Needling Technique (with or without Cryotherapy) versus Cryotherapy Alone in Treatment of Multiple Plantar Warts

Abstract Background Plantar warts are common benign tumors caused by human papilloma virus (HPV) infection of the epidermal cells with an estimated annual incidence of 14%. Needling, a novel therapeutic approach, stimulates the immune system resulting in clearance of even untreated lesions, in several patients. Introduction of human papilloma virus infected keratinocytes into the subcutaneous layer may facilitate a desired immune response. On the other hand, Cryotherapy, an inexpensive and simple traditional provider administered procedure using liquid nitrogen in a spray or cryoprobe, is frequently used in many countries as a first line of treatment of plantar warts. Objective To evaluate the efficacy and safety of immunotherapeutic modality (needling) versus locally destructive modality (cryotherapy), as well as combination of both immunotherapeutic modality and locally destructive modality (cryotherapy) in treatment of multiple plantar warts. Methods This is a randomized therapeutical prospective clinical study included 60 patients aged from 19 to 55 years with planter warts (>2) who haven't received treatment for the condition within the previous month, divided into 3 groups, 20 patients per group, one group subjected to needling procedure, another group subjected to cryotherapy and the third group subjected to a combination treatment of both needling and cryotherapy. Results Regarding patients' satisfaction, there was a statstical significant difference between the 3 studied groups as regard patients' satisfaction (median/range), being higher in cryotherapy and combined treatment groups than in needling group. This is the rapid effect of cryotherapy in warts treatment which shows higher scores in the 8th week. Also, not all patients are satisfied with needling since it is not commonly used as cryotherapy, which makes patients question its efficacy especially when used alone. As it is a painful procedure that has to be performed with local anesthetic which consumes a lot of time. Regarding reported side effects of our study, patients of needling group experienced pain, mild bleeding and mild infection. While patients of cryotherapy group experienced pain, blistering, infection and high recurrence rates. Patients of the combination treatment group experienced pain, mild bleeding and blistering. Conclusion Combining cryotherapy (locally destructive method) and needling (immunotherapeutic method) provides promising results as it combines benefits of cryotherapy, being rapid, safe and shows rapid response together with benefits of needling, being an immuno-stimulant that provides effective, long lasting, minimally invasive, low-cost treatment with excellent safety profile and low recurrence rates for treatment of plantar warts.