http://bmj.com/cgi/content/abstract/325/7362/461
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 Collections under
which this article appears: Systematic
reviews (incl meta-analyses): examples Other
Infectious Diseases Dermatology
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Sam Gibbs
a Department of Dermatology, Ipswich Hospital NHS Trust, Ipswich IP4 5PD, b School of Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, c Department of Dermatology, Addenbrooke's NHS Trust, Cambridge CB2 2QQ, d Department of Service Development, Finance and Information, Norfolk Health Authority, Norwich NR7 0HT
Correspondence to: S Gibbs
sgibbs@fish.co.uk
Objective: To assess the evidence for the efficacy of local
treatments for cutaneous warts.
Methods: Systematic review of randomised controlled trials.
Main outcomes measures: Total clearance of warts and adverse effects
such as irritation, pain, and blistering.
Study selection: Randomised controlled trials of any local
treatment for uncomplicated cutaneous warts. All published and
unpublished material was considered, with no restriction on date or
language.
Results: 50 included trials provided generally weak evidence
because of poor methods and reporting. The best evidence was for
topical treatments containing salicylic acid. Data pooled from six
placebo controlled trials showed a cure rate of 75% (144 of 191) in
cases compared with 48% (89 of 185) in controls (odds ratio 3.91, 95%
confidence interval 2.40 to 6.36). Some evidence for the efficacy of
contact immunotherapy was provided by two small trials comparing
dinitrochlorobenzene with placebo. Evidence for the efficacy of
cryotherapy was limited. No consistent evidence was found for the
efficacy of intralesional bleomycin, and only limited evidence was
found for the efficacy of topical fluorouracil, intralesional
interferons, photodynamic therapy, and pulsed dye laser.
Conclusions: Reviewed trials of local treatments for cutaneous
warts were highly variable in methods and quality, and there was a
paucity of evidence from randomised, placebo controlled trials on
which to base the rational use of the treatments. There is good
evidence that topical treatments containing salicylic acid have a
therapeutic effect and some evidence for the efficacy of
dinitrochlorobenzene. Less evidence was found for the efficacy of all
the other treatments reviewed, including cryotherapy.
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What is already known on this topic No one treatment is strikingly effective and little is known about the absolute and relative efficacy of these treatments What this study adds Evidence, which is generally of a poor quality, shows a beneficial effect of topical salicylic acid and contact immunotherapy with dinitrochlorobenzene Little evidence exists for the efficacy of cryotherapy and no consistent evidence for the efficacy of all the other treatments reviewed |
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