The efficacy of cryotherapy compared to the other modalities for the management of palmoplantar warts: a systematic review and network meta-analysis


https://doi.org/10.4081/dr.2024.10121
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Authors

  • Anwar Alrashidi
    dr.anwaralrashidi@gmail.com
    Department of Dermatology, King Fahad Medical City, Riyadh, Saudi Arabia.
  • Esraa Shaheen College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Amal Abualola College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Alanoud A. Alharkan Department of Family Medicine, King Abdulaziz Medical City, National Guard Hospital, Riyadh, Saudi Arabia.
  • Abdulaziz Aljuaid College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Khalid M. Alshareef College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Abdullah A. Ghaddaf College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
  • Samer Alamri Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
  • Sahal J. Samarkandy College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah; King Abdullah International Medical Research Center, Jeddah; Department of Dermatology, King Abdulaziz Medical City, Jeddah, Saudi Arabia.

There are several treatment modalities for Palmoplantar Warts (PPW) introduced, but none have been proven to be significantly effective in all patients. The study aims to assess the efficacy and safety of cryotherapy compared to other modalities for PPW.

Searches were conducted in Medline, Embase, Scopus, and CENTRAL databases, along with additional reference and citation tracking from included studies.

Randomized Controlled Trials (RCTs) comparing various treatments for PPW were included.

Two independent pairs extracted the data from the included studies. Outcomes assessed included cure rates, pain scores, recurrence rates, and adverse events. Network meta-analysis using Netmeta in R software was utilized, with treatments ranked by p-scores.

A total of 27 RCTs that enrolled 2,539 participants were deemed eligible. As per p-scores, needling yielded the highest odd for the cure rate (p=1.00), followed by intralesional injection of the Measles, Mumps, and Rubella (MMR) vaccine (p=0.90). For the pain score, 76% topical monochloroacetic acid (p=0.13) showed the lowest mean pain score, while cryotherapy yielded the highest score (p=0.90). Furthermore, cryotherapy showed the highest odds for recurrence rate (p=0.75), followed by intralesional injection of Candida antigen (p=0.61). 0.05% intralesional bleomycin (p=0.93) was the highest agent for adverse events rate, followed by cryotherapy (p=0.61).

Needling was the most effective in achieving a cure rate. Cryotherapy has the highest odds for pain score and recurrence rate, while 0.05% intralesional bleomycin has the highest adverse events profile.