Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial

Bruggink, Sjoerd; Gussekloo, Jacobijn; Berger, Marjolein Y.; Zaaijer, Krista; Assendelft, W.J.J.; Waal, Margot W. M. de; Bavinck, Jan Nico Bouwes; Koes, Bart W.; Eekhof, Just

doi:10.1503/cmaj.092194

Cited by 126 publications

(139 citation statements)

References 18 publications

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“…In agreement with others, we found that the location and size of warts do not seem to influence this outcome. 12,13 Associations with the number of warts are not consistent in other studies, 10,12,13 and we could not provide clear evidence on this issue either.…”

Section: Comparison With Other Studiescontrasting

confidence: 66%

“…6 Less potent over-the-counter (OTC) cryotherapy or salicylic acid (usually 17%) treatments are offered in pharmacies without a prescription. 7 Because warts resolve spontaneously and available treatments often fail, especially in the case of plantar warts, [8][9][10] a wait-and-see policy may be considered in treatment decisions. 11 Studies on the natural course of warts are scarce and outdated, however.…”

Section: Introductionmentioning

confidence: 99%

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Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study

Bruggink

Eekhof

Egberts

et al. 2013

The Annals of Family Medicine

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PURPOSE Because cutaneous warts resolve spontaneously and available treatments often fail, family physicians and patients may consider a wait-and-see policy. We examined the natural course of cutaneous warts and treatment decisions in a prospective observational cohort of primary schoolchildren. METHODSWe inspected the hands and feet of children aged 4 to 12 years from 3 Dutch primary schools for the presence of warts at baseline and after a mean follow-up of 15 months. Parental questionnaires at follow-up provided information on inconvenience caused by warts and any treatments used. RESULTSOf the 1,134 eligible children, 1,099 (97%) participated, of whom 366 (33%) had cutaneous warts at baseline. Among these children with warts, loss to follow-up was 9% and the response rate to the parental questionnaires was 83%. The complete resolution rate was 52 per 100 person-years at risk (95% CI, 44-60). Younger age (hazard ratio = 1.1 per year decrease; 95% CI, 1.0-1.2) and non-Caucasian skin type (hazard ratio = 2.0; 95% CI, 1.3-2.9) increased the likelihood of resolution. During follow-up, 38% of children with warts at baseline treated their warts: 18% used over-the-counter treatment only, 15% used a family physician-provided treatment only, and 5% used both. Children were more likely to initiate treatment if the warts measured at least 1 cm in diameter (odds ratio = 3.2; 95% CI, 1.9-5.3) and especially if parents reported that the warts caused inconvenience (odds ratio = 38; 95% CI, 16-90).CONCLUSIONS One-half of primary schoolchildren with warts will be free of warts within 1 year. Young age and non-Caucasian skin type enhance resolution. Children with large or inconvenient warts are more likely to start treatment. These findings will be useful in the process of shared decision making with parents and children.

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Section: Comparison With Other Studiescontrasting

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study

Bruggink

Eekhof

Egberts

et al. 2013

The Annals of Family Medicine

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“…10 Two important trials published within the last few years 11,12 are included in a recently updated Cochrane review. 13 Bruggink et al 11 studied 250 patients in primary care who were randomized to one of three treatment regimens: SA 40% ointment, fortnightly cotton-bud cryotherapy, or no treatment for 13 weeks. The cure rates for all sites combined were 15%, 49% and 8%, respectively; subgroup cure rates were: hand warts, 17%, 46% and 7%, respectively, and plantar warts, 33%, 30% and 23%, respectively.…”

Section: Destructive Treatmentsmentioning

confidence: 99%

“…10 Where possible, subgroup analysis of data from these trials suggests that cure rates are generally better for hand warts than for plantar warts. Two recently published trials 11,12 have provided much betterquality data than previously and have compared cryotherapy directly with SA. 13 As discussed in the section on SA (section 8.2.1.a.…”

Section: 29mentioning

confidence: 99%

British Association of Dermatologists' guidelines for the management of cutaneous warts 2014

et al. 2014

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“…An abundant amount of literature is available on the use of cryotherapy for treatment of cutaneous [12] and anogenital warts [9,[13][14][15][16]. Within this small spectrum of reports even fewer studies have been published about cryotherapy use for treatment of oral condyloma acuminatum.…”

Section: Discussionmentioning

confidence: 99%

Oral Multifocal Papillary Lesions in a Young Child: Clinico-Pathologic and Medico-Legal Considerations

Salek¹

2013

J Dent Oral Disord Ther

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Services (CPS) for further investigation and for ensuring child safety [6]. A diagnosis of HPV-positive multifocal oral lesions in a child could potentially represent condyloma acuminatum or Heck's disease since clinical and histopathology findings and the presence of HPV without specific subtyping are not pathognomonic for either disease. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions that were confirmed positive for HPV by histopathology and in situ hybridization. California CPS was notified as per our clinical protocols for further investigation. Case ReportA 12-year-old Hispanic boy was referred to the Orofacial Pain and Oral Medicine Clinic at the Herman Ostrow School of Dentistry for evaluation of multifocal intraoral lesions. Head and neck examination revealed the presence of multiple asymptomatic, pink to white in color, coalescing lesions of the lower lip, buccal mucosa, and commissures as demonstrated in Figure 1. Some of the lesions appeared sessile, others pedunculated, and others papillary; all had similar and overlapping features. The lesions were not painful and were rubbery soft to palpation. The remainder of the head and neck exam was unremarkable, and a review of systems and medical history were non-contributory. The patient was not taking any medications and the social history was non-contributory. The patient and his mother AbstractHuman papilloma virus (HPV) is a non-enveloped DNA virus that infects cutaneous and mucosal epithelial cells. Oral lesions of HPV can present as solitary or multifocal lesions, and multifocal lesions can represent a diagnostic challenge clinically with important medicolegal considerations in some cases. We report a unique case of a 12-year-old boy presenting with oral multifocal papillary mucosal lesions which upon biopsy was found to be consistent with a diagnosis of condyloma acuminatum or Heck's disease histopathologically; in situ hybridization studies also confirmed positivity for low risk HPV subtypes in affected tissue. Based on the pathology results and our clinical protocols, we contacted social servicesto rule out the sexually transmitted disease condyloma. A final diagnosis of Heck's disease was rendered after clinico-pathologic and social correlation. Cryotherapy with topical anesthesia was used to successfully treat the lesions with no evidence of recurrence on 6 month follow-up.

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Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial

Cited by 126 publications

References 18 publications

Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study

Natural Course of Cutaneous Warts Among Primary Schoolchildren: A Prospective Cohort Study

British Association of Dermatologists' guidelines for the management of cutaneous warts 2014

Oral Multifocal Papillary Lesions in a Young Child: Clinico-Pathologic and Medico-Legal Considerations

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