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ORIGINAL ARTICLE
Year : 2006  |  Volume : 51  |  Issue : 2  |  Page : 108-110
Comparative efficacy of topical 5% 5-fluorouracil with electrosurgery in treatment of warts


Department of Dermatology, Dayanand Medical College and Hospital, Ludhiana, Affiliated to Baba Farid University of Health Sciences, Faridkot, India

Correspondence Address:
Alka Dogra
Deptt. of Dermatology DMC and H, Ludhiana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.26930

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   Abstract 

Warts are common dermatologicals disorder which are dificult to treat. In the present study the efficacy of topical 5% 5-fluorouracil was evaluated in various types of warts and compared with the conventional electrosurgical method which included both electrodessication and electrofulguration. 50 patients clinically diagnosed as warts were enrolled. 25 patients were treated with topical 5% 5-fluorouracil applied for 4 hrs twice daily for 3 weeks, while another 25 were treated with electrosurgery. It was observed that electrosurgery yielded better initial results than 5-fluorouracil (72 and 52% respectively), but at the end of 6 months, the results were favourable for 5-fluorouracil as compared to electrosurgery (44 and 36% respectively). This was due to the signficantly low recurrence rate with 5-fluorouracil in contrast to electrosurgery (8 and 48% respectively). Though electrosurgery yielded quicker initial results but 5-fluorouracil was better as long term measurer because of its significantly lower recurrence rates.


Keywords: Warts, 5-fluorouracil, Electrosurgery


How to cite this article:
Dogra A, Gupta SK, Bansal A. Comparative efficacy of topical 5% 5-fluorouracil with electrosurgery in treatment of warts. Indian J Dermatol 2006;51:108-10

How to cite this URL:
Dogra A, Gupta SK, Bansal A. Comparative efficacy of topical 5% 5-fluorouracil with electrosurgery in treatment of warts. Indian J Dermatol [serial online] 2006 [cited 2019 May 20];51:108-10. Available from: http://www.e-ijd.org/text.asp?2006/51/2/108/26930



   Introduction Top


Warts or verrucae are caused by Human Papillomavirus, belonging to the family Papovaviridae. Various morphological patterns konwn as verruca vulgaris (common warts), verruca plana (plane warts or flat warts), plantar warts, filiform warts, digitate warts, and anogenital warts (condyloma acuminata) occur.

A variety of therapeutic modalities are available, but to date, no single therapy has proven uniformly successful. Recurrence rates for most therapies are relatively high.[1] Electrosurgery is a common mode of treatment and it involves the principle of tissue destruction by heat.[2],[3] But this method has the disadvantage of causing pain, scarring, respiratory papillomatosis in the operator and high recurrence rates.[4],[5]

In this study, an alternative mode of therapy with topical 5% 5-fluorouracil was evaluated. 5-fluorouracil is a fluorinated pyrimidine which interferes with DNA synthesis by decreasing the availability of thymine and hence inhibiting viral replication.[6] We report the comparative efficacy of topical 5% 5-fluorouracil and electrosurgery.


   Materials and Methods Top


Fifty patients clinically diagnosed as warts were selected. Pregnant and lactating females, patients with cardiac pacemakers or patients who had taken any form of prior treatment were excluded from the study. The patients were alternatively allocated into two groups (Group A and B). Group A patients were treated with topical 5% 5-fluorouracil applied for 4 hours twice daily for 3 weeks. Group B patients were treated with electrosurgery (including both electrodessication and electrofulguration) till all the lesions were treated. The end point achieved was:

Electrodessication: Charring of tissue

Electrofulguration: Lesion shrivelled up and lightened in colour with the formation of superficial ash. The response to therapy was evaluated in both the groups and the patients were followed up for a period of 6 months for evidence of recurrence or any other complaints.

The response to therapy was graded as follows

Good: All warts disappeared during the period of therapy.

Moderate: Upto 50% of warts disappeared.

Poor: None or very few warts disappeared.


   Results Top


Out of the 50 patients included in the study, 32 were males and 18 females. Most of the patients were between 16 to 30 years, accounting for 58% of cases. 40% of the patients were students by occupation. Nearly half of the patients (48%) had disease duration of 1 to 6 months. The most common affected site was feet (32%), followed by hands (30%) and face (26%). Verruca vulgaris or common warts was the most common morphological pattern seen (44%), followed by plantar warts (28%), plane warts (16%), anogenital warts (6%) and filiform warts (6%).

The therapeutic effect of both the modalities was compared [Table - 1]. At the end of therapy, 52% of the patients showed a good response, 36% moderate response and 12% no response to 5-fluorouracil, while among the electrosurgery group, 72% patients showed a good response, 16% moderate response and 12% poor response.

The therapeutic effect in relation to morphology was also compared in both the groups [Table - 2]. The evaluation of mean score of response revealed that 5-fluorouracil was better than electrosurgery in case of plane warts, plantar warts and condyloma acuminata, while it was equally effective as electrosurgery for common warts, whereas electrosurgery was better than 5-fluorouracil in case of filiform warts.

Another important observation was that 5-fluorouracil resulted in a significantly lower recurrence rates (8%) as compared to electrosurgery (48%). Pain was the major limiting side effect with electrosurgery (64%) while none of the patients with 5-fluorouracil complained of pain. Similarly secondary infection was more common with electrosurgery (20%) as compared to none with 5-fluorouracil. Scarring and hypopigmentation were more common with electrosurgery while erythema, photosensitivity and hyperpigmentation were more common with 5-fluorouracil, as shown in [Table - 3].


