title: Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial.
abstract: Cryotherapy and salicylic acid (SA) often fail as treatments for skin warts. We examined the effectiveness of monochloroacetic acid (MCA) for patients with common or plantar warts. Consecutive patients aged 4 years and older with one or more newly diagnosed common or plantar warts were recruited in 53 Dutch general practices. We randomly allocated eligible patients to 13-week treatment protocols of office-applied MCA versus liquid nitrogen cryotherapy every 2 weeks for patients with common warts (n=188), and MCA versus cryotherapy combined with daily SA self-application for patients with plantar warts (n=227). The primary outcome was the proportion of patients whose warts were all cured at 13 weeks. In the common wart group, cure rates were 40/92 (43%, 95% confidence interval 34-54) for MCA and 50/93 (54%, 44-64) for cryotherapy (risk difference (RD) -10%, -25-4.0, P=0.16). In the plantar wart group, cure rates were 49/106 (46%, 37-56) for MCA and 45/115 (39%, 31-48) for cryotherapy combined with SA (RD 7.1, 5.9-20, P=0.29). For common warts, MCA is an effective alternative to cryotherapy to avoid pain during the treatment, although pain after the treatment is similar. For plantar warts, office-applied MCA may be preferred over cryotherapy combined with SA, on the basis of comparable effectiveness, less treatment pain, and less treatment burden.
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands. Electronic address: s.c.bruggink@lumc.nl.
authors.forename: Sjoerd C
authors.initials: SC
authors.lastname: Bruggink
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Paulette F
authors.initials: PF
authors.lastname: Egberts
authors.affiliation: Department of Dermatology (B1-Q), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jan Nico Bouwes
authors.initials: JNB
authors.lastname: Bavinck
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Margot W M
authors.initials: MWM
authors.lastname: de Waal
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands; Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, 117-hag, Nijmegen, The Netherlands.
authors.forename: Willem J J
authors.initials: WJJ
authors.lastname: Assendelft
authors.affiliation: Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Just A H
authors.initials: JAH
authors.lastname: Eekhof
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D002648:Child; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009426:Netherlands; D010146:Pain / Q000453:epidemiology; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome; D014860:Warts / Q000628:therapy*; D055815:Young Adult
chemical_list: D000085:Acetates; C006972:chloroacetic acid