Evaluation of the therapeutic efficacy of topical 50% hydrogen peroxide vs. 100% trichloroacetic acid vs. 5% 5-fluorouracil in the treatment of warts

Abstract

Background: Warts (verruca) are caused by human papilloma virus (HPV), which is known to affect the skin and mucosae. Over two hundred strains of HPV have been identified to date, among which few strains cause cutaneous lesions. Various treatment modalities have been elucidated in treating verruca lesions, yet the best therapeutic option is yet to be determined. Objectives: To evaluate the efficacy and safety of topical 50% hydrogen peroxide (H2O2), 100% trichloroacetic acid (TCA), and 5% 5-fluorouracil (5-FU) as a topical application in the treatment of warts. Methods: This was a prospective, interventional, clinical trial that included sixty patients with warts randomly allotted into three groups. Group A and group B were treated every week with topical 50% H2O2 and 100% TCA, respectively, and group C with 5% 5-FU under tape occlusion twice a day. The treatment was executed for a maximum period of eight weeks. The patients were evaluated with the Physician Wart Assessment (PWA) every two weeks of treatment and at three months after treatment completion. Results: At the end of the eight weeks of treatment, 13 patients (65%) in the H2O2 group, 11 patients (55%) in the TCA group, and 8 patients (40%) in the 5% 5-FU group displayed complete clearance of warts (PWA grade 0). In our study, side effects were significantly higher in the TCA group (70%) and in the 5% 5-FU group (60%), notably lower in the H2O2 group (30%) (p = 0.011). The most frequent side effect was irritation (25%), which was reported in all groups. No relapse was encountered at three months of treatment completion. Conclusion: According to our study, H2O2 and TCA have the advantage of earlier action over 5% 5-FU. However, H2O2 remarkably stands as a safer therapeutic option concerning the clearance of lesions, patient tolerability, and side effects. Key words: Warts, H2O2, TCA, 5%, 5-FU