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WArts Randomised Treatment Study
DOI 10.1186/ISRCTN42730629
ClinicalTrials.gov identifier
EudraCT number
Public title WArts Randomised Treatment Study
Scientific title Randomised controlled trial of the treatment of warts in general practice
Acronym WARTS
Serial number at source NTR419
Study hypothesis The usual treatment for warts in Dutch general practice is cryotherapy with liquid nitrogen. More than 50% of all warts are treated with cryotherapy alone and in only 14% salicylic acid is used as mono-therapy.

The prestigious Cochrane review concludes that there is an urgent need for high-quality randomised controlled trials on the routine treatments for common warts, particularly cryotherapy. While there is convincing evidence for the efficacy of topical salicylic acid compared to placebo,

high quality studies in which cryotherapy and salicylic acid are compared to natural history are still lacking.

According to the Cochrane review the most urgent need is for a trial to compare topical salicylic acid, cryotherapy and placebo. Since the most recent amendment (May 2003) no new studies are published.
Lay summary Not provided at time of registration
Ethics approval Received from the local medical ethics committee
Study design Multicentre, randomised controlled parallel group trial
Countries of recruitment Netherlands
Disease/condition/study domain Warts (Verruca vulgaris)
Participants - inclusion criteria All patients from the age of 4 onward, who present themselves to their practice with one or more new warts of the type vulgaris on hands or feet will be included. New warts are warts which are presented for the first time in the general practice by patients who have had no general practice (or dermatological) treatment for warts in the past year. For all patients duration of presence of the warts and the previous treatment(s) will be registered.
Participants - exclusion criteria Immuno-incompetent patients and mosaic warts larger than 1 cm in diameter.
Anticipated start date 01/03/2006
Anticipated end date 01/03/2008
Status of trial Completed
Patient information material
Target number of participants 250
Interventions Treatment arms:
For the treatment with cryotherapy we chose a high-intensity regimen: a 2-weekly consultation till the wart has disappeared (maximum 13 weeks), 3 applications of the same wart per session, each application until a frozen halo appears of 2 mm around its base.

For the local treatment with salicylic acid vaseline album (petrolatum) we used a once a day application of a concentration of 40% for warts on the sole of the feet and on other parts of the skin. We chose a concentration of 40% to offer patients a stronger therapy than the over-the-counter therapies (like Formule-W), which have a concentration of 17%. Covering the skin up with tape will protect the skin around the wart. Application will be continued till the wart has disappeared (maximum 13 weeks).

Patients who were randomised into the natural history arm will be informed about the high spontaneous cure rate. We refrained from a placebo-comparison because this insufficiently resembles daily practice. An expectantly awaiting group will in the intervention period reliably reflect patient behaviours, including seeking of additional therapy (ability to maintain the expectantly awaiting policy).
Primary outcome measure(s) ‘Cure', meaning that the wart(s) have totally disappeared (normal skin) at 13 weeks.
Secondary outcome measure(s) 1. The number of warts that still exist at follow-up, irrespective of the extent of regression (because for a separate wart regression cannot be validly assessed)
2. The subjective hindrance caused by the warts as scored by the patient on a numerical rating scale (0 - 10)
3. The subjective hindrance caused by the treatment as scored by the patient on a seven point scale (during the treatment period this will be scored weekly in a booklet)
4. Pain and other adverse effects of the treatments (pain, new warts, scars, irritation of the skin, dermatitis discomfort, invalidation, time)
5. Subjective judgement of the effect of the treatment by the patient at follow-up
6. Subjective judgement of the effect of the treatment by the research nurse at follow-up
7. Referral to a dermatological department, assessed at 26 weeks
8. After three months of the intervention period, patients for whom the warts have not disappeared are free to switch therapy. In the follow-up period we will carefully register to which therapies patients have switched and also if, and after how long this therapy leads to total disappearance of the warts.
9. The consumption of co-interventions during the intervention period and thereafter will also be used as secondary endpoints
Sources of funding The Netherlands Organisation for Health Research and Development (ZonMw) (The Netherlands)
Trial website
Publications 2010 results in: http://www.ncbi.nlm.nih.gov/pubmed/20837684
2013 results in: http://www.ncbi.nlm.nih.gov/pubmed/23518443
Contact name Dr  J.A.H.  Eekhof
  Address Leiden University Medical Centre
P.O. Box 2088
  City/town Leiden
  Zip/Postcode 2301 CB
  Country Netherlands
  Tel +31 (0)71 527 5318
  Email j.a.h.eekhof@lumc.nl
Sponsor Sponsor not yet defined (The Netherlands)
  Address -
  City/town -
  Zip/Postcode -
  Country Netherlands
Date applied 27/01/2006
Last edited 06/01/2014
Date ISRCTN assigned 27/01/2006
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