Comparison of the efficacy of intralesional5‐fluorouracil/lidocaine/epinephrine injection with cryotherapy to treat common and palmoplantar warts: A randomized, controlled trial

Abstract

Cutaneous warts are treated by different treatments with various efficacy. Intralesional injection of 5-fluorouracil (IL 5-FU) has been compared with placebo and a few other wart treatments. Our objective was to compare the efficacy of IL 5-FU injection with cryotherapy to treat common and palmoplantar warts. Forty-five patients with common and palmoplantar warts were treated with either IL 5-FU admixed with lidocaine and epinephrine (5-FU + LE) or cryotherapy, once weekly for six sessions. The patients were assessed for clinical response score, the thickness of warts, pain score, and quality of life in treatment sessions, 2 and 8 weeks after the last session. Nine patients (64.3%) in the 5-FU + LE group, and five patients (35.7%) in cryotherapy group experienced complete response (p = 0.285). Both treatments caused improvement of clinical response score in the patients during the treatment time (p < 0.001), but the efficacy of treatments was not significantly different (p = 0.793).Changes in wart thickness were significantly more marked in the 5-FU + LE group compared to the cryotherapy group (p = 0.021). The patients in the cryotherapy group experienced more severe pain compared to the 5-FU + LE group (p = 0.011).The quality of life better improved in the 5-FU + LE group compared to the cryotherapy group (p = 0.02). To conclude, most of the patients that experienced complete clinical response had received 5-FU + LE injection, though the difference was not significant. However, 5-FU + LE injection accompanied less pain and caused more reduction in wart thickness and more improvement in quality of life compared to the cryotherapy.

The treatment of plantar warts using microwave—A review of 85 consecutive cases in the United States

“…Nonetheless, the ITT results compare favorably to other treatment modalities (Figure 4), and corroborated findings from a pilot UK study treating plantar warts with up to four microwave sessions. [10][11][12][13][14]16 In contrast to patients treated with cryotherapy or salicylic acid, we found no significant differences in clearance rates between children and adults (61.0% [25/41] vs. 59.1% [26/44]). 13 Other factors potentially affecting treatment outcomes may include the number and size of lesions, inclusion of patients with recalcitrant warts, hands warts or history of selftreatment, as well as energy settings of the microwave device.…”

“…Most patients included in this study required up to three treatment sessions over approximately 12 weeks (with the intention to treat clearance rate of 61.5% (48/78); clearance rate per treatment completion was 90.6% [48/53]; Table 2), similar to existing microwave treatment data and other standard wart treatment patterns and time frames reported in the literature (Figure 4). 9–14 Clearance rates (per ITT) were numerically higher in patients who received one or two additional treatment sessions after the primary session (χ 2 [2, N = 78] = 2.07, p = 0.36), with up to 71.0% (22/31) achieving the treatment end point after completing the third session, compared with 55.3% (16/30) and 58.9 (10/17) for the first and second session, respectively (Table 3).…”

“…The clearance rate of plantar warts in our study was 60.0% (51/85), which is notably higher compared to patients treated with cryotherapy (13.6% [15/110] to 29.7% [11/37]) or topical salicylic acid (14.3% [17/119] to 32.6% [14/43]). [11][12][13] Intralesional bleomycin injection, although effective with 69.2% (18/26) of patients achieving clearance at week 8, may have limited utility due to pain at the injection site; especially for patients with multiple warts. 12,22 With intralesional bleomycin injection one case of hemorrhagic eschar was also reported.…”

“…[11][12][13] Intralesional bleomycin injection, although effective with 69.2% (18/26) of patients achieving clearance at week 8, may have limited utility due to pain at the injection site; especially for patients with multiple warts. 12,22 With intralesional bleomycin injection one case of hemorrhagic eschar was also reported. 22 Similarly, another study reported a 93.3% (14/15) clearance rate in patients treated using a solution of 1% cantharidin, 20% podophyllin resin, and 30% salicylic acid following surgical delamination of plantar warts.…”

“…Clearance rates, defined as the complete visible clearance of warts with or without dermoscopic evaluation, were extracted from five studies treating patients with cryotherapy, salicylic acid, 5-fluorouracil, and/or bleomycin. [10][11][12][13][14] Data from matching control or placebo groups were also extracted if available. *Mixed patient cohort of common and plantar warts.…”