Intralesional acyclovir on par with cryotherapy as treatment for plantar warts

The use of intralesional acyclovir elicits similar efficacy to cryotherapy in the treatment of plantar warts, but the procedure is more painful, according to a study.

A group of researchers compared the efficacy and safety of intralesional acyclovir with cryotherapy in 68 patients with plantar warts. They randomized these individuals to receive intralesional acyclovir (34 patients with a total of 51 warts) or undergo cryotherapy (34 patients with a total of 72 warts). Patients in both groups received a maximum of five sessions with 2-week intervals.

Plantar warts were completely cured in 68.6 percent of patients in the intralesional acyclovir group and in 61.1 percent of those in the cryotherapy group (p=0.393). However, a higher number of sessions was necessary to achieve complete cure in the intralesional acyclovir arm (3.8 vs 3 sessions; p=0.001).

Furthermore, intralesional acyclovir was significantly more painful than cryotherapy, with an average visual analogue scale score of 6.5 vs 4.65 (p=0.005).

The study was limited by the absence of blinding because of the distinct difference between the two treatment modalities used, according to the researchers.

"Plantar warts are known for their recalcitrant nature,” the researchers said. “Intralesional acyclovir injection has been recently tried for treatment of warts.”