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Intervention Review

Topical treatments for cutaneous warts

  1. Sam Gibbs1,*,
  2. Ian Harvey2

Editorial Group: Cochrane Skin Group

Published Online: 19 JUL 2006

Assessed as up-to-date: 23 MAY 2006

DOI: 10.1002/14651858.CD001781.pub2

How to Cite

Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD001781. DOI: 10.1002/14651858.CD001781.pub2.

Author Information

  1. 1

    Ipswich Hospital NHS Trust, Department of Dermatology, Ipswich, UK

  2. 2

    University of East Anglia, School of Health Policy and Practice, Norwich, UK

*Sam Gibbs, Department of Dermatology, Ipswich Hospital NHS Trust, Ipswich, IP4 5PD, UK. sam.gibbs@ipswichhospital.nhs.uk. sam.gibbs@ipsh-tr.anglox.nhs.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 JUL 2006

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This is not the most recent version of the article. View current version (12 SEP 2012)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Viral warts are common and usually harmless but very troublesome. A very wide range of local treatments are used.

Objectives

To assess the effects of different local treatments for cutaneous, non-genital warts in healthy people.

Search methods

We searched the Cochrane Skin Group Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to March 2005), EMBASE (1980 to March 2005) and a number of other biomedical databases. The references of all trials and selected review articles were also searched. In addition, we contacted pharmaceutical companies involved in local treatments for warts and experts in the field

Selection criteria

Randomised controlled trials of local treatments for cutaneous non-genital viral warts in immunocompetent (healthy) people.

Data collection and analysis

Data was extracted and two authors independently selected the trials and assessed methodological quality.

Main results

Sixty trials were identified that fulfilled the criteria for inclusion. The evidence provided by these studies was generally weak due to poor methodology and reporting.

In 21 trials with placebo groups that used participants as the unit of analysis, the average cure rate of placebo preparations was 27% (range 0 to 73%) after an average period of 15 weeks (range 4 to 24 weeks).

The best available evidence was for simple topical treatments containing salicylic acid, which were clearly better than placebo. Data pooled from five placebo-controlled trials showed a cure rate of 117/160 (73%) compared with 78/162 (48%) in controls, which translates to a risk ratio of 1.60 (95% confidence interval 1.16 to 2.23), using a random effects model.

Evidence for the absolute efficacy of cryotherapy was surprisingly lacking. Two trials comparing cryotherapy with salicylic acid and one comparing duct tape with cryotherapy showed no significant difference in efficacy.

Evidence for the efficacy of the remaining treatments reviewed was limited.

Authors' conclusions

There is a considerable lack of evidence on which to base the rational use of topical treatments for common warts. The reviewed trials are highly variable in method and quality. Cure rates with placebo preparations are variable but nevertheless considerable. There is certainly evidence that simple topical treatments containing salicylic acid have a therapeutic effect. There is less evidence for the efficacy of cryotherapy, but reasonable evidence that it is only of equivalent efficacy to simpler and safer treatments. The benefits and risks of topical dinitrochlorobenzene and 5-fluorouracil, intralesional bleomycin and interferons, photodynamic therapy and other miscellaneous treatments remain to be determined.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Topical treatments for skin warts

Viral warts are one of the most common skin diseases. They are caused by the human papilloma virus and most commonly found on the hands and feet. While warts are not harmful and usually go away in time without any treatment, they are unattractive and can be painful. Warts can be removed with wart paints containing salicylic acid. These are cheap and readily available, but slow to work. Cryotherapy, usually using liquid nitrogen, is often considered more effective than wart paints but is more expensive. The review of trials found that there was not enough evidence to compare treatments and that there was not enough evidence to support the use of cryotherapy (freezing) over wart paints as initial treatment for viral warts. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

疣的外用治療

病毒疣是常見而無害的,但是相當地煩人。有相當多不同的外用治療可以使用。

目標

評估不同的局部治療對於健康成人非生殖器疣的效果。

搜尋策略

我們搜尋了Cochrane Skin Group Specialised Register (2005年三月) ,Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966年到2005年三月), EMBASE (1980年到2005年三月) ,還有其他生物醫學資料庫.我們也搜尋了所有臨床試驗及部分回顧性文獻的參考資料。除此之外,我們還與生產疣的外用治療的藥商和這方面的專家連絡。

選擇標準

在正常免疫功能的健康成人身上的非生殖器疣的局部治療的隨機對照試驗

資料收集與分析

在調出資料後,由兩位作者獨立地選擇臨床試驗,並評估該試驗的品質。

主要結論

一共找到60個符合條件的試驗。 ‘由於實驗設計和報告方式不佳,這些試驗的證據等級大多很薄弱’ 。在21個有 ‘安慰劑’ 對照組並以受試者為一個單位分析的臨床試驗中,對照組在平均15 ‘週’ (範圍4到24 ‘週’) 的治療之後,平均治癒率為27% (範圍0到73%) 。證據等級最佳的治療方式為含有水楊酸的單純外用治療,水楊酸組明顯地比安慰劑組有效。由5組安慰劑對照試驗的資料綜合起來,發現實驗組的治癒率為117/160 (73%) 而對照組為78/162 (48%) ,以 ‘隨機效果模型計算風險比率’ 為1.60 (95% 信賴區間1.16至2.23) 。關於冷凍治療之絕對療效的證據令人驚訝地缺乏。另外兩個比較冷凍治療和水楊酸治療的試驗以及一個比較膠帶治療和冷凍治療的試驗,發現在治療效果上沒有明顯的差別。而本文回顧的其他治療方式對疣的療效証據力都相當有限。

作者結論

對於疣的外用治療的証據是相當缺乏的。我們所回顧的文獻在方法和品質上差異很大。即使是使用安慰劑也有顯著的治癒率但是差異很大。目前有明確証據顯示含有水楊酸的外用藥膏具有療效。冷凍治療療效的証據較少,但是証據顯示它的療效僅相當於較簡單而較安全的治療。至於外用dinitrochlorobenzene、5fluorouracil、病灶中注射bleomycin及interferons,光治療或是其他治療方式的好處和風險,仍有待確定。

翻譯人

本摘要由馬偕醫院黃政傑翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

沒有足夠的証據証明冷凍治療應取代外用藥物作為疣的第一線治療。疣是最常見的皮膚疾患之一。它們是由人類乳突病毒感染所引起,最常見於手和腳。雖然疣沒什麼傷害性,而且在沒有治療的狀況下也常自行消失,它們會影響美觀並且有時會痛。疣可以藉由含水楊酸的外用藥根治。這些外用藥便宜而且易得,不過作用較慢。使用液態氮的冷凍治療常被認為比外用藥有效但是較貴。文獻回顧發現,沒有足夠的的証據可用來比較這些治療的療效,因此還需要更多的研究。