Abstract
Objective: To assess the efficacy of 70% Trichloroacetic acid and Cryotherapy as a treatment modality in the resolution of plantar warts.
Methods: This quasi-experimental study was conducted in the Dermatology department of a care hospital, from September 2024 to February 2025. 70 patients visiting the outpatient department meeting the inclusion criteria were enrolled in the study after approval from the hospital ethical committee. Informed written consent was taken from participants, and they were allocated into two groups. Group A was treated with Cryotherapy every two weeks, and those in Group B received a 70% Trichloroacetic acid application every week. All patients were followed for 8 weeks in order to assess the efficacy and to monitor the side effects of treatment.
Results: The mean age in the Cryotherapy group was 35.9 ± 9.16 years, and in the Trichloroacetic acid group was 33.67 ± 9.64 years. There were 44 (62.85%) male and 26 (37.14%) female participants in this study. Efficacy of therapy for plantar warts was observed in 14 (40%) patients in the 70% Trichloroacetic acid group, while in 9 (25.71%) patients in the Cryotherapy group, having a non-significant p value of 0.203.
Conclusion: 70% Trichloroacetic acid is equally effective as compared to Cryotherapy in the treatment of
plantar warts, and it may be considered as a suitable alternative therapeutic option due to its comparable efficacy, easy availability, cost-effectiveness, and tolerability.
Keywords: Cryotherapy, Efficacy, Plantar Warts, Trichloroacetic Acid
References
Asghar N, Asghar M, Rehman N, Afridi IU, Khalid S. Epidemiological and clinical patterns of viral warts presenting to dermatology OPD of Hayatabad Medical Complex, Peshawar. J Pak Assoc Dermatol. 2022; 32(1):78-84.
Mekkawy MM, Elghazally SA, Mahran AM. Cutaneous, non-genital warts: Updates on clinico-epidemiological features of an endemic disease. J Curr Med Res Pract. 2025; 10(1): 1-10. https://doi.org/10.21608/jcmrp.2024.333555.1156.
Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts. J Evid Based Med. 2022 Sep;15(3):284-301. https://doi.org/10.1111/jebm.12494. Epub 2022 Sep 18.
Palma S, Gnambs T, Crevenna R, Jordakieva G. Airborne human papillomavirus (HPV) transmission risk during ablation procedures: a systematic review and meta‐analysis. Environ Res. 2021;192: 110437.https://doi.org/10.1016/j.envres.2020.110437.
Cohen PR, Erickson CP, Calame A. Cutaneous squamous cell carcinoma masquerading as a verruca: case report and literature review of coexisting wart and invasive squamous cell carcinoma on the hand. Cureus. 2022; 14(12): e32408. https://doi.org/10.7759/cureus.32408.
Khalili M, Amiri R, Iranmanesh B, Ghaysuri F, Aflatoonian M. Combination therapy for the treatment of cutaneous and genital warts. J Pak Assoc Dermatol. 2024; 34(4): 1048-1061.
NAwad SM, Gomaa AS, Hassan HA, Tawfik YM. Efficacy of cryotherapy combined with intralesional purified protein derivative (PPD) versus intralesional PPD monotherapy in the treatment of multiple common warts. J Cutan Med Surg.2023; 27(2): 117-25. https://doi.org/10.1177/12034754231152224.
Ebrahim HM, Asaad AM, El Desoky F, Morsi HM. Bacillus Calmette‐Guerin polysaccharide nucleic acid vs Bacillus Calmette‐Guerin vaccine in the treatment of warts: a comparative, double‐blind, controlled study. Dermatol Ther. 2021; 34(1): e14549. https://doi.org/10.1111/dth.14549.
Karrabi M, Kheirkhah M, Shahrestanaki E, Thomas S, Sahebkar M. Comparison of 40% trichloroacetic acid and cryotherapy for the treatment of plantar warts: a single‐blind, randomized clinical trial. Dermatol Ther. 2020; 33(4): e13559. https://doi.org/10.1111/dth.13559.
Cengiz FP, Emiroglu N, Su O, Onsun N. Effectiveness and safety profile of 40%
trichloroacetic acid and cryotherapy for plantar warts. J Dermatol. 2016; 43(9):1059-61. https://doi.org/10.1111/1346-8138.13370.
Garcio-oreja S, Alvaro-Afonso FJ, Tardaguila- Garcia A, Lopez- Moral M, Garcia-Madrid M, Lazaro-Martnez JL. Efficacy of cryotherapy for planter warts: A systemic review and meta-analysis. Dermatol Ther. 2022; 35(6): e15480. https://doi.org/10.1111/dth.15480.
Faleiro KN, Shukla P. Role of autoinoculation in the management of cutaneous warts: a comparison study with 100% tricholoroacetic acid application. Int J Res Dermatol 2020; 6(4):537-543. https://doi.org/10.18203/issn.2455-4529.
Abdel Meguid AM, Abdel Motaleb AA, Abdel Sadek AMI. 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
Pezeshkpoor F, Banihashemi M, Yazdanpanah MJ, Yousefzadeh H, Sharghi M, Hoseinzadeh H. Comparative study of topical 80% tri‐ chloroacetic acid with 35% trichloroacetic in the treatment of the common wart. J Drugs Dermatol. 2012;11(11): e66-69
Muhaidat JM, Al‐Qarqaz FA, Alshiyab DM, Alkofahi HS, Khader Y, Ababneh MY. Comparison of the efficacy and safety of two cryotherapy protocols in the treatment of common viral warts: a prospective observational study. Dermatol Res Pract. 2020; 2309309. https://doi.org/10.1155/2020/2309309
Usman H, Khan AR, Naseem S, Shaukat I. Comparison of efficacy of 50% salicylic acid versus cryotherapy in the treatment of plantar warts. J Pak Assoc Dermatol. 2024; 34(2):346-350.
Albalat W, Attwa E, Ebrahim HM. Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study. J Dermatol Treat. 2022; 33(2): 857-63. https://doi.org/10.1080/09546634.2020.1782821.
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.
Mohta A, Chand Ghiya B, Dutt Mehta R, Soni P, Khokhar R, Sharda P et al. Skin needling with 100% trichloroacetic acid vs. needling with bleomycin in the treatment of recalcitrant cutaneous warts. Clin Exp Dermatol. 2022 Apr; 47(4): 730-734. https://doi.org/10.1111/ced.14968.

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Copyright (c) 2025 Sameena Kausar, Shazia, Hina Mazhar, Sumyra Saleem, Tehseen Naveed, Ommaya Irshad

