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

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.


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.


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-