sam Gibbs , Douglas G Altman , Ian Harvey , Jane Sterling , Rosemary Stark

Details of included trials

Reference Salicylic acidSetting, design*No of participants randomised (dropouts or withdrawals), age, type and site of wartsInterventionsOutcomesNotesQuality
Varnavides et al 199745Secondary care, blind51 (9), adults, refractory, hands and feetInterferon alfa (10 IU/ml weekly £12) v placeboCure in 12/23 (52%) v 12/19 (63%) at 24 weeksMedium
Rosado-Cancino et al 198934Secondary care, open40 (0), children, refractory, anywhereDinitrochlorobenzene v placeboCure in 16/20 (80%) v 7/20 (35%) Duration of trial unclearLow
Wilson 198348Secondary care, open60 (0), adults, ordinary, hands onlyDinitrochlorobenzene v cryotherapy v no treatmentCure in 16/20 (80%), 10/20 (50%), and 8/20 (40%) at 4 monthsPublished as abstract onlyLow
Photodynamic therapy
Stahl et al 197939Secondary care, open149 (29), adults and children, ordinary, hands and feetMethylene blue and dimethyl sulphoxide v salicylic acid and creosoteCure in 5/65 (8%) v 8/56 (15%) at 8 weeksLow
Stender et al 199942Secondary care, blind, intention to treat analysis, within patient30 (2), adults, refractory, hands and feetWhite (£3 and £1), red (£3), and blue (£3) light v cryotherapy (£4)Cure in 73%, 71%, 42%, 28%, and 20% of warts at 4-6 weeksWarts used as unit of analysis, results in % only, no placebo groups, and salicylic acid used in all groupsMedium
Stender et al 200043Secondary care, blind, intention to treat analysis, within patient45 (5), adults, refractory, hands and feet20% aminolaevulinic acid and red light v placebo photodynamic therapyCure in 64/114 (56%) v 47/113 (42%) of warts at 18 weeksHigh
Viein et al 197746Secondary care, blind, left and right comparison study56 (6), adults and children, refractory, hands and feetProflavine and dimethyl sulphoxide or neutral red and dimethyl sulphoxide v placebo photodynamic therapy (£8)Cure in 10/27 (37%) proflavine v 10/23 (43%) neutral red at 8 weeksPlacebo half cured in all responders and no placebo response in all non-respondersMedium
Pulsed dye laser
Robson et al 200033Secondary care, open40 (5), adults, not stated, any siteMonthly pulsed dye laser (up to £4) v “conventional” treatmentCure in 66% v 70% of warts Warts used as unit of analysis andcure rates expressed as percentages onlyLow
  • All studies except left and right comparison studies and within patient design were parallel group randomised controlled trials. ?=not clear. Cryotherapy is with liquid nitrogen.

  • * Blinding refers to assessment of outcome only and not blinding of participants

  • † Refractory broadly defined as warts that did not respond to previous treatments

  • ‡Callusolve contains a quarternary ammonium germicide.