ORIGINAL ARTICLE J Pub Health Med Res 2015;3(1):5-7

Comparative efficacy of Electrosurgery with topical 50%

Trichloroacetic acid in treatment of warts
Harika C1, Sankeerth V1, Jagannath Kumar V2
1
Post graduate, 2Professor and HOD, Department of Dermatology
S.S. Institute of Medical Science and Research Centre, Davangere
(Received: 18/12/2014, Revised: 10/01/2015, Accepted: 1/03/2015)

Abstract :
Introduction : Verruca vulgaris is the common benign proliferation of the skin that are encountered in
dermatological practice caused by Human Papilloma Virus. The clinical management of verruca vulgaris is often
challenging. Multiple modalities of treatment are currently existing, but none of them is singularly effective.
Aim : This study was designed to compare the therapeutic response of warts to trichloroacetic acid versus
electrosurgery.
Materials and methods : This is a randomized double blind prospective study. The study was carried out for 12
months and it included 60 patients. Patients with genital warts, immune compromised patients, pregnant and
lactating mothers are excluded in the study. Statistical Analysis used: chi square test.
Results: Electrosurgery was used in 30 patients with complete clearance in 27 cases. 50% TCA was used in 30
cases with complete clearance in 7 patients.
Conclusions: Electrosurgery treatment in warts is the best treatment when compared to 50% Trichloroacetic acid
Key words: verruca vulgaris; Electrosurgery; 50% Trichloroacetic acid(TCA)

Introduction : benign and dysplastic skin lesions. A solution of TCA is

Warts or verrucae are caused by human papillomavirus, applied topically and must be allowed to dry until a white
belonging to the family Papoviridae. Various frosting develops and its application is accompanied by a
4
morphological patterns known as verruca vulgaris burning sensation that lasts for two to five minutes .
(common warts), verruca plana (plane warts or flat We undertook this study to compare the efficacy of
warts), plantar warts, filiform warts, digitate warts and topical 50% TCA and Electrosurgery.
anogenital warts (condyloma acuminate) occur. This Materials and Methods :
infection can cause physical and emotional distress in
Study Design: Prospective randomized double blind
patients. A variety of therapeutic modalities are
study 60 consecutive patients with warts attending
available, but to date no single therapy has proven
department of dermatology and venereology were
uniformly successful. Recurrence rates for therapies are
subjects for the study. Sixty patients were randomly
relatively high1. selected by envelope method. Study was done over a
Electrosurgery is a common mode of treatment and it period of one year
involves the principle of tissue destruction by heat2. But Inclusion criteria: Patients presenting with all
this method has the disadvantage of causing pain, morphological types of warts irrespective of age, sex and
scarring, respiratory papillomatosis in the operator and duration were included in the study.
3
high recurrence rate .
Exclusion criteria: Patients with genital warts,
In this study, an alternative mode of therapy with topical immune-compromised patients, pregnancy and lactating
50% trichloroacetic acid was evaluated. Trichloroacetic women were excluded from the study.
acid is a caustic and hemostatic agent. A saturated
A detailed history regarding the age, sex, occupation,
solution could be used alone for the treatment of many
duration of disease, family history of disease was
Address Correspondence to :
obtained. A thorough dermatological examination was
Dr. Harika C done taking care to note morphology and distribution of
Post graduate, Department of Dermatology warts. All cases were diagnosed by paring. Written
S.S.I.M.S. and R.C., Davangere consent was obtained from all the patients.
Email : [email protected]
Mobile : 9663257779
The two modalities tried were:
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Harika C et.al. Comparative efficacy of Electrosurgery with topical 50% Trichloroacetic acid in treatment of warts

