Comparing two cryotherapy techniques for treatment of Plantar Warts.

Abstract

Aim This study aimed to compare two Techniques of Cryotherapy, The C02 Gun & Probe technique and the Portable N20 pressurized spray technique for effectiveness, pain, and effect on the quality of life of the patient when treating plantar warts. Research design and methods A quasi-experimental matched subject study was conducted at B'Kara Health Centre, Birkirkara, Malta. The study was conducted between October 2011 and March 2012. 20 subjects with a newly diagnosed verruca pedis (plantar wart) on the sole of the foot were selected for the study. Subjects were matched for confounding variables in relation to site of lesion, gender and age, and were divided into two groups. Group A (n=10) were treated using the C02 Gun & Probe technique whilst Group B (n=10) were treated using the Portable N20 pressurized spray technique. The plantar warts were measured at time 0 (before applying treatment) and at Time 1(3 weeks following treatment) using a metre ruler. The patients were also asked to fill in the Foot Function Index at Time 0 and at Time1 and were asked to fill in the Visual Analog Scale for pain assessment during treatment. Results The study found no significant difference in the effectiveness (p= 0.387), pain caused during treatment (P=0.855) and FFI scores (p=0.172) for Total change on QOL between group A and Group B at Time 1 when comparing both treatments. However, comparison of the mean scores showed that the C02 Gun & Probe method was slightly more effective in reduction of size (1.85mm versus 1.19mm). Pain during treatment was almost identical when using both techniques, with mean VAS values of 5.99 versus 6.17. The FFI scores on all 3 subscales (Pain, Disability and Activity Limitation) showed a larger increase in the Gun & probe method, when compared to the Pressurised N20 Portable device. Conclusion Although this study has found no significant difference between two different techniques of cryotherapy, mean differences have indicated that the C02 Gun & Probe technique is more effective in reducing the size of the warts when compared to the N20 Pressurized Spray Technique; however the C02 Gun & Probe technique caused a larger impact on quality of life. Recommendations from this study suggest that patients should be advised on the possible adverse effects of the C02 technique, and that the N20 Pressurized spray technique could be introduced in the Maltese healthcare system as an alternative treatment for plantar warts. The portability of the N20 Pressurized spray technique makes it also suitable for domiciliary care and in-patient care.