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Needling Versus Liquid Nitrogen Cryotherapy for the Treatment of Pedal Warts

A Randomized Controlled Pilot Study

Daniel J. Cunningham Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Crawley, Australia. Dr. Bower is now with School of Medicine, Faculty of Health, University of Tasmania, Tasmania, Australia.

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Jessica T. Brimage Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Crawley, Australia. Dr. Bower is now with School of Medicine, Faculty of Health, University of Tasmania, Tasmania, Australia.

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Reza N. Naraghi Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Crawley, Australia. Dr. Bower is now with School of Medicine, Faculty of Health, University of Tasmania, Tasmania, Australia.

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Virginia M. Bower Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry, and Health Sciences, The University of Western Australia, Crawley, Australia. Dr. Bower is now with School of Medicine, Faculty of Health, University of Tasmania, Tasmania, Australia.

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 BAppSc (Pod), MPH, Grad Cert HPE
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Background

We hypothesized that needling of a pedal wart creates local inflammation and a subsequent cell-mediated immune response (CMIR) against human papillomavirus. The primary objective of this study was to investigate whether needling to induce a CMIR against human papillomavirus is an effective treatment for pedal warts compared with liquid nitrogen cryotherapy. A secondary objective was to investigate whether the CMIR induced by needling is effective against satellite pedal warts.

Methods

Eligible patients with pedal warts were randomly allocated to receive either needling or liquid nitrogen cryotherapy. Only the primary pedal wart was treated during the study. Follow-up was 12 weeks, with outcome assessments made independently under blinded circumstances.

Results

Of 37 patients enrolled in the study, 18 were allocated to receive needling and 19 to receive liquid nitrogen cryotherapy. Regression of the primary pedal wart occurred in 64.7% of the needling group (11 of 17) and in 6.2% of the liquid nitrogen cryotherapy group (1 of 16) (P =  .001). No significant relationship was found between needling of the primary pedal wart and regression of satellite pedal warts (P = .615) or complete pedal wart regression (P = .175). There was no significant difference in pain, satisfaction, or cosmesis between the two groups.

Conclusions

The regression rate of the primary pedal wart was significantly higher in the needling group compared with the liquid nitrogen cryotherapy group.

Corresponding author: Virginia M. Bower, BAppSci (Pod), MPH, School of Medicine, Faculty of Health, University of Tasmania, Locked Bag 1377, Launceston Tasmania 7250, Australia. (E-mail: virginia.bower@utas.edu.au)