Comparison of effectiveness and safety of topical 0.1% adapalene gel with cryotherapy in the treatment of plantar warts
Keywords:
Plantar warts, Effectiveness, Adapalene, CryotherapyAbstract
Background: Plantar warts have traditionally been treated using cryotherapy. However, keeping in mind the technicalities and safety concerns alternative treatment modalities have been tried. Adapalene gel is among the alternative treatment modalities with ease of use, cost effectiveness and safety making it an alternative to treat plantar warts effectively. Objective: To compare the efficacy and safety of topical adapalene 0.1% gel with cryotherapy in the treatment of plantar warts. Methods: This clinical perspective study was conducted at outdoor patient department of dermatology, KEMU/Mayo Hospital Lahore from 1.11.22 to 31.10.23. Total 88 patients (44 in each group) were included in the study. Patients were randomly divided in group A and group B. Group A applied topical adapalene 0.1% gel twice daily under occlusion using plastic wrap. In group B, cryotherapy was performed by doctor, two freeze-thaw cycles, each of 15-20 seconds duration done fortnightly up to 12 weeks, using liquid nitrogen operated cryogun. Patients were assessed monthly till clearance of all warts or completion of therapy and then follow up was done 4 weeks after completion of treatment for 3 months for any recurrences. Effectiveness and safety according to operational definition was noted at 1 month after completion of therapy. Results: Effectiveness of treatment showed no significant difference between both groups at 1st, 2nd and 3rd month. However, at 4th (Group-A: 59.09% vs. Group-B: 27.27%, p-value=0.040) 5th (Group-A: 68.18% vs. Group-B: 43.18%, p-value=0.005) and 6th month (Group-A: 90.91% vs. Group-B: 68.18%, p-value=0.027) effectiveness of treatment groups showed significant difference between groups. As far as side effects are concerned none of the patients experienced any side effects with adapalene gel. However, in cryotherapy group few patients experienced side effects like scarring, cutaneous abscess and cellulitis.Conclusion: It can be concluded from the results of this research that for treating patients with planter warts, topical adapalene gel is safer and more effective than cryotherapy.References
Abu El‐Hamd M, Aboeldahab S. Possible clinical efficacy and tolerability of platelet‐rich plasma in the treatment of patients with recalcitrant plane warts: The first clinical study. J Cosmet Dermatol. 2021;20(11):3623-9.
Huang K, Xie Y, Li M, Liu D, Su J, Li F, et al. A comparative study: superficial shaving combined with photodynamic therapy versus cryotherapy in the treatment of recalcitrant plantar warts. Lasers Surg Med. 2020;52(8):747-52.
Wahid MHA, Kadry AM. Efficacy of Planter Warts Treatment with Tretinoin Phonophoresis: Randomized Single Blinded Controlled Trial. Curr Sci Int. 2017;6(3):656-61.
Malik M, Hussain Mi, Bilal S. Efficacy of oral zinc sulphate versus topical application of salicylic acid (16.7%) & lactic acid (16.7%) combination in the treatment of plantar warts. J Med Physiol Biophys. 2018;51(1):95-8.
O'Mahony C, Gomberg M, Skerlev M, Alraddadi A, de las Heras‐Alonso M, Majewski S, et al. Position statement for the diagnosis and management of anogenital warts. J Eur Acad Dermatol Venereol. 2019;33(6):1006-19.
Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar warts: epidemiology, pathophysiology, and clinical management. JOM. 2018;118(2):92-105.
Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenital cutaneous warts–clinical presentation, diagnosis and treatment. J Dtsch Dermatol Ges. 2019;17(6):613-34.
Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: A review. Dermatol Ther. 2020;33(6):e14034.
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.
Rusu A, Tanase C, Pascu G-A, Todoran N. Recent advances regarding the therapeutic potential of adapalene. Pharmaceuticals (Basel). 2020;13(9):217.
Gupta M. Adapalene in the management of warts in pediatric population. Indian J Paed Dermatol. 2019;20(1):29-31.
Walczuk I, Eertmans F, Rossel B, Cegielska A, Stockfleth E, Antunes A, et al. Efficacy and safety of three cryotherapy devices for wart treatment: a randomized, controlled, investigator-blinded, comparative study. Dermatol Ther. 2018;8:203-16.
Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006(3):CD001781.
Al-Hilo MM, Al-Saedy SJ, Jawad WA. Treatment of plane wart with topical adapaline gel 0.1%: An open therapeutic trial. J App Med Sci. 2013;2(2):87-98.
Gupta R, Gupta S. Topical adapalene in the treatment of plantar warts; randomized comparative open trial in comparison with cryo-therapy. Indian J Dermatol. 2015;60(1):102.
Hashmi F, Bristow I. Treating plantar warts: utilising natural immunity to induce wart regression. Dermatol Nurs. 2014;13(1):42-5.
Viennet C, Gheit T, Muret P, Aubin F, Cabou J, Marchal A, et al. Assessment of the efficacy of a new formulation for plantar wart mummification: new experimental design and human papillomavirus identification. Clin Exp Dermatol. 2013;38(1):85-8.
García‐Oreja S, Álvaro‐Afonso FJ, García‐Álvarez Y, García‐Morales E, Sanz‐Corbalán I, Lazaro Martinez JL. Topical treatment for plantar warts: A systematic review. Dermatol Ther. 2021;34(1):e14621.
Longhurst B, Bristow I. The treatment of verrucae pedis using Falknor’s needling method: a review of 46 cases. J Clin Med. 2013;2(2):13-21.
Al‐Naggar MR, Al‐Adl AS, Rabie AR, Abdelkhalk MR, Elsaie ML. Intralesional bleomycin injection vs. microneedling‐assisted topical bleomycin spraying in treatment of plantar warts. J Cosmet Dermatol. 2019;18(1):124-8.
Mahboob M, Ahmed N, Rahman A, Naz K, Niaz F, Farooq O. Comparison of Topical 0.1% Adapalene Gel Versus Cryotherapy In Patients With Plantar Warts. J Ayub Med Coll. 2022;34(3):417-21.
Maj A, Siddique MA, Hussain LCM. Efficacy of Topical 1% Adapalene Versus Cryotherapy in Treatment of Plantar Warts. Pak J Med Health Sci. 2022;16(12):512-.
Amar A, Nida S, Malik S. Efficacy of topical adapalene in treatment of plantar warts. Pak Armed Forces Med J. 2020;70(1):240-44.
Ezz El-Dawela R, Fatehy AN, Elmoneim AAA. Prevalence of skin diseases among school children. J Egypt Women Dermatol Soc. 2012;9(1).47-51.
Al-Mutairi N, AlKhalaf M. Mucocutaneous warts in children: clinical presentations, risk factors, and response to treatment. Acta Dermatovenerol Alp Pannonica Adriat. 2012;21(4):69-72.
Allayali AZ, Fallatah K, Alorfi S, Mogharbel B. Prevalence and risk factors of Verruca vulgaris among primary school children in Medinah and Jeddah, Saudi Arabia. J Clin Exp Dermatol Res. 2017;8(01):1-7.