Efficacy

Cryotherapy versus placebo or no treatment

Two small RCTs21,22 involving 69 adults compared cryotherapy with either placebo cream21 or no treatment.22 The pooled data did not demonstrate a significant difference in cure rates: 35% v34%; OR 0-82 (CI 0-16-4-24). One trial21 had a very low cure rate for cryotherapy (1/11) and the other22 had a very high cure rate in its placebo group (8/20).

Cryotherapy versus SA

Two RCTs15,16 compared SA with cryotherapy in 320 adults and children. There was no significant difference in cure rates between the two treatments: 65% v 62%; OR 1-15 (CI

Length of freeze

Four RCTs23-26 compared aggressive and gentle cryotherapy in 592 adults and children; however, definitions of aggressive and gentle differed and some studies included refractory warts whereas others did not. Overall, cure was achieved in 52% with aggressive cryotherapy and 31% with gentle cryotherapy; OR 3-69 (CI

Interval between freezes

Three RCTs15,27,28 showed no significant difference in cure rates between 2- 3- and 4-week intervals. Cure was generally achieved more quickly with shorter treatment intervals.

Optimum number of freezes

Only one RCT29 examined this question in 115 adults and children not cured after 3 months of three-weekly cryotherapy and showed no benefit of prolonging cryotherapy for a further 3 months. Cure rates were 43% and 38% in the treated and non-treated groups, respectively (no data available to calculate OR).

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