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
Accepted: 7 October 2024
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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.
Hashmi F, Bristow I. Treating plantar warts: utilizing natural immunity to induce wart regression. Dermatol Nurs. 2014;13:42-6.
Witchey D, Witchey N, Roth-Kauffman M, Kauffman M. Plantar warts: epidemiology, pathophysiology, and clinical management. J Am Osteopath Assoc. 2018;118:92-105. DOI: https://doi.org/10.7556/jaoa.2018.024
Viennet C, Gheit T, Muret P, et al. Assessment of the efficacy of a new formulation for plantar wart mummification: new experimental design and human papillomavirus identification. Clin Exp Dermatol. 2013;38:85-8. DOI: https://doi.org/10.1111/ced.12025
Al Aboud AM, Nigam PK. Wart. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/
García-Oreja S, Alvaro-Afonso FJ, García-Alvarez Y, et al. Topical treatment for plantar warts: a systematic review. Dermatol Ther. 2021;34:e14621. DOI: https://doi.org/10.1111/dth.14621
Bruggink SC, Gussekloo J, de Koning MN, et al. HPV type in plantar warts influences natural course and treatment response: secondary analysis of a randomised controlled trial. J Clin Virol 2013;57:227-32. DOI: https://doi.org/10.1016/j.jcv.2013.02.021
García-Oreja S, Álvaro-Afonso FJ, Tardáguila-García A, et al. Efficacy of cryotherapy for plantar warts: a systematic review and meta-analysis. Dermatol Ther. 2022;35:e15480. DOI: https://doi.org/10.1111/dth.15480
Muse ME, Stiff KM, Glines KR, et al. A review of intralesional wart therapy. Dermatol Online J. 2020;26:13030/qt3md9z8gj. DOI: https://doi.org/10.5070/D3263048027
Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62:e1-34. DOI: https://doi.org/10.1016/j.jclinepi.2009.06.006
Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928. DOI: https://doi.org/10.1136/bmj.d5928
Cockayne S, Curran M, Denby G, et al. EVerT: cryotherapy versus salicylic acid for the treatment of verrucae - A randomised controlled trial. Health Technol Assess. 2011;15:1-170. DOI: https://doi.org/10.3310/hta15320
Abdel-Latif AA, El-Sherbiny AF, Omar AH. Silver duct tape occlusion in treatment of plantar warts in adults: is it effective? Dermatol Ther. 2020;33:1-6. DOI: https://doi.org/10.1111/dth.13342
Karrabi M, Kheirkhah M, Shahrestanaki E, et al. Comparison of 40% trichloroacetic acid and cryotherapy for the treatment of plantar warts: a single-blind, randomized clinical trial. Dermatol Ther. 2020;33:e13559. DOI: https://doi.org/10.1111/dth.13559
Abd El‐Magiud EM, Abd El‐Samea GM, Gaber HD. Intralesional injection of measles, mumps, and rubella vaccine versus cryotherapy in treatment of warts: a randomized controlled trial. Dermatologic Therapy. 2020;33:e13257. DOI: https://doi.org/10.1111/dth.13257
Amar A, Nida S, Malik S. Efficacy of topical adapalene in treatment of plantar warts. Pakistan Armed Forces Medical Journal. 2020;70:240-4.
Kaur Arora A, Dogra A, Kumar Gupta S. Efficacy of cryotherapy versus radiofrequency ablation in the treatment of plantar warts. Iranian Journal of Dermatology. 2014;17:85-90.
Boroujeni NH, Handjani F. Cryotherapy versus CO2 laser in the treatment of plantar warts: a randomized controlled trial. Dermatology practical & conceptual. 2018;8:168. DOI: https://doi.org/10.5826/dpc.0803a03
Bruggink SC, Gussekloo J, Berger MY, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. Cmaj. 2010;182:1624-30. DOI: https://doi.org/10.1503/cmaj.092194
Bruggink SC, Gussekloo J, Egberts PF, et al. Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial. Journal of Investigative Dermatology. 2015;135:1261-7. DOI: https://doi.org/10.1038/jid.2015.1
Cengiz FP, Emiroglu N, Su O, Onsun N. Effectiveness and safety profile of 40% trichloroacetic acid and cryotherapy for plantar warts. The Journal of Dermatology. 2016;43:1059-61. DOI: https://doi.org/10.1111/1346-8138.13370
Cunningham DJ, Brimage JT, Naraghi RN, Bower VM. Needling versus liquid nitrogen cryotherapy for the treatment of pedal warts: a randomized controlled pilot study. Journal of the American Podiatric Medical Association. 2014;104:394-401. DOI: https://doi.org/10.7547/0003-0538-104.4.394
Hafeez L, Jabbar A, Tahir R, et al. Efficacy of intralesional bleomycin versus cryotherapy in the treatment of palmoplantar warts. Journal of Pakistan Association of Dermatologists. 2021;31:661-7.
Liu JJ, Li HT, Ren YY, et al. Long-pulsed neodymium-doped yttrium-aluminum-garnet laser versus cryotherapy for the treatment of cutaneous warts: a randomized controlled trial. Journal of the American Academy of Dermatology. 2022;87:1328-35. DOI: https://doi.org/10.1016/j.jaad.2020.09.085
Maj A, Siddique MA, Hussain LC. Efficacy of topical 1% adapalene versus cryotherapy in treatment of plantar warts. Pakistan Journal of Medical & Health Sciences. 2022;16:3743. DOI: https://doi.org/10.53350/pjmhs20221612512
Meymandi SS, Vaseli MB, Aflatoonian M, Abroud F. Efficacy of cryotherapy combined with topical cantharidin application versus cryotherapy and placebo in the treatment of verruca vulgaris: A randomized, controlled clinical trial. Journal of Pakistan Association of Dermatologists. 2017;27:42-7.
