Local treatments for cutaneous warts: systematic review

Area of Science:

• Dermatology
• Evidence-based medicine
• Pharmacology

Background:

• Cutaneous warts are common skin infections caused by human papillomaviruses.
• Various local treatments are available, but their efficacy is often debated.
• A systematic review is needed to consolidate evidence on treatment effectiveness.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) evaluating local treatments for cutaneous warts.
• To assess the efficacy and adverse effects of different therapeutic interventions.
• To provide evidence-based recommendations for clinical practice.

Main Methods:

• Systematic review of 50 randomized controlled trials (RCTs).
• Inclusion of all published and unpublished RCTs on local treatments for uncomplicated cutaneous warts.
• Assessment of total wart clearance and adverse effects like irritation, pain, and blistering.

Main Results:

• Topical salicylic acid demonstrated the strongest evidence of efficacy, with a 75% cure rate in pooled placebo-controlled trials (OR 3.91).
• Contact immunotherapy (dinitrochlorobenzene) showed some evidence of efficacy in small trials.
• Limited or inconsistent evidence was found for cryotherapy, intralesional bleomycin, topical fluorouracil, intralesional interferons, photodynamic therapy, and pulsed dye laser.

Conclusions:

• High variability in study quality and methodology limits definitive conclusions for most treatments.
• Topical salicylic acid is supported by good evidence for therapeutic effect in treating cutaneous warts.
• Further high-quality, placebo-controlled RCTs are needed to establish the efficacy of other local wart treatments.