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Liquid nitrogen best for removing warts

Posted Sep 21 2010 12:00am

CMAJ.ca - Cryotherapy with liquid nitrogen is the most effective method to remove common warts, found a study published in the Canadian Medical Association Journal (CMAJ).

The study - a randomized controlled trial - looked at 240 participants aged 4 to 79 in the Netherlands. The patients were assigned to three groups: cryotherapy with liquid nitrogen every two weeks, daily self-application of salicylic acid, or a wait-and-see approach.

Warts are a common childhood complaint, present in up to one-third of primary school children, which can cause discomfort. About 6 percent of children and 2 percent of the general population seek help from their family physician each year. Cryotherapy with liquid nitrogen is the most frequent treatment followed by application of salicylic acid to the skin.

If a wart was no longer visible, with skin color and lines re-established, and could not be felt, it was considered cured. Cure rates for patients with common warts (mostly located on hands) with cryotherapy were 49 percent, 15 percent in the salicylic acid group and 8 percent in the wait-and-see group.

“Despite the fact that cryotherapy caused more frequent and more severe side effects than salicylic acid, patients were most satisfied when treated with cryotherapy,” writes Dr. Sjoerd Bruggink with coauthors.

There was no difference in cure rates of plantar warts between the three treatment groups. Plantar warts in children had relatively high spontaneous cure rates of 50 percent but low cure rates of 5 percent in adolescents and adults.

“Although earlier evidence favoured salicylic acid application above cryotherapy, the present randomized controlled trial is the first that provides evidence to support the use of cryotherapy above salicylic acid, however, for common warts only,” the authors conclude.

A free PDF copy of the study is available for download here:

Reference: Sjoerd C. Bruggink, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: a randomized controlled trial. CMAJ 10.1503/cmaj.092194; published online ahead of print September 13, 2010.

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