a. Electrosurgery recurrence as shown in [ fig 1 ] and [ Table-1] . In 50%

b. 50% TCA TCA group of 7 patients had complete clearance.
(a) Electrosurgery Three patients had recurrence. In 18 patients there was
no improvement and 2 had partial clearance as
Prior to the electrosurgery, the procedure was explained shown in [ Table-2] and [ fig 2 ].
to the patient in detail to remove apprehension. The
procedure was carried out in Minor-OT with adequate As per the statistical analysis electrosurgery treatment
lighting. The operator and assistant wore mask to was superior to the 50% trichloroacetic acid ( P< 0.001).
prevent exposure to smoke born microbes. Preparatory Discussion:
to electrosurgery, the lesion and surrounding skin was In the present study 60 cases of verruca were evaluated
cleaned with povidine-iodine. Alcohol was not used for comparative efficacy of topical 50% TCA solution
because of the potential for alcohol to ignite with against conventional electrosurgical method.
electrosurgery. 1% lidocaine with epinephrine was used Electrosurgery :
for local anaesthesia. The procedure was undertaken In the present study out of 30 patients subjected for
with the patient in lying down position. After removal of electrosurgery there was complete cure in 28 patients
the wart, the base was again cauterized until bleeding (93%) and in 2 patients there was recurrence.
stopped completely. The wound was dressed with sterile
gauze. Follow-up was done every month for 6 months. Chang et al.5 in their study of 302 patients with warts, 11
patients were treated with electro-cautery. Eight patients
(b) 50% TCA had complete clearance(72.2%). As compared to above
The reagent was applied carefully avoiding normal skin study, in the present study shows higher rate of complete
using a sharpened matchstick biweekly and the patient clearance. This could be attributed to more numbers of
was trained thus to do it at home. The lesions were treated patients in the present study.
for a period of six weeks or till the disappearance of the Alexander Berman. 6 used electro-surgery for 2 patients
lesions whichever is earlier. After the disappearance of with flat warts found complete clearance in both
the lesions, the patient was followed up every month for patients. The above study had no recurrence in
a period of 6 months. comparison to present study; this could be attributed to
The results were assessed as follows: Complete less number of patients in the above study.
clearance was defined as total clearance of warts, with Topical 50% TCA:
no evidence of residual warts. Partial clearance was
defined as improvement in the number and or size of In the present study, out of 30 patients in which 50%
warts, but without complete eradication of warts. No TCA was utilized, there was complete clearance in only 7
improvement was defined as warts in which there is no patients. In 18 patients (60%) and there was no response,
reduction in number or size or worsened with treatment. 2(66.66%) patient had partial clearance and in 3
All patients were followed-up monthly for a period of 6 patients(10%) there was recurrence.
months. Reappearance of warts, at the sites of earlier Pezeshkpoor et al.7 in his study used different
lesions during follow up was considered as concentration of TCA(80% and 35%) in 62 patients and
Recurrence. showed complete clearance to TCA 80% in 14
Statistical Analysis Used : Chi Square test patients(46.7%) and TCA 35% in 3 patients (12%). The
above study showed more complete response to high
Results:
concentration of TCA in comparison to present study
Out of 60 patients included in the study, 39 were males ; which showed poor response to TCA.
21 were females. Most of the patients were between 16 to
Conclusion:
30 years, accounting for 58% cases. 40% of the patients
were students by occupation. Nearly half of the Warts or verrucae are one of the commonest conditions
patients(45%) had disease duration of 1 to 6 months. The in dermatological practice. Though spontaneous cure is
most common affected site was hands (32%), followed known in warts it is not possible to wait for the same.
by feet (30%) and face (26%). Verruca vulgaris was the Though there are many modalities of treatment there is
most common morphological pattern seen (42%), no specific treatment because the selection of modality
followed by plantar warts (30%), plane warts(20%); of treatment depends on the size, location, type of
anogenital warts(4%); filiform warts (4%). lesions, chances of side effects and patient's willingness
to treatment. In view of the absence of a universally
In electrosurgery group of 28 patients (93%) had
specific treatment many modalities of therapy exist and
complete clearance. Two patients had
many remedies are added frequently. In the present study
J Pub Health Med Res 2015;3(1):5-7 6
Harika C et.al. Comparative efficacy of Electrosurgery with topical 50% Trichloroacetic acid in treatment of warts

concluded that electrosurgery scored over the TCA 50% Percentage No. of patients Result
method for the treatment of warts, as there was
significant decrease in the recurrence after 23.3% 7 Complete clearance
electrosurgery therapy. 6.6% 2 Partial clearance
Percentage No. of patients Result 60% 18 No improvement
93% 28 Complete clearance 10% 3 Recurrence
- - Partial clearance [Table-2] Response to TCA 50%: In present study, out of 30
patients only 7 patients had complete clearance and 2
- - No improvement had recurrence. In 19 patients there was no
Recurrence 2 6.6% improvement and 2 had partial clearance

[Table- 1] Response to Electrosurgery : In electrosurgery

group 28 patients (93%) had complete clearance.
2 patients had recurrence

Fig -1 : Electrocautry before and after

Fig 2 : Before and after TCA 50%

References : 5. Chang TSC, Goh BK, Chong WS, Chan YC, Giam YC. Viral warts
1. Brentifens MH , Yeung Yue Ka, Lee PC, Tyring SK. Human in children seen at a tertiary referral centre. Ann Acad Med
Papillomavirus; A review. Dermatol Clin 2002;20: 315-31. Singapore. 2004; 33: 53-6.
2. Drake LA, Ceilley RI, Cornelison RL , Dobes WL, Dorner W, Goltz 6. Berman A. Failure of flat warts to recur in electrosurgically altered
RW, et al. Guidelines of care of warts. Human Papillomavirus.J Am skin. Arch Dermatol. 1978;114(12):1797-9.
Acad Dermatol 1995;32:98-103. 7. Pezeshkpoor F, Banihashemi M, Yazdanpanash MJ et al.
3. Blankenship Ml. Physical modalities electrosurgery, Comparative study of topical 80% trichloroacetic with 35%
electrocautery and electrolysis. Int J Dermatol 1979; 18: 443-52. trichloroacetic acid in the treatment of the common wart. J Drugs
Dermatol.2012 Nov;11(11):e66-9.
4. Sterling JC, Handfield-Jones S, Hudson PM. British Association of
Dermatologists. Gudielines for the management of cutaneous
warts. Br J Dermatol 2001;144:4-11.

How to Cite this article :

Harika C, Sankeerth V, Jagannath Kumar V, Comparative efficacy of Electrosurgery with topical 50% Trichloroacetic acid
in treatment of warts. J Pub Health Med Res, 2015;3(1):5-7
Funding: Declared none
Conflict of interest: Declared none

J Pub Health Med Res 2015;3(1):5-7 7