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

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7362.461 (Published 31 August 2002) Cite this as: BMJ 2002;325:461

Local treatments for cutaneous warts: systematic review

  1. Sam Gibbs, consultant (sgibbs{at}fish.co.uk)a,
  2. Ian Harvey, professor of epidemiology and public healthb,
  3. Jane Sterling, honorary consultantc,
  4. Rosemary Stark, library and information services managerd
  1. aDepartment of Dermatology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD
  2. bSchool of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  3. cDepartment of Dermatology, Addenbrooke's NHS Trust, Cambridge CB2 2QQ
  4. dDepartment of Service Development, Finance and Information, Norfolk Health Authority, Norwich NR7 0HT
  5. Cancer Research UK Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Oxford OX3 7LF
  1. Correspondence to: S Gibbs
  • Accepted 20 February 2002

Abstract

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 All published and unpublished material was considered, with no restriction on date or language.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.

Footnotes

  • Funding Norfolk Health Authority provided funding for the translation of some trials.

  • Competing interests None declared.

Commentary: Systematic reviewers face challenges from varied study designs

  1. Douglas G Altman, professor of statistics in medicine. (doug.altman{at}cancer.org.uk)
  1. aDepartment of Dermatology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD
  2. bSchool of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ
  3. cDepartment of Dermatology, Addenbrooke's NHS Trust, Cambridge CB2 2QQ
  4. dDepartment of Service Development, Finance and Information, Norfolk Health Authority, Norwich NR7 0HT
  5. Cancer Research UK Medical Statistics Group, Centre for Statistics in Medicine, Institute of Health Sciences, Oxford OX3 7LF
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