Comparison of outcome with 50% salicylic acid versus cryotherapy in the treatment of plantar warts
DOI:
https://doi.org/10.61581/mjsp.v6i3.348Keywords:
Cold Therapy, Cryotherapy, Human Papillomavirus, Salicylic Acid, Plantar Warts, Verruca, WartsAbstract
Objective: “To compare the outcome of 50% salicylic acid versus cryotherapy in treating plantar warts.”
Methodology: An RCT was conducted at the dermatology department of Nishtar Hospital, Multan, from August 1st, 2024, to January 31st, 2025. A total of 656 patients with plantar warts were randomly allocated to Group A (cryotherapy) and Group B (50% salicylic acid). All patients were evaluated at the conclusion of week 12 following the commencement of therapy. The outcome was classified as complete response (absence of warts), partial response (decreased number of warts), and no response after 12 weeks of treatment. The outcome was compared using a 5% significance level chi-square test, and a p-value of ? 0.05 was considered significant.
Results: Both groups were comparable in terms of mean age, gender, duration of warts, and the number of warts. Group A had a higher complete response rate than Group B (30.8% vs. 24.7%; p = 0.134). No significant associations were found between patient response and study groups for age (p = 0.180), gender (p = 0.120), duration of warts (p = 0.249), or number of warts (p = 0.458).
Conclusion: Our study concludes that cryotherapy had a better complete response rate than 50% salicylic acid at 12 weeks of therapy.
Key Words: Cold Therapy; Cryotherapy; Human Papillomavirus; Salicylic Acid; Plantar Warts; Verruca; Warts;
Downloads
References
1. Yousefi Z, Aria H, Ghaedrahmati F, Bakhtiari T, Azizi M, Bastan R. An update on human papillomavirus vaccines: history, types, protection, and efficacy. Front Immunol. 2022;12:805695.
2. Kuriyama Y, Kosaka M, Kaneko A, Nishioka H, Anzawa K, Hattori T, et al. Skin surface material for detecting human papillomavirus infection of skin warts. J Dermatol. 2023;50(11):1450–8. DOI: 10.1111/1346-8138.16920
3. Hekmatjah J, Farshchian M, Grant-Kels JM, Mehregan D. The status of treatment for plantar warts in 2021: No definitive advancements in decades for a common dermatology disease. Clin Dermatol. 2021;39(4):688–94. DOI: 10.1016/j.clindermatol.2021.05.024
4. 4. Ghorzang E, de Koning MNC, Bouwes Bavinck JN, Gussekloo J, Quint KD, Goeman JJ, et al. HPV type-specific distribution among family members and linen in households of cutaneous wart patients. J Eur Acad Dermatol Venereol. 2022;36(1):119–25. DOI: 10.1111/jdv.17684
5. Anwar A, Rafiq Z, Us Salam S. Comparison of efficacy of electrocautery vs. cryotherapy in the treatment viral warts. J Fatima Jinnah Med Univ. 2022;15(4):177–80. DOI: 10.37018/pzcw5103
6. Nofal A, Albalat W, Ismail A, Khattab FM. Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study. J Dermatolog Treat. 2022;33(2):922–7. DOI: 10.1080/09546634.2020.1789540
7. Ismael AI, Yousef AE, Elkholy BM. An overview of the treatment lines for warts. J Pharm Negat Results. 2022;13(7):4391–4.
8. Albalat W, Attwa E, Ebrahim HM. Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study. J Dermatolog Treat. 2022;33(2):857–63. DOI: 10.1080/09546634.2020.1782821
9. Usman H, Khan AR, Naseem S, Shaukat I. Comparison of efficacy of 50% salicylic acid versus cryotherapy in the treatment of plantar warts. J Pak Assoc Dermatol. 2024;34(2):346–50.
10. Qamar HY, Batool MA, Hanif IQ. Comparison of the efficacy of 40% topical salicylic acid and cryotherapy in patients with palmoplantar warts. J Med PhysiolBiophys. 2018;43:28–32.
11. García-Oreja S, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Martinez L. Topical treatment for plantar warts: A systematic review. Dermatologic therapy. 2021;34(1):e14621.
12. García-Oreja S, Álvaro-Afonso FJ, Sevillano-Fernández D, García-Morales EA, López-Moral M, Lázaro-Martínez JL. Does HPV biotype influence the characteristics and evolution of plantar warts? J Evid Based Med. 2024;17(1):10–2. DOI: 10.1111/jebm.12584
13. Mekkawy MM, Elghazally SA, Mahran AM. Cutaneous, non-genital warts: Updates on clinico-epidemiological features of an endemic disease. J Curr Med Res Pract. 2025;10(1):1–10. DOI: 10.21608/jcmrp.2024.333555.1156
14. Yousaf F, Raza N, Ahmed N, Sadiq S, Anwar A. Comparison of intralesional vitamin d3 versus cryotherapy for management of plantar warts. Pakistan Armed Forces Medical Journal. 2019;(6): 22-5
15. Truong K, Joseph J, Manago B, Wain T. Destructive therapies for cutaneous warts: A review of the evidence. Aust J Gen Pract. 2022;51(10):799–803. DOI: 10.31128/AJGP-01-22-6305
16. Shallal MJ, Madlool SW, Naif AA. Molecular Detection of Cutaneous Warts Among Male and Female Patients in Thi-Qar Province. University of Thi-Qar Journal Of Medicine. 2023;25(1):39–50.
17. Asghar N, Asghar M, Rehman N, Afridi IU, Khalid S. Epidemiological and clinical patterns of viral warts presenting to dermatology OPD of Hayatabad Medical Complex, Peshawar: Epidemiological and clinical patterns of viral warts. Journal of Pakistan Association of Dermatologists. 2022;32(1):78–84.
18. Khan FA, Hussain M, Khan BM, Afsar S, Shafique M, Haq SU, et al. To compare efficacy between cryotherapy and mitomycin microneedling for the treatment of plantar warts. J Ayub Med Coll Abbottabad. 2023 [cited 2025 Jul 10];35(1):133–6. Available from: https://demo.ayubmed.edu.pk/index.php/jamc/article/view/10932
19. Bruggink SC, Gussekloo J, Zaaijer K, Assendelft W, Berger MY, Koes BW. Warts: cryotherapy, salicylic acid or expectantly awaiting? A randomised controlled trial. J Invest Dermatol. 2008;128(8).
20. Alrashidi AR, Shaheen E, Abualola A, Alharkan AA, Aljuaid A, Alshareef KM, et al. The efficacy of cryotherapy compared to other modalities in the management of palmoplantar warts: a systematic review and network meta-analysis. Dermatol Reports. 2025;17(2):10121. doi: 10.4081/dr.2024.10121.
21. Maj A, Siddique MA, Hussain LCM. Efficacy of topical 50% salicylic acid versus cryotherapy in treatment of plantar warts. Pakistan Journal of Medical and Health Sciences. 2022;16(12):512–4. DOI: 10.53350/pjmhs20221612512
22. Chopra R. Efficacy of cryotherapy versus salicylic acid in the treatment of plantar warts: a comparative study. Indian J Dermatol. 2021;66(1):60–4.
Published
Issue
Section
License
Copyright (c) 2025 Shoaib Iqbal, Aliya Akhtar, Raheel Tahir, Sidra Tahir, Amra Batool, Asma Batool
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work’s authorship and initial publication in this journal.
