Comment

The evidence from available RCTs for the absolute and relative effectiveness of cryotherapy for warts is both limited and contradictory. Moreover, as with the RCTs on topical SA, heterogeneity of study design and methods and the likely heterogeneity of the populations being studied make it impossible to synthesise data and draw firm conclusions. For instance, some trials included all types of warts on the hands and feet in all age groups whereas others were more selective and simply looked at hand warts or excluded certain groups such as mosaic plantar warts or refractory warts. Of particular note is the likelihood that wart clinic "populations" used for these studies may have had very different characteristics in different periods of time. For instance, studies done in the 1970s in the UK would have included a higher proportion of participants with incident warts and a greater chance of cure and/or spontaneous resolution. In the 1980s and 1990s, more people with warts were treated in primary care; thus, hospital wart clinics would have had a more selected population with a higher proportion of refractory warts and correspondingly lower cure rates.

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