Efficacy of cryotherapy for plantar warts: A systematic review and meta-analysis

Sara García-Oreja, Francisco Javier Álvaro-Afonso, Aroa Tardáguila-García, Mateo López-Moral, Marta García-Madrid, José Luis Lázaro-Martínez, Sara García-Oreja, Francisco Javier Álvaro-Afonso, Aroa Tardáguila-García, Mateo López-Moral, Marta García-Madrid, José Luis Lázaro-Martínez

Abstract

Recent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than alternative treatments. A systematic review using meta-analyses of the efficacy of cryotherapy in plantar warts treatment was performed. Systematic electronic searches were conducted. The primary endpoint was complete clearance of plantar warts. Risk-of-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used Review Manager v5.4.1 software. Cryotherapy appears to have lower cure rates than other treatments (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.78) with substantial heterogeneity (I2 = 80%). A second subgroup analysis had low heterogeneity (I2 = 28.2%). Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to the physical treatment group (OR 0.05, 95% CI 0.01-0.49) with substantial heterogeneity (I2 = 79%), and antiviral, chemotherapy, and retinoid group (OR 0.30, 95% CI 0.14-0.66) without heterogeneity (I2 = 0%). Intralesional versus spray-on cryotherapy appears to be more effective (OR 0.21, 95% CI 0.09-0.48). No difference in efficacy between two rounds of 10-s and four rounds of 5-s freeze-thaw cycles in cryotherapy was found. Evidence of the superiority of antivirals and chemotherapy over cryotherapy in the treatment of plantar warts was found. However, no evidence supports the superiority or inferiority of cryotherapy compared to other treatments.

Keywords: HPV; cryotherapy; human papillomavirus; meta-analyses; plantar warts; systematic review.

Conflict of interest statement

This review was written independently. The authors did not receive financial or professional help with the preparation of the manuscript.

© 2022 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.

Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta‐analyzes (PRISMA) flow diagram of the literature search and study selection for the systematic review of cryotherapy in plantar warts
FIGURE 2
FIGURE 2
Risk of bias graph: review authors' judgments about each risk of bias item presented as percentages across all included studies
FIGURE 3
FIGURE 3
Risk of bias summary: review authors' judgments about each risk of bias item for each included study
FIGURE 4
FIGURE 4
Forest plot of comparison: 1 cure rate, outcome: 1.1 cryotherapy versus other treatments

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Source: PubMed

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