Stikstoftherapie is de effectiefste behandeling voor handwratten in de huisartsenpraktijk*

Objective

To compare the effectiveness of cryotherapy, salicylic acid and a wait-and-see policy in hand- and plantar warts in general practice.

Design

Three-armed pragmatic randomized trial (www.controlled-trials.com; ISRCTN42730629).

Method

Consecutive patients presenting for the first time with cutaneous warts were recruited from 30 Dutch general practices. We randomly allocated eligible patients to the following treatment groups: liquid-nitrogen cryotherapy every 2 weeks, daily self-application of salicylic acid, or to a wait-and-see protocol. The primary outcome measure was the percentage of patients who were cured of all warts at 13 weeks. Analysis was done on an intention to treat basis. We carried out separate subgroup analysis for common warts and plantar warts. Secondary outcomes included therapy adherence, side effects, and satisfaction with treatment. Research nurses assessed outcomes during home visits at 4, 13, and 26 weeks.

Results

A total of 250 patients participated (age 4-78 years) and 240 were analysed at 13 weeks (loss to follow-up 4%). Cure rates were 39% (95% CI: 29-51) for cryotherapy, 24% (95% CI: 16-35) for salicylic acid, and 16% (95% CI: 10-25) for wait-and-see policy. This difference in effectiveness was clearest in participants with common warts (n = 116), in whom cryotherapy had cure rates of 49% (95% CI: 34-64), salicylic acid of 15% (95% CI: 7-30), and wait-and-see policy of 8% (95% CI: 3-21). The cure rates in participants with plantar warts (n = 124) did not differ between the treatment groups.

Conclusion

In primary care cryotherapy is the most effective therapy for common warts. For plantar warts, after 13 weeks we found no clinically relevant differences between the effectiveness of cryotherapy, salicylic acid and the wait-and-see policy.

Conflict of interest: none declared. Financial support: This study was made possible by financial assistance from the Fund ‘Quotidian Disorders’ (Fonds Alledaagse Ziekten) of The Netherlands Organisation for Health Research and Development (ZonM). This organisation has had no influence on the design of the study or on the collection, analysis and interpretation of the data, the writing of the article or the submission of the article for publication.