Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3271 (Published 07 June 2011) Cite this as: BMJ 2011;342:d3271
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Having personally delivered a cryotherapy service in Primary care for
a number of years, I was amazed at the paper published. In my experience,
cryotherapy is both an effective and convenient method for treating warts,
veruccae and a variety of other minor skin lesions.
The methodology of this research is clearly flawed and I can only conclude
that the "dose" of cryotherapy, inadequate. In the past I have often come
across insufficient treatment intensity with cryotherapy by other
practitioners. This may lead to less inflammation or blistering, but is
much less effective than a more "robust" approach!
Competing interests: No competing interests
Cockayne and colleagues compared a 'gentle freeze' with liquid
nitrogen using a spray or probe with salicyclic acid in the treatment of
plantar warts. This haphazard application of a liquid nitrogen cannot be
considered Cryotherapy. One of the problems with 'Cryotherapy' is that no
specific training is required before using the equipment - and poor
practice and technique - as appears to have been encouraged in this study-
are tolerated. The parameters for delivering cryotherapy in a reliable
and reproducible manner are well-defined and should have formed the basis
of the study. As it stands, the only conclusion can be that uncontrolled
freezing of plantar warts in a variety of health settings is no more
effective than patient administered salicylic acid. This says more about
the clinics than the techniques.
Competing interests: No competing interests
Re:Re:'Not Cryotherapy'
Further to comments by Matt Dexter, I am surprised by the overall
poor treatment effect of Cockayne et al, and also by the way patient
satisfaction was overlooked, in discussion and conclusion.
The only significant results were for better patient satisfaction with
cryotherapy, across all timeframes. Why measure and report this and then
ignore it in recommedations? When treatment effects were equal, patients
preferred cryotherapy, perhaps because it demanded less of them on a daily
basis. Cost is an important factor in recommendations, but satisfaction
matters, and it is linked to acceptability and adherence.
Competing interests: No competing interests