title: Paring and intense pulsed light versus paring alone for recalcitrant hand and foot warts: a randomized clinical trial with blinded outcome evaluation.
abstract: OBJECTIVE
  Treatment of recalcitrant viral warts remains a therapeutic challenge. Intense pulsed light (IPL) has been suggested effective to clear wart tissue. The objective was in a randomized controlled trial to assess the efficacy of paring followed by IPL versus paring alone for recalcitrant hand and foot warts.
  
  
  METHODS
  Eighty-nine patients with recalcitrant hand and foot warts were included and randomized (1:1) to three treatments at 3-week intervals with either paring of warts followed by IPL or paring of warts alone. IPL was given with the Ellipse Flex IPL system (Danish Dermatologic Development A/S, Hørsholm, Denmark, 400-950 nm, 5.5 millisecond pulse duration in double pulses with a 2 millisecond interval, 26.0-32.5 J/cm(2) repetitive passes). The primary outcome was complete and partial clearance of warts evaluated by blinded photo assessment at 6 weeks after final treatment. Secondary outcomes were treatment related pain and adverse reactions.
  
  
  RESULTS
  We found no significant difference in clearance of warts between the two intervention groups (OR 1.64, 95% confidence interval 0.62-4.38). Paring followed by IPL resulted in complete or partial clearance of wart tissue in nine (22%) and five patients (12.2%) versus five (13.5%) and four patients (10.8%) from paring alone. Mostly plantar warts were treated (92.1%). The pain intensity after paring and IPL was moderate and significantly higher than the pain intensity after paring alone (P<0.0005). No adverse reactions were observed from the two interventions.
  
  
  CONCLUSIONS
  Paring followed by IPL did not differ significantly from paring alone in clearance of recalcitrant hand and foot warts but caused significantly more pain.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark. katrinetogsverd@hotmail.com
authors.forename: Katrine
authors.initials: K
authors.lastname: Togsverd-Bo
authors.forename: Christian
authors.initials: C
authors.lastname: Gluud
authors.forename: Per
authors.initials: P
authors.lastname: Winkel
authors.forename: Helle K
authors.initials: HK
authors.lastname: Larsen
authors.forename: Hans B
authors.initials: HB
authors.lastname: Lomholt
authors.forename: Marie
authors.initials: M
authors.lastname: Cramers
authors.forename: Peter
authors.initials: P
authors.lastname: Bjerring
authors.forename: Merete
authors.initials: M
authors.lastname: Haedersdal
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D005533:Foot Dermatoses / Q000473:pathology / Q000532:radiotherapy*; D006229:Hand Dermatoses / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007834:Lasers; D028022:Low-Level Light Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011336:Probability; D018570:Risk Assessment; D016037:Single-Blind Method; D016896:Treatment Outcome; D014860:Warts / Q000473:pathology / Q000532:radiotherapy*