Comparative Efficacy of Cryotherapy Versus Topical Trichloroacetic Acid 90% in   Treatment of Common Warts

Authors

  • Kiran Gul Department of Dermatology, Combined Military Hospital, Abbottabad/National University of Medical Sciences (NUMS) Pakistan
  • Bushra Muzaffar Department of Dermatology, Combined Military Hospital, Abbottabad/National University of Medical Sciences (NUMS) Pakistan
  • Muhammad Adeel Siddiqui Department of Dermatology, Combined Military Hospital, Abbottabad/National University of Medical Sciences (NUMS) Pakistan
  • Majid Hussain Department of Dermatology, Combined Military Hospital, Jhelum/National University of Medical Sciences (NUMS) Pakistan
  • Sara Ilyas Department of Dermatology, Combined Military Hospital, Abbottabad/National University of Medical Sciences (NUMS) Pakistan
  • Huma Farid Department of Dermatology, Combined Military Hospital, Abbottabad/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v75i6.10022

Keywords:

Common warts, Cryotherapy, Trichloroacetic Acid 90%.

Abstract

Objective: To compare the efficacy of Cryotherapy using liquid Nitrogen versus Trichloroacetic acid 90% in treatment of common warts.

Study Design: Randomized Control Trial (ClinicalTrials.gov: NCT05712811).

Place and Duration of Study: Department of Dermatology, Combined Military Hospital Abbottabad, Pakistan from Jun to Nov 2022.

Methodology: Sixty patients with common warts (hard lesions, raised lumps with rough surfaces at the back of fingers, around nails and palm of hands) diagnosed by consultant dermatologist on clinical presentation were included in this study. The sample size was calculated by WHO Sample Size calculator. After randomization, patients were divided into two groups. Group-A was managed with Cryotherapy using liquid Nitrogen and Group-B was managed with topical Trichloroacetic acid 90%. Clinical evaluation was done at the end of twelfth week and then three months after the end of therapy to ascertain efficacy. Efficacy was established in terms of absence of all lesions with no recurrence/reappearance in both groups.

Results: Cryotherapy using liquid nitrogen was more efficacious (83.3%) in terms of absence of all lesions with no recurrence/reappearance of warts as compared to 90.0% topical Trichloroacetic acid (60.0%) (p-value 0.045).

Conclusion: This randomized controlled trial showed that Cryotherapy using liquid nitrogen was significantly more efficacious in treating common warts as compared to topical Trichloroacetic acid 90%.

Downloads

Download data is not yet available.

References

REFERENCES

1. Abdel AM, Abdel M, Abdel S, Cryotherapy vs trichloroacetic acid 90% in treatment of common warts. J Cosmet Dermatol 2019; 18(2): 608-613.

https://doi.org/10.1111/jocd.12805

2. Morita MM, Marcondes TSP, Haddad-Jr V, Miot HA. Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial. Surg Cosmet Dermatol 2021; 13: 20210041.

http://doi.org/10.5935/scd1984-8773.2021130041

3. Abdul Q, Mohammad MP, Farah S. Effectiveness of topical 100% trichloroacetic acid in treatment of anogenital warts in male patients. Fortune J Health Sc 2022; 5: 37-42.

https://www.doi.org/10.26502/fjhs.044

4. Essa N, Saleh MA, Mostafa RM, Taha EA, Ismail TA. Prevalence and factors associated with warts in primary school children in Tema District, Sohag Governorate, Egypt. J Egypt Public Health Assoc 2019; 94(1): 6-9.

https://doi.org/10.1186/s42506-018-0007-0

5. Bodar P, Agarwal P, Saikia S, Dalal T, Jagati A. Evaluating the efficacy of 100% trichloroacetic acid needling in the treatment of palmoplantar warts. Indian J Drugs Dermatol 2020; 6: 13-16.

https://doi.org/10.4103/ijdd.ijdd_38_19

6. Choi JY, Park JH, Oh SH, Lee JH, Lee JH, Lee DY, et al. Efficacy of punch reduction prior to cryotherapy in patients with common warts: a case-control study in a single tertiary center. Ann Dermatol 2017; 29(2): 200-205.

https://doi.org/10.5021/ad.2017.29.2.200

7. Ali A, Allahyar T, Ahmad B. A comparison of two treatment methods, trichloroacetic acid, and laser therapy, in the wart treatment: a randomized double-blind clinical trial in a university hospital in Tehran, Iran. Ann Mil Health Sci Res 2022; 20(4): e13467.

https://doi.org/10.5812/amh-134671

8. Wessels I, Maywald M, Rink L. Zinc as a gatekeeper of immune function. Nutrients 2017; 9(12): 1286-1289.

https://doi.org/10.3390/nu9121286

9. Gao H, Dai W, Zhao L, Min J, Wang F. The role of zinc and zinc homeostasis in macrophage function. J Immunol Res 2018; 2018: 6872621.

https://doi.org/10.1155/2018/6872621

10. Waqas N, Khan SA, Naheed A, Sheikh ZI. Efficacy of trichloroacetic acid 90%in the treatment of recalcitrant common warts. J Rawal Med Coll 2017; 21(3): 245-247.

