Abstract
BACKGROUND:
Common warts are common diseases encountered in daily dermatologic practice. They are caused by human papilloma virus which has about 200 genotypes. Although spontaneous resolution can occur in 65-78% after two years but disfigurement and social embarrassment necessitate treatment.
Hydrogen peroxide has damaging effects on nucleic acids, proteins and lipids. It is currently used for debridement of wounds and has healing promotion and antimicrobial effects. It was recently approved for the treatment of seborrheic keratosis.
OBJECTIVE:
To evaluate topical 50% hydrogen peroxide use in the treatment of common warts regarding the safety and efficacy.
PATIENTS AND METHODS:
This interventional study was carried out during the period from April 2019 to July 2020 at Dermatology Center / Baghdad Medical city. Thirty patients were enrolled in this study; 9 of them were defaulted for unknown reasons and 21 patients completed the study.
Each patient was fully assessed to determine the clinical type, sites, size and number of warts. All patients did not receive any treatment for warts in the last month before enrollment in the study. A layer of 50% hydrogen peroxide solution was applied to each wart and allowed to dry for 2 minutes and the application was repeated 2 to 3 times till the appearance of white frost or bubbling or the patient feels stinging sensation. If the warts had thick hyperkeratotic surfaces, a simple paring with scalpel was done. The solution was applied once weekly for 3 weeks. A total number of 57 lesions were treated.
RESULTS:
Twenty-one patients completed the study. The total number of lesions was 57. Regarding lesions response to treatment; 51(89.5%) lesions were cured, 6 (10.5%) lesions showed partial response and no lesion was recorded to show no response. Regarding the number of weeks needed to achieve cure; 18 (31.6%) lesions achieved cure in the first week, 22(38.5%) patients in the second week and 8(14%) in the third week. On follow up one month later, a further 3 (5%) lesions were also cured. Regarding relapse, 2 lesions (3.5%) were seen as relapse during the follow up visit, one month after stopping the treatment. Regarding the side effects for treatment; the following were noted; 16 (76.2%) patients had pruritus, 16(76.2%) patients had erythema, 12(57.1%) had stinging, and 9(42.9%) patients had pain.
CONCLUSION:
Hydrogen peroxide 50% solution is an effective topical therapy for common warts. It is non-costly, available, does not need local anesthesia with temporary and tolerable side effects.
Keywords
10. Salman S, Ahmed MS, Ibrahim AM, Mattar OM, El-Shirbiny H, Sarsik S, et al. Intralesional immunotherapy for the treatment of warts: a network meta-analysis. Journal of the American Academy of Dermatology. 2019;80:922-30.
11. Al-Hamamy HR, Salman HA, Abdulsattar NA. Treatment of plane warts with a low-dose oral isotretinoin. International Scholarly Research Notices Dermatology. 2012; Article 163929, 3pages
12. Uyar B, Sacar H. Comparison of cryotherapy session intervals in the treatment of external genital warts. Dermatologica Sinica. 2014;32:154-56.
13. Dalimunthe DA, Siregar R, Tanjung C. Comparative clinical efficacy between electrodessication with curettage and application of 80% phenol solution in treatment of common warts. Open access Macedonian journal of medical sciences. 2018;6:326.
14. Balasubramaniam D, Burkhart CG. Hydrogen Peroxide Use for Chemical Destruction in Seborrheic Keratosis: A Review. The Open Dermatology Journal. 2019;13.
15. Zandi S, Ahmad Zadeh R, Yousefi SR, Gharibi F. Promising New Wart Treatment: A Randomized, Placebo-Controlled, Clinical Trial. Iran Red Crescent Med J. 2016;18:e19650-e.
16. Abdel Meguid AM, Abdel Motaleb AA, Abdel Sadek AMI. Cryotherapy vs trichloroacetic acid 90% in treatment of common warts. Journal of cosmetic dermatology. 2019;18:608-13.
17. Institute for Quality and Efficiency in Health Care. Warts: Overview. Cologne, Germany: InformedHealth.org; 2019 [cited 2020 10/28]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279586/.
18. ClinicalTrials.gov[internet]. United States: National Library of Medicine. Identifier: NCT03687372: Topical Solution for the Treatment of Common Warts. September 6, 2019 [cited 2020 10/28]. Available from: https://clinicaltrials-gov/ct2/show/ study/NCT 03687372.
19. Smith SR, Tyring SK, Grande KK, Schlessinger J, Gold MH, Shanier SD. Hydrogen Peroxide Topical Solution, 45% for Common Warts: Phase 2 Efficacy and Safety Trial Results. Journal of drugs in dermatology : Journal of Drugs in dermatology. 2020;19:969-76.
20. Banihashemi M, Pezeshkpoor F, Yazdanapanah MJ, Family S. Efficacy of 80% solution in comparison with cryotherapy in the treatment of common warts of hands. Singapore Medical Journal 2008;49:1035
21. Mehta KIS, Mahajan VK, Chauhan PS, Chauhan S, Sharma V, Rawat R. Evaluation of efficacy and safety of intralesional bleomycin in the treatment of common warts: Results of a pilot study. Indian Journal of Dermatology, Venereology, and Leprology. 2019;85:397.
22. Abd El-Magid WM, Nada EEA, Mossa RA. Intralesional injection of vitamin D3 versus zinc sulfate 2% in treatment of plantar warts: a comparative study. Journal of Dermatological Treatment. 2019:1-6.
23. DuBois J, Grande K, Bradshaw M, Schnyder J. Safety of hydrogen peroxide topical solution 40% and 45%(w/w) in patients with seborrheic keratoses on the trunk, extremities, and face: Results of a phase 2, randomized, double-blind, vehicle-controlled, parallel-group study: 10513. Journal of the American Academy of Dermatology. 2019;81.
)
