Efficacy and safety of topical methotrexate gel 1% in combination with microneedling vs. cryotherapy for the treatment of cutaneous warts: a prospective randomized controlled trial.

BACKGROUND

Cutaneous warts continue to represent a therapeutic challenge because of treatment resistance and the inconvenience of most modalities of treatment. Topical methotrexate (MTX) with improved delivery methods may be a viable tool for certain localized dermatological conditions. Regarding cutaneous warts, MTX, either topical or intralesional, is one of the promising lines of treatment.

OBJECTIVES

To investigate the efficacy and safety of topical MTX hydrogel 1% combined with microneedling in the treatment of cutaneous warts compared with traditional cryotherapy.

METHODS

Sixty-eight patients with common or plantar warts were enrolled in this study. Patients were divided randomly into two groups: group A, which included 34 patients who received topical MTX hydrogel 1% combined with microneedling, and group B, which included 34 patients who received cryotherapy. All patients were followed up for 3 months after finishing treatment to detect any recurrence.

RESULTS

Regarding size after treatment, the complete resolution of warts was higher in group B (65%, 22/34) than in group A (53%, 18/34). The difference between both groups in clinical response did not reach statistical significance. There was no statistically significant difference between groups A and B regarding pain and erythema (P = 0.28 and P = 0.51, respectively). The rates of blistering and hypopigmentation were significantly higher in group B than in group A (P < 0.001 and P < 0.05, respectively). During the 3-month follow-up period, no recurrence was found in either group.

CONCLUSIONS

Topical MTX hydrogel 1% combined with microneedling is an effective and safe therapeutic option in the treatment of common and plantar warts.