11. Mahmoudi H, Ghodsi SZ, Tavakolpour S, Daneshpazhooh M. Cryotherapy plus oral zinc sulfate versus cryotherapy plus placebo to treat common warts: a double blind, randomized, placebo-controlled trial. Int J Womens Dermatol 2017; 4(2): 87–90. https://doi.org/10.1016/j.ijwd.2017.09.004

12. Abdel Meguid AM, Abdel Motaleb AA, Abdel Sadek AMI. Cryotherapy vs trichloroacetic acid 90% in treatment of common warts. Cosmet Dermatol 2019; 18(2): 608-613.

https://doi.org/10.1111/jocd.12805

13. Al-Ghurair FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebocontrolled clinical trial. Br J Dermatol 2002; 146(3): 423-431. https://doi.org/10.1046/j.1365-2133.2002.04617.x

14. Waqas N, Khan SA, Naheed A, Sheikh ZI. Efficacy of oral zinc sulphate in the treatment of recalcitrant common warts. J Rawal Med Coll 2017; 21(3): 245-247.

15. Hassan I, Bhat T, Altaf H, Sameem F, Masood Q. Role of oral zinc sulphate in warts-a placebo controlled, single-blinded study. Our Dermatol Online 2013; 4(1): 24-27.

https://doi.org/10.7241/ourd.20131.04

16. Mun JH, Kim SH, Jung DS, Ko HC, Kim BS, Kwon KS. Oral zinc sulfate treatment for viral warts: an open-label study. J Dermatol 2010; 38(6): 541-545.

https://doi.org/10.1111/j.1346-8138.2010.01056.x

17. Kwok CS, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. Br J Dermatol 2011; 165(2): 233-246. https://doi.org/10.1111/j.1365-2133.2011.10218.x

18. Bruggink SC, Gussekloo J, Berger MY, Zaaijer K, Assendelft WJ, de Waal MW, et al. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. Can Med Assoc J 2010; 182(15): 1624-1630. https://doi.org/10.1503/cmaj.092194

19. Mahmoudi H, Ghodsi SZ, Tavakolpour S, Daneshpazhooh M. Cryotherapy plus oral zinc sulfate versus cryotherapy plus placebo to treat common warts: A double blind, randomized, placebo-controlled trial. Int J Womens Dermatol 2017; 4(2): 87–90. https://doi.org/10.1016/j.ijwd.2017.09.004

20. Bhattacharya PT, Misra SR, Hussain M. Nutritional aspects of essential trace elements in oral health and disease: an extensive review. Scientifica 2016; 2016: 5464373.

https://doi.org/10.1155/2016/5464373

21. Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis 1993; 20: 344-345.

22. Damstra RJ, van Vloten WA. Cryotherapy in the treatment of condylomata acuminata: a controlled study of 64 patients. J Dermatol Surg Oncol 1991; 17: 273-276.

https://doi.org/10.1111/j.1524-4725.1991.tb03642.x

23. Pirotta MV, Stein AN, Fairley CK. Patterns of treatment of external genital warts in Australian sexual health clinics. Sex Transm Dis 2009; 36: 375-379.

https://doi.org/10.1097/olq.0b013e3181971e4e

24. Lotfabadi Farzaneh Malek, Ali G. Liquid nitrogen cryotherapy versus 70% trichloroacetic acid in the treatment of anogenital warts: a randomized controlled trial. Iran J Dermatol 2015; 18: 151-155.

25. Suwartono H, Andrijono. Efficacy of Trichloroacetic Acid (TCA) Compared to cryotherapy in treating patients with Positive IVA Result. Indonesian J Obstet Gynaecol 2020; 8(4): 249-251. https://doi.org/10.32771/inajog.v8i4.1382

Downloads

Published

31-12-2025

Issue

Section

Original Articles

How to Cite

1.
Gul K, Muzaffar B, Siddiqui MA, Hussain M, Ilyas S, Farid H. Comparative Efficacy of Cryotherapy Versus Topical Trichloroacetic Acid 90% in   Treatment of Common Warts. Pak Armed Forces Med J [Internet]. 2025 Dec. 31 [cited 2026 Jan. 2];75(6):1085-9. Available from: https://pafmj.org/PAFMJ/article/view/10022