The Efficacy of Topical Ointments in the Treatment of Common Cutaneous Warts: A Meta-Analytical Study

Abstract

Among skin warts, Cutaneous Warts, caused by the human papillomavirus (HPV), are one of
the most common dermatological problems worldwide. About 7-12% of people suffer from HPV
worldwide, and many times they visit their primary health care providers for diagnosis and treatment.
There are various topical drugs available in the market; however, the treatment response varies a lot
due to different efficacies, reoccurrences, and side effects. In order to compare the efficacies and safety
of different topical treatments used for common, plantar, and flat warts, a meta-analysis has been
performed. A systematic literature search was conducted, and studies reporting wart clearance rates,
recurrence, or adverse effects associated with topical agents, including salicylic acid (SA), imiquimod,
5-fluorouracil (5-FU), cantharidin, formic acid, podophyllotoxin, cidofovir, and occlusive therapy,
were included. The results showed that salicylic acid demonstrated the best pooled clearance rates (60-
75%; OR = 4.1 vs placebo), cantharidin ranked second (70-85%), followed by imiquimod (50-75%). 5-
Fluorouracil was found to have moderate efficacy (55-65%). The recurrence rate was lower in
imiquimod (10-20%) and cantharidin (12-18%) treatments, while side effects were relatively mild.
There was some heterogeneity among the included studies (I² = 52-64%). On balance, salicylic acid
will remain the treatment of choice due to its well-established profile, availability, and low cost.
Combination and/or sequential therapy could prove effective in resistant cases, but individualized
treatment approaches as well as additional high-quality RCTs are required.