   Discussion Top


In the present study 50 cases of verruca were evaluated for comparative efficacy of topical 5% 5-fluorouracil cream against conventional electrosurgical method.

Earlier reports also reveal the successful use of 5-fluorouracil as a therapeutic option for warts. Goncalves reported 50% cure rates for common warts after 5-fluorouracil therapy.[7] Hursthouse et al reported 60% clearance rates after 4 week therapy with 5% 5-fluorouracil.[8] Chattopadhyay reported 30% good response and 50% moderate response to 5% 5-fluorouracil.[9],[10] In the present study, 52% cases showed a good response, 36% moderate response and 12% poor response at the end of therapy with 5-fluorouracil, while in case of electrosurgery, 72% cases showed a initial good response, 16% moderate response and 12% poor response. In case of plane warts, 100% cases showed a good response to 5-fluorouracil while in electrosurgery, 80% showed a moderate response and 20% a poor response. This was consistent with the findings of Lee et al who reported clearance in 9 out of 11 patients with verruca plana treated with 5-fluorouracil.[11] The mean score of response for verruca vulgaris was comparable in both the groups. In case of plantar warts 50% of cases showed a good response to 5-fluorouacil in comparison to 33.33% with electrosurgery. In case of condylomata acuminata, 100% of the cases showed a good response to 5-fluorouracil, while in case of electrosurgery, 100% of patients showed a moderate response. In case of filiform warts 100% of the cases yielded a good response with electrosurgery in contrast to poor response (100%) with 5-fluorouracil.

Eight percent of the cases in the 5-fluorouracil group developed recurrent lesions in contrast to 48% with electrosurgery. Similar findings were reported by Chattopadhyay et al who reported 30% recurrence rate with electrosurgery and none with 5-fluorouracil.[9],[10] Krebs also reported 5-fluorouracil to be valuable for preventing recurrence.[12] Stone et al also noticed 25% recurrence rates with electrodessication.[13]

Pain and secondary infection was a significant side effect in electrosurgery group (64 and 20% respectively) while they were absent in 5-fluorouracil group. 8% of patients treated with 5-fluorouracil complained of photosensitivity in contrast to none in electrosurgery.

Other side effects noticed in 5-fluorouracil group were erythema (8%), erosion (12%), hyperpigmentation (12%), which was also noticed by Lee et al,[11] while the side effects noticed with electrosurgery were hypopigmentation (12%), scarring (16%), and paraesthesia (4%).

The present study concluded that 5-fluorouracil scored over the conventional electrosurgical method for the treatment of warts, as there was a significant decrease in the recurrence after 5-fluorouracil therapy; however, electrosurgery yielded quicker initial response than 5-fluorouracil.

 
   References Top

1.Brentjens MH, Yeung-Yue Ka, Lee PC, Tyring SK. Human Papillomavirus; A revew. Dermatol Clin 2002;20:315-31.   Back to cited text no. 1  [PUBMED]  
2.Clinical Effectiveness Group (Association of Genitourinary Medicine and the Medical Society for the study of Venereal diseases). National Guidelines for the management of anogenital warts. Sex Transm Inf 1999;75:S71-5.   Back to cited text no. 2    
3.Drake LA, Ceilley RI, Cornelison RL, Dobes WL, Dorner W, Goltz RW, et al . Guidelines of care for warts. Human papillomavirus. J Am Acad Dermatol 1995;32:98-103.   Back to cited text no. 3    
4.Blankenship ML. Physical modalities-electrosurgery, electrocautery and electrolysis. Int J Dermatol 1979;18:443-52.   Back to cited text no. 4  [PUBMED]  
5.Sterling JC, Kurtz JB. Viral infections. In : Champion RH, Burton JC, Burns DA, Breathnach SM editors; Rook/Wilkinson/Ebling. Textbook of dermatology. 6th ed. Blackwell Science: Oxford, England; 1998. p. 995-1096.   Back to cited text no. 5    
6.Miller E. The metabolism and pharmacology of 5-fluorouracil. J Surg Oncol 1971;3:309-15.   Back to cited text no. 6    
7.Goncalves JC. 5-fluorouracil in the treatment of common warts of the hands. Br J Dermatol 1975;92:89-91.  Back to cited text no. 7  [PUBMED]  
8.Hursthouse MW. A controlled trial on the use of topical 5-fluorouracil on viral warts. Br J Dermatol 1975;92:93-6.  Back to cited text no. 8  [PUBMED]  
9.Chattopadhyay SP. Fluorouracil as a topical agent in the treatment of anogenital warts. Indian J Dermatol 2000;45:121-4.   Back to cited text no. 9    
10.Chattopadhyay SP, Das PK. Evaluation of 5-fluorouracil in treatment of warts. Indian J Dermatol Venereol Leprol 1991;57:51.   Back to cited text no. 10    
11.Lee S, Kim JE, Chun SI. Treatment of verruca plana with 5% 5-fluorouracil. Dermatologica 1980;160:383-9.   Back to cited text no. 11    
12.Krebs HB. Treatment of extensive vulvar condylomata acuminata with topical 5-fluorouracil. South Med J 1990;83:761-4.  Back to cited text no. 12    
13.Stone KM, Becker TM, Hadgu A, Kraus SJ. Treatment of external genital warts: A randomized clinical trial comparing podophyllin, crytoherapy and electrodessication. Genitourin Med 1990;66:16-9.  Back to cited text no. 13    


    Tables

[Table - 1], [Table - 2], [Table - 3]



 

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    Abstract
    Introduction
    Materials and Me...
    Results
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