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.
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.