Iran. This study was single-blinded, where the dermatologist involved
knew the prescription, but the patients did not, and was
performed on 62 patients with common warts who were referred
to the dermatology clinic of Ghaem Hospital in Mashhad, Iran.
Patients were randomly divided into two groups: 31 patients
were treated with TCA 80% (group A), and 31 patients with TCA
35% (group B). The division of participants was performed by a
simple random-selection method: the patients who entered the
study on odd days received TCA 80%, and the patients who entered
the study on even days received TCA 35%.
Treatment and Follow-up
Exclusion criteria were patients younger than seven years,
recent treatment of warts with another therapy, defects in
wound healing such as diabetes, peripheral vascular disease,
and distribution of the lesions anywhere except for the hands
and feet. Before the procedure, the patients were advised to
soak the lesions in tap water for two to five minutes until they
become soft. After the lesions were dried, the TCA solution
was applied with light pressure using a swab and allowed to
dry until a white frosting developed. Treatment was continued
for up to six weeks, and all patients were followed up each
week. Any clinical improvement was evaluated by the same
dermatologist at the end of week 7. After 12 weeks, the recurrence
rate was evaluated.
Improvement to treatment responses was divided into four
groups: no change (no changes in the number of warts), mild
(clearing of less than 25% of warts), moderate (clearing of 25%
to 75% of warts), and good (clearing of more than 75% of warts).
Any side effects of treatment were recorded, such as erythema,
itching, burning sensations, ulcers, scars, hyperpigmentation
or hypopigmentation, infections, or edema.
Statistical Analysis
Data were collected and group comparisons involving categorical
data made using chi-square analysis. Numerical data are
expressed as mean ± standard deviation (SD) or as proportions
of the sample size.
Data were analyzed using SPSS for Windows (version 11.5; SPSS
Inc, Chicago, IL). A P value less than .05 was considered significant.
RESULTS
Sixty-two patients with common warts were entered in our
study. For various reasons, including irregular follow-up, using
physical tools such as razor blades to remove the lesions,
and failure to complete treatment, seven patients (one patient
in group A and six patients in group B) were excluded, and 55
patients were included in the final analysis (Figure 1). Thirty
patients (12 male and 18 female, aged 17.7 ± 9.6 years) were
treated with TCA 80%, and 25 patients (5 male and 20 female,
aged 20.4 ±7.8 years) were treated with TCA 35%.
The weekly clinical improvement of the two groups is demonstrated
in Table 1. In group A (n=30), clinical improvement after
six weeks was: 10 patients (33.3%) with a mild response, 6 patients
(20%) with a moderate response, and 14 patients (46.7%)
with a good response. In group B (n=25), 16 patients (64%) had
a mild response, 6 patients (24%) had a moderate response,
and 3 patients (12%) had a good response. There was a statistically
significant difference between the two treatment groups
(P=.017), with group A showing a more favorable response.
Side effects such as burning sensations, tingling, local pain,
scarring, and temporary hyperpigmentation were seen in 30%
(n=9) of group A patients and in 20% (n=5) of group B patients.
Complications in group A were more severe than in group B,
but there was no statistically significant difference between the
two groups. In group A, the patients with 6 to 8 warts had a
mild response, the patients with 6 warts had a moderate response,
and the patients with 1 to 3 warts had a good response.
In group B, the patients with 5 to 7 warts had a mild response,
the patients with 3 to 5 warts had a moderate response, and
the patients with 1 to 2 warts had a good response. (Figure 2).
Twelve weeks after complete clearance, recurrence rates were
10% in group A, and 18.8% in group B.
DISCUSSION
There is no specific antiviral therapy available for curing HPV
infections, and most treatments focus primarily on the destruction
or removal of visible lesions or on the induction of
cytotoxicity against the infected cell.2 An extensive range of
medications have been used to treat the common wart with
different degrees of efficacy. These medications include keratolytic
agents such as salicylic acid (67% efficacy), formic acid
puncture (92% efficacy), glutaraldehyde (72% efficacy), silver
nitrate (43% efficacy), imiquimod (70%-88% efficacy), oral
zinc sulfate (86.9% efficacy), and oral cimetidine (32%-68%
efficacy).12-21 In a previous study, our group found 82.6% efficacy
using topical 80% phenol solution on the common wart.22
Cryotherapy has a similar efficacy to salicylic acid, and this
method is inexpensive and available in every office. Trichlo-
