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Our Dermatol Online. 2014; 5(3): 261
Date of submission:  23.06.2014 / acceptance: 26.06.2014
Conflicts of interest: None

Rahim Asghariazar, Hamideh Herizchi Ghadim, Shahla Babaeinezhad, Sina Nobahari


Ass. Prof. Antonio Chuh MD FRCP FRCPCH1, Prof. Vijay Zawar MD DNB DV&D FAAD2

1School of Public Health, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
2Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, India
How to cite this article: Chuh A, Zawar V. Comment: The comparison study of 5 Fluorouracil vs. cryotherapy in the treatment of the backhand resistant common wart. Our Dermatol Online. 2014; 5(3): 261.

We refer to the study conducted by Asghariazar R et al comparing the efficacy of 5-fluorouracil against cryotherapy in the management of backhand resistant common warts [1]. We congratulate their success in reporting such a high-quality study. We would humbly like to offer a few pieces of advice, which might further augment the clinical relevance and the scientific content for future studies along similar veins.
Firstly, human papillomavirus infection causing cutaneous extragenital viral warts is lifelong, and cannot be eradicated by any active treatment strategy [2,3]. The aims to treat are to alleviate the physical and psychological discomforts of the patients, and to prevent further spread of the infection by autoinoculation [4]. We thus advocate that the inclusion criteria while recruiting patients for future studies should include evaluations of their physical and psychological discomforts, including impacts of the disease on the quality of life of patients. For patients with low impacts, counselling education about the expected disease course and implications for future active treatment might not be indicated clinically, and thus may be excluded from the study recruitments. An example is depicts as Figure 1.
Secondly, many good systemic reviews revealed, there exists little significance for the results of many treatment strategies including cryotherapy to be compared to those of placebo treatment [5,6]. We thus advocate that future studies might include placebo as one of the study arms so that the genuine clinical and psychological benefits of treatments can be validly and reliable quantified. Outcome measures could also be both clinician-rated and patient-rated. Thirdly, viral warts exhibit Köebner phenomenon. Action ablation treatment might lead to future relapse of lesions. Moreover, as the human papillomavirus infection is lifelong, transient symptomatic remission might not infer long-term disease relief [7]. We therefore advocate future studies to be designed with sufficiently long follow-up periods so that the effectiveness of various treatment strategies could be reliably compared to each other and to placebo on significantly longer time frames.
1. Asghari Azar R, Herizchi H, Babayi Nejad Sh, Nobahari S. The comparison study of 5 Fluorouracil vs. cryotherapy in the treatment of the backhand resistant common wart. Our Dermatol Online. 2014;5:258-60.
2. Lynch MD, Cliffe J, Morris-Jones R. Management of cutaneous viral warts. BMJ. 2014;348:g3339.
3. Nordentoft EL1, Waldorf FB. Viral warts on hands and feet are often self-limiting. Ugeskr Laeger. 2013;175:1559-61.
4. Dall’oglio F1, D’Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2012;13:73-96.
5. Gibbs S1, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006:19:CD001781.
6. Kwok CS1, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012;9:CD001781.
7. Muñoz-Santos C1, Pigem R, Alsina M. New treatments for human papillomavirus infection. Actas Dermosifiliogr. 2013;104:883-9

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