title: Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial.
abstract: OBJECTIVE
  To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts.
  
  
  METHODS
  A multicentre, open, two arm randomised controlled trial.
  
  
  METHODS
  University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland.
  
  
  METHODS
  240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid.
  
  
  METHODS
  Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks.
  
  
  METHODS
  Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment.
  
  
  RESULTS
  There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI -8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients' preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference -3.15% (-16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62).
  
  
  CONCLUSIONS
  Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN18994246, National Research Register N0484189151.
authors.affiliation: Department of Health Sciences, York Trials Unit, University of York, UK. sarah.cockayne@york.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Cockayne
authors.forename: Catherine
authors.initials: C
authors.lastname: Hewitt
authors.forename: Kate
authors.initials: K
authors.lastname: Hicks
authors.forename: Shalmini
authors.initials: S
authors.lastname: Jayakody
authors.forename: Arthur Ricky
authors.initials: AR
authors.lastname: Kang'ombe
authors.forename: Eugena
authors.initials: E
authors.lastname: Stamuli
authors.forename: Gwen
authors.initials: G
authors.lastname: Turner
authors.forename: Kim
authors.initials: K
authors.lastname: Thomas
authors.forename: Mike
authors.initials: M
authors.lastname: Curran
authors.forename: Gary
authors.initials: G
authors.lastname: Denby
authors.forename: Farina
authors.initials: F
authors.lastname: Hashmi
authors.forename: Caroline
authors.initials: C
authors.lastname: McIntosh
authors.forename: Nichola
authors.initials: N
authors.lastname: McLarnon
authors.forename: David
authors.initials: D
authors.lastname: Torgerson
authors.forename: Ian
authors.initials: I
authors.lastname: Watt
mesh_terms: D000287:Administration, Topical; D002648:Child; D017679:Cryotherapy; D005260:Female; D006801:Humans; D008297:Male; D020156:Salicylic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom; D014860:Warts / Q000188:drug therapy / Q000628:therapy*
chemical_list: D020156:Salicylic Acid