| Background:Cutaneous warts are extremely common, benign, and usually self-limiting. Infection of epidermal cells with the human papilloma virus (HPV) results in cell proliferation and a thickened, warty papule on the skin. The most common sites involved are hands and feet, though any area of skin can also be infected. Genital warts are also common and frequently sexually transmitted, but are not discussed in this chapter. There are few reliable, population-based data on the prevalence of cutaneous warts. The prevalence rate varies according to different ages, populations, and periods of time, and it is the highest in children and young adults. Two large population-based studies revealed prevalence rates of0.84%and12.9%. Warts are caused by HPV, of which there are over70different types. Lesions are most common at sites of trauma, and probably result from inoculation of virus into minimally damaged areas of epithelium. Non-genital warts in immunocompetent people are harmless and usually resolve spontaneously as a result of natural immunity within months or years. The rate of resolution is highly variable and probably depends on a number of factors, including host immunity, age, HPV type, and site of infection. One frequently cited study of an institutionalized population showed that65%warts resolved within a2-year period.Objective:The aim of this system evaluation is to assess the efficacy and safety of Local treatments for cutaneous warts.Methods:We searched Cochorane Library, PubMed, Medline, Springlink, Embase, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), VIP database. Reference lists of prior reviews, systematic reviews, and trials were also checked. The most recent searches were completed in December2013. Two reviewers independently screened searched studies, extracted data and evaluated their methodological qualities. RevMan5.1software was used for meta-analysis. Results:102studies were included.①Based on meta-analysis, topical treatment including salicylic acid, interferon, dinitrochlorobenzene, bleomycin,5-fluorouracil, laser, heat therapy was better than placebo.②Topical cryotherapy was better than salicylic acid or products containing salicylic acid when treated for warts, the difference between the two groups had statistical significance (RR=0.90,95%CI0.78to1.03).③When using with topical cryotherapy, length of freeze and interval between freezes were important factors for ensuring the efficacy,2-week intervals was better than3-week (RR=1.14,95%CI1.04to1.26), aggressive cryotherapy was better than gentle cryotherapy (RR1.54=95%CI1.26to1.87).④ALA-PDT was better than common treatment for warts (RR=1.23,95%CI1.12to1.36), the rate of side-effect was fewer (RR=0.43,95%CI0.26to0.71).⑤Different concentrations of bleomycin were not statistically significant when treated for warts.⑥Combination therapy for duct tape, retinoic acid, imiquimod and5-fluorouracil was better than alone.⑦Laser therapy to treat warts was better than liquid nitrogen cryotherapy (RR=1.28,95%CI1.20to1.36), the rate of side-effect was fewer (RR=0.23,95%CI0.11to0.46). The differences between CO2Laser and Q-switching laser had no statistical significance.Conclusion:Among them, Topical preparations containing SA or5-FU, BLM, IFN, PDL, DNCB, ALA-PDT, heat therapy, duct tape, retinoic acid, imiquimod were generally effective and safe for treating warts. Topical cryotherapy with length of freeze and interval between freezes were important factors for ensuring the efficacy. According to different routes of administration, Laser therapy and ALA-PDT tended to be a fairly well-tolerated form of therapy in either improving the complete response rate or reducing the side-effect rate for the treatment of genital warts. The combination therapy provided significantly better outcomes than a single treatment. |
PDF Full Text Request