Warts

A raised growth on the surface of the skin or other organ. NIH - National Cancer Institute

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What works? Research summarized

Evidence reviews

Systemic treatments for cutaneous warts: a systematic review

BACKGROUND: Systemic therapies are routinely used for the management of cutaneous warts. However, there is a lack of evidence-based data on their effectiveness.

Warts (non-genital)

INTRODUCTION: Warts are caused by the human papillomavirus (HPV), of which there are over 100 types. HPV probably infects the skin via areas of minimal trauma. Risk factors include use of communal showers, occupational handling of meat, and immunosuppression. In immunocompetent people, warts are harmless and resolve as a result of natural immunity within months or years.

Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials

Many topical treatments for cutaneous warts exist and previous reviews of trials did not follow intention-to-treat (ITT) principles for analysis. We aimed to perform a meta-analysis and pooled analysis of randomized controlled trials (RCTs) of topical treatment for cutaneous warts using ITT principles. Systematic electronic searches (Cochrane library, Medline, Embase, Clinical trial registers) were conducted in May 2009. Included trials reported completed cure of warts and data were extracted from these trials. We performed random-effects meta-analysis and assessed heterogeneity using the I(2) statistic and conducted a pooled analysis of each treatment. We found 77 relevant studies of which the majority were of low methodological quality. Salicylic acid (SA) was superior to placebo with a risk ratio (RR) for cure of 1·60 [95% confidence interval (CI) 1·15-2·24]. Cryotherapy was not statistically better than placebo, RR 0·89 (95% CI 0·27-2·92), but aggressive cryotherapy was significantly better than gentle cryotherapy with a RR of 2·06 (95% 1·20-3·52). Combined therapy of SA and cryotherapy had a higher cure rate than either SA or cryotherapy alone. The results of the pooled analysis found a cure rate of 23% (5-73%) in placebo trials, 52% (0-87%) in SA trials, 49% (0-69%) in cryotherapy trials, 54% (45-75%) in aggressive cryotherapy trials and 58% (38-78%) in the combined cryotherapy and SA trials. Aside from the use of SA and aggressive cryotherapy there is insufficient evidence from RCTs to support the use of other therapies. Higher quality evidence is needed to evaluate other therapies.

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Summaries for consumers

Topical treatments for skin warts

Viral warts are a common skin disease, most frequently affecting the hands and feet, caused by the human papilloma virus. While warts are not harmful and usually go away in time without any treatment, they can be unsightly and painful. Warts on the soles of the feet are also called 'plantar warts' or 'verrucas'.

5‐FU for genital warts in nonimmunocompromised individuals

Genital warts is one of the most common types of sexually transmitted infection, with an estimated occurrence of about 32 million cases worldwide each year. The warts affect the genital area and cause such symptoms as itching, burning, discomfort, pain, or bleeding with intercourse. Because of the recurrence and the stigma associated with genital warts, frequently there are psychological burdens associated with the disease that possibly could become traumatic as feeling of shame, worry, fear, anger, and lowered self‐esteem develop. Lesions can spread on one person and because they are easily spread between people, genital warts potentially can be a serious public health problem. There are many options for treating genital warts, but none so far are superior to the others. At this time, there is no available evidence that treatment efficiently eliminates genital warts or hinders its progression to malignancy. This review evaluated the effectiveness and safety of topical 5‐FU for treatment of genital warts in nonimmunocompromised individuals. Evidence from the studies we reviewed showed that 5‐FU had better results for cure than placebo or no treatment; MCSA; and Podophylin 2%, 4% or 25%. No statistical difference was found when 5‐FU was compared with CO2 Laser treatment, and results were poor when 5‐FU was compared with 5‐FU + INFα‐2a (high dose) or 5‐FU + CO2 Laser INFα‐2a (high dose). The weak point of this review was the great variability in the methods and quality of the studies that we included.

Imiquimod for anogenital warts in non‐immunocompromised adults

Although 30% of AGW spontaneously vanish without treatment, currently there is no way to know whether a lesion will go or remain. There are a wide range of treatment options and the choice is based on the experience of the clinicians, patient preferences and adverse effects.

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