Destructive therapies for cutaneous warts: A review of the evidence.

BACKGROUND AND OBJECTIVES: Non-genital warts are benign cutaneous growths caused by infection with the human papillomavirus. Although warts can resolve spontaneously, patients might seek treatment due to discomfort or social ostracism. This review summarises high-quality studies investigating the efficacy of chemical and physical destructive wart therapies. METHOD: We performed a literature review (up to June 2021) of published articles for wart management from MEDLINE and Embase databases. We considered systematic reviews, randomised controlled trials (RCTs), cohort studies and case series. We included studies that investigated chemical or physical destructive therapies. RESULTS: Fifteen therapies were evaluated and included salicylic acid, cryotherapy, silver nitrate, phenol, cantharidin, glycolic acid, pyruvic acid, citric acid, formic acid, trichloroacetic acid, monochloroacetic acid, zinc, laser, surgery and electrocautery. Very few treatment options have been studied through RCTs. DISCUSSION: To attenuate transmission, hygienic practices need to be adopted in conjunction with any treatment. Important considerations when treating patients with warts include the location of the wart, the evidence supporting the proposed treatment and potential adverse effects of treatment.

A systematic review of randomised controlled trials investigating laser assisted drug delivery for the treatment of keloid and hypertrophic scars.

The objective of this article is to study the clinical efficacy and adverse events of laser-assisted drug delivery in the treatment of hypertrophic and keloid scars. We searched the following databases up to 22 October 2020: the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials (Clinical Trials) in The Cochrane Library, MEDLINE, EMBASE, and reference lists of articles for randomised clinical trials (RCTs) of laser-assisted drug delivery for the treatment of hypertrophic and keloid scars. We also searched online trials registries for ongoing trials and contacted trial authors where appropriate. Our outcomes of interest were objective clinical evaluation of scars, participant satisfaction, and adverse effects of the treatments. Two authors independently extracted data and assessed trial quality using Cochrane Risk of Bias 2. Two authors independently abstracted data. We included 10 RCTs involving a total of 329 participants: six trials utilised parallel-arm RCTs whilst four employed split-scar design. Three trials had high risk of bias with the remaining seven rated as having some concerns. The interventions and outcomes were too varied to be combined statistically. High-quality randomised controlled trials assessing laser-assisted delivery for drugs in the context of hypertrophic and/or keloid scarring are needed. Studies with a larger number of participants, with longer follow-up times, and standardised evaluation of outcome and adverse effects are warranted.