Adalatkhah H, Khalilollahi H, Amini N, Sadeghi-Bazargani H. Compared therapeutic efficacy between intralesional bleomycin and cryotherapy for common warts: a randomized clinical trial. Dermatology Online Journal. 2007;13. DOI: https://doi.org/10.5070/D362G0G3MJ
Ahmad HM, Abdel-Azim ES, Abdel-Aziz RT. Clinical, histopathologic, and viral load study after treatment of plantar warts with 10% formaldehyde soaks versus liquid nitrogen cryotherapy. Journal of the Egyptian Women's Dermatologic Society. 2018;15:165-71. DOI: https://doi.org/10.1097/01.EWX.0000544113.64787.76
Anwar A, Tahir K, Shahid M, Aman S. Comparison of efficacy of ablative CO2 laser vs. liquid nitrogen cryotherapy in the treatment of palmoplantar warts. Journal of Pakistan Association of Dermatologists. 2021;31:366-72.
Gibson JR, Harvey SG, Barth J, et al. A comparison of acyclovir cream versus placebo cream versus liquid nitrogen in the treatment of viral plantar warts. Dermatology. 1984;168:178-81. DOI: https://doi.org/10.1159/000249695
Ali M, Siddiqui MA, Hussain M. Comparative study between treatment with cryotherapy alone versus cryotherapy plus salicylic acid dressing for planter warts. Pakistan Journal of Medical & Health Sciences. 2022;16:3871. DOI: https://doi.org/10.53350/pjmhs20221612724
Muhammad J, Akhtar N, Ahmad MK, Anwar MI. Comparison of efficacy between intralesional bleomycin and cryotherapy in plantar warts. Journal of Pakistan Association of Dermatologists. 2019;29:35-9.
Kaçar N, Taşlı L, Korkmaz S, et al. Cantharidin–podophylotoxin–salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study. Journal of the European Academy of Dermatology and Venereology. 2012;26:889-93. DOI: https://doi.org/10.1111/j.1468-3083.2011.04186.x
Siddiqui S, Aman S. Comparison of efficacy of cryotherapy versus Ionic Contraviral Therapy (ICVT) in the treatment of viral warts. Journal of Pakistan Association of Dermatologists. 2022;32:15-21.
Stefanaki C, Lagogiani I, Kouris A, et al. Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: a randomized study. Journal of Dermatological Treatment. 2016;27:80-2. DOI: https://doi.org/10.3109/09546634.2015.1034079
Attwa E, Elawady R, Salah E. ‘Cryo-immuno-therapy’is superior to intralesional Candida antigen monotherapy in the treatment of multiple common warts. Journal of Dermatological Treatment. 2021;32:1018-25. DOI: https://doi.org/10.1080/09546634.2020.1720585
Izadi Firouzabadi L, Khamesipour A, Ghandi N, et al. Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: a randomized controlled trial. Dermatologic Therapy. 2018;31:e12564. DOI: https://doi.org/10.1111/dth.12564
Albalat W, Attwa E, Ebrahim HM. Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study. J Dermatolog Treat. 2020;26:1-7. DOI: https://doi.org/10.1080/09546634.2020.1782821
Kwok CS, Gibbs S, Bennett C, et al. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews. 2012;2012:CD001781. DOI: https://doi.org/10.1002/14651858.CD001781.pub3
Keefe M, Dick DC. Cryotherapy of hand warts--a questionnaire survey of 'consumers'. Clin Exp Dermatol. 1990;15:260-3. DOI: https://doi.org/10.1111/j.1365-2230.1990.tb02085.x
Dawber R. Cold kills! Clin Exp Dermatol. 1988;13:137-50. DOI: https://doi.org/10.1111/j.1365-2230.1988.tb01958.x
Aldana-Caballero A, Marcos-Tejedor F, Mayordomo R. Diagnostic techniques in HPV infections and the need to implement them in plantar lesions: a systematic review. Exp Rev Mol Diagn. 2021;21:1341-8. DOI: https://doi.org/10.1080/14737159.2021.2004889
Gibbs S, Harvey I. Topical treatments for cutaneous warts (review). Cochrane Database Syst Rev. 2006;2006:CD001781. DOI: https://doi.org/10.1002/14651858.CD001781.pub2
Kumari P, Yadav D, Vijay A, et al. Falknor's needling method as a potential immunotherapy in palmo-plantar warts. Indian Journal of Dermatology, Venereology and Leprology. 2019;85:129. DOI: https://doi.org/10.4103/ijdvl.IJDVL_809_17
Longhurst B, Bristow I. The treatment of verrucae pedis using Falknor’s needling method: a review of 46 cases. Journal of Clinical Medicine. 2013;2:13-21. DOI: https://doi.org/10.3390/jcm2020013
Salman S, Ahmed MS, Ibrahim AM, et al. Intralesional immunotherapy for the treatment of warts: A network meta-analysis. Journal of the American Academy of Dermatology. 2019;80:922-30. DOI: https://doi.org/10.1016/j.jaad.2018.07.003
Hekmatjah J, Farshchian M, Grant-Kels JM, Mehregan D. The status of treatment for
plantar warts in 2021: no definitive advancements in decades for a common dermatology disease. Clin Dermatol. 2021;39:688-94. DOI: https://doi.org/10.1016/j.clindermatol.2021.05.024
Zhu P, Qi RQ, Yang Y, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). Journal of Evidence‐Based Medicine. 2022;15:284-301. DOI: https://doi.org/10.1111/jebm.12494
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