Letters to the Editor

Electrodesiccation and Curettage for Removal of Nongenital Warts



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Am Fam Physician. 2012 Apr 15;85(8):online.

Original Article: Treatment of Nongenital Cutaneous Warts

Issue Date: August 1, 2011

Available at: http://www.aafp.org/afp/2011/0801/p288.html

to the editor: I read this article discussing the treatment of nongenital cutaneous warts, and I appreciate the information shared by the authors. Throughout my 31-year career, I have often removed cutaneous warts by means of electrodesiccation and curettage under local anesthesia. This has proved to be a very effective and well-tolerated technique, which I learned during my residency many years ago. The rate of recurrence has been negligible. I often finish the procedure with the application of bichloroacetic acid to ensure hemostasis, as well as to help eradicate residual human papillomavirus. I would appreciate the perspective of the authors with regard to the published effectiveness of this technique compared with other methods for removing cutaneous warts.

Author disclosure: No relevant financial affiliations to disclose.

in reply: A wide range of therapies has been proposed for treatment of cutaneous warts. When choosing a treatment (especially a first-line treatment) for warts, we need to consider its cost, simplicity, effectiveness, and rate of adverse effects, including pain.

Surgical removal of warts by curettage followed by cautery was an early method that is still widely practiced. Although success rates of 65 to 85 percent have been reported, scarring and recurrence occur in up to 30 percent of patients.1 However, there are no controlled trials or randomized controlled trials evaluating this approach.

Some experts recommend against surgical excision and cautery as a standard therapy for warts because it can cause pain and scarring that are difficult to treat.2 Sharp surgical excision with 1-mm margins also has been described with excellent results and no recurrence in a hand surgery textbook.3 We found no published studies on the use of bichloroactetic acid after curettage.

Author disclosure: No relevant financial affiliations to disclose.

REFERENCES

1. Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2006;4(4):273–293.

2. Arndt KA, Bowers KE, Alam M, Reynolds R, Tsao S, eds. Manual of Dermatologic Therapeutics. 6th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2002:241–251.

3. Green DP. Green's Operative Hand Surgery. 5th ed. Philadelphia, Pa: Churchill Livingstone; 2005:149–151, 411, 2193–2195.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.



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