Comparative Study of Topical 80% Trichloroacetic Acid With 35% TrichloroaceticAcid in the Treatment of the Common Wart

November 2012 | Volume 11 | Issue 11 | Original Article | 66 | Copyright © November 2012

Fakhrozaman Pezeshkpoor MD,a Mahnaz Banihashemi MD,a Mohammad Javad Yazdanpanah MD,a Hadis Yousefzadeh,b Mohammad Sharghi MD,c Hossein Hoseinzadehd

aResearch Center for Cutaneous Leishmaniasis, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran bImmunology PhD Student, Student Research Assembly of MUMS, MUMS, Mashhad, Iran cResident of Dermatology, Faculty of Medical Sciences, MUMS, Mashhad, Iran dGeneral Physician, Faculty of Medical Sciences, MUMS, Mashhad, Iran

Background: Common warts caused by the human papillomavirus (HPV) are considered to be the most common infectious skin disease. No individual treatment for common warts is effective as monotherapy in eradicating the lesions. The aim of this study is to evaluate the clinical efficacy of a 35% and an 80% trichloroacetic acid (TCA) solution in the treatment of the common wart.
Methods: In this single-blinded clinical trial, 62 eligible patients with common warts referred to the dermatology clinic of Ghaem Hospital in Mashhad, Iran. Patients were randomly divided into two groups, each treated with a TCA solution (group A, TCA 80%; group B, TCA 35%) once per week until complete clearance of the lesions or for a maximum duration of six weeks. Seven patients were excluded from the final analysis (one patient in group A and six patients in group B) for various reasons, including irregular follow-up, using physical tools such as razor blades to remove the lesion, and failure to complete treatment; and 55 patients were included in the final analysis.
Results: Improvement to treatment responses was classified as: 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). At the end of follow-up, the clinical improvement of group A (n=30) 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%) showed a mild response, 6 patients (24%) a moderate response, and 3 patients (12%) a good response. There was a statistically significant difference in improvement between the two treatment groups (P=.017). Improvement was greater with a higher concentration of TCA solution.
Conclusion: This study showed that a different concentration of TCA solution was an effective form of treatment for common warts. Trichloroacetic acid 80% is more effective, but this solution must be used only with careful consideration by a physician.

J Drugs Dermatol. 2012;11(11)e66-e69.


Common warts are caused by the human papillomavirus (HPV). They affect 2% to 20% of school-aged children.1 This infection can cause physical and emotional distress in patients.2 There are different available treatments for the common wart, but in all cases, none of these treatments are individually effective in eradicating the lesions. Moreover, until now, there have not been any available specific antiviral therapies for HPV infection.3 The first line of therapy is salicylic acid resulting in regression of warts in two thirds of patients.4,5 In addition, cryotherapy, usually using liquid nitrogen, which freezes tissues and destroys the warts, is one of the most effective treatments. Chemical cauterization materials, such as monochloroacetic acid and trichloroacetic acid (TCA), have also been used as treatment. 6Trichloroacetic acid is a caustic and hemostatic agent. A saturated solution could be used alone for the treatment of many benign and dysplastic skin lesions. A solution of TCA with a concentration of 60% to 90% has been used for genital warts and for vaginal and anal lesions.7,8 Trichloroacetic acid is applied topically and must be allowed to dry until a white frosting develops, and its application is accompanied by a burning sensation that lasts for two to five minutes.9 Studies using TCA 80% on genital warts have reported clearance rates of 70% to 81% after six applications. 10,11 We hypothesized that applying a lower-concentration TCA solution could have different improvement results for the treatment of the common wart. This study was conducted to evaluate the clinical efficacy of TCA 80% and a lower concentration of TCA solution (35%) in the treatment of common warts. To date, this lower-concentration solution has not been used for treatment of the common wart.


Patients and Study Procedures

This clinical trial study was approved by the Medical Ethics Committee of Mashhad University of Medical Sciences in Mashhad,