Needling versus liquid nitrogen cryotherapy for the treatment of pedal warts: A randomised controlled trial pilot study.

Abstract

Abstract Background: The hypothesis of this study was that needling of a pedal wart would create local inflammation and a subsequent cell-mediated immune response against human papillomavirus. The primary objective of this study was to investigate if needling to induce a cell-mediated immune response against human papillomavirus is an effective treatment of pedal warts in comparison to liquid nitrogen cryotherapy. A secondary objective of this study was to investigate if the cell-mediated immune response induced by needling is effective against satellite pedal warts. Methods: Eligible participants presenting to the University of Western Australia Podiatry Clinic with pedal wart/s were randomly allocated to treatment - either needling or liquid nitrogen cryotherapy. Only the primary pedal wart was treated during the study. Participant follow-up was twelve weeks with outcome assessments made independently under blinded circumstances. Results: Thirty-seven participants were enrolled in the study, 18 allocated to needling and 19 to liquid nitrogen cryotherapy. Regression of the primary pedal wart occurred in 64.7% (11/17) of the needling group and 6.2% (1/16) of the liquid nitrogen cryotherapy group (p=0.001). There was no significant relationship found between needling of the primary pedal wart and regression of satellite pedal warts (p=0.615) or complete pedal wart regression (p=0.175). 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 to the liquid nitrogen cryotherapy group.