Comparative short-term efficacy of 15% potassium hydroxide versus cryotherapy in treatment of viral warts
DOI:
https://doi.org/10.61529/idjp.v35i2.543Abstract
Background: Viral warts are benign skin lesions, which are ascribed to human papillomavirus. There are several possible treatments options. The objective of this study is to evaluate the short-term effectiveness of 15% potassium hydroxide with cryotherapy in treating viral warts.
Methods: It was quasi-experimental study done in the Department of Dermatology, PNS Shifa Hospital, Karachi after getting ethical approval from September 2025 – April 2026. 260 patients with viral warts aged 10 years and above were enrolled with non-probability sequential sampling into two groups, Group A was treated to topical 15% potassium hydroxide (KOH) applied as a single application per day over four weeks, and Group B underwent a series of four weeks treatment based on the weekly use of cryotherapy. The analysis of data was done in SPSS 23; chi-square test was used and a p-value ≤0.05 was considered statistically significant.
Results: A total of 260 patients were enrolled, with 130 patients in each treatment group. After 4 weeks, treatment success (good/excellent response) was achieved in 99 (76.2%) patients receiving 15% potassium hydroxide compared with 73 (56.1%) receiving cryotherapy (p = 0.002). Pain (43.1% vs 13.8%), blistering (31.5% vs 4.6%), and pigmentary changes (20.8% vs 3.8%) were more frequent with cryotherapy (all p < 0.001). Potassium hydroxide independently predicted treatment success (AOR = 2.45, 95% CI: 1.42–4.21; p = 0.001).
Conclusion: Clinical response was better with topical 15% potassium hydroxide than with cryotherapy for viral warts, which was well tolerated.
Keywords: Cryotherapy, Potassium hydroxide, Treatment efficacy, Viral warts
References
Ghazvini FJ, Yazdanpanah MJ, Nahidi Y, Torabi S, Ganjali R, Mohammadpour AH, et al. Comparison of topical potassium hydroxide 5% solution with cryotherapy in the treatment of genital warts: a randomized controlled clinical trial. Int J STD AIDS. 2025; 36(3): 205-11. DOI: https://doi.org/10.1177/09564624241300776
Bashir F, Tahir K, Shaheen G, Naveed A, Shafqat A, Azad M. Comparison of efficacy of 10% potassium hydroxide (KOH) versus liquid nitrogen cryotherapy in the treatment of palmoplantar warts. J Pak Assoc Dermatol. 2024; 34(1): 185-90. DOI: https://doi.org/10.66344/jpad.34.1.2024.2551
Elmoalef WS, Elsayed MH, Elhusseiny RM. A comparative study between topical 15% potassium hydroxide and 20% salicylic acid in treatment of multiple palmoplantar warts. QJM. 2021; 114(Suppl 1): hcab093.046.
DOI: https://doi.org/10.1093/qjmed/hcab093.046
Muhaidat JM, Al-Qarqaz FA, Alshiyab DM, et al. Comparison of efficacy and safety of cryotherapy protocols in viral warts. Dermatol Res Pract. 2020; 2020: 2309309. DOI: https://doi.org/10.1155/2020/2309309
Hofny ERM, Alhakami KF, Abouelmagd SA, Hassan SA, Fathy E, Hassan H. Topical methotrexate gel with microneedling vs cryotherapy in cutaneous warts: randomized trial. Clin Exp Dermatol. 2025; 50(8): 1535-41. DOI: https://doi.org/10.1093/ced/llaf102
Camargo CL, Belda W Jr, Fagundes LJ, et al. 5% potassium hydroxide solution versus cryotherapy in genital warts in men: a comparative study. An Bras Dermatol. 2014; 89(2): 236-40. DOI: https://doi.org/10.1590/abd1806-4841.20141702
Al-Hamdi KI, Al-Rahmani MA. Evaluation of topical potassium hydroxide solution for treatment of plane warts. Indian J Dermatol. 2012; 57(1): 38-41. DOI: https://doi.org/10.4103/0019-5154.92675
Firouzabadi LI, Khamesipour A, Ghandi N, Hosseini H, Teymourpour A, Firooz A. Thermotherapy versus cryotherapy in treatment of skin warts: randomized controlled trial. Dermatol Ther. 2018; 31(1): e12564. DOI: https://doi.org/10.1111/dth.12564
Khozeimeh F, Jabbari Azad F, Mahboubi Oskouei Y, et al. Intralesional immunotherapy compared to cryotherapy in treatment of warts. Int J Dermatol. 2017; 56(4): 474-8. DOI: https://doi.org/10.1111/ijd.13535
Jahic M. Cryotherapy of genital warts. Mater Sociomed. 2019; 31(3): 212-4. DOI: https://doi.org/10.5455/msm.2019.31.212-214
Jayaprasad S, Subramaniyan R, Devgan S. Comparative evaluation of topical 10% potassium hydroxide and 30% trichloroacetic acid in the treatment of plane warts. Indian J Dermatol. 2016; 61(6): 634-9. DOI: https://doi.org/10.4103/0019-5154.193670
Yanofsky VR, Linkner RV, Pompei D, Goldenberg G. Current update on treatment of genital warts. Expert Rev Dermatol. 2013; 8(3): 321-32. DOI: https://doi.org/10.1586/edm.13.24
García-Oreja S, Álvaro-Afonso FJ, Tardáguila-García A, López-Moral M, García-Madrid M, Lázaro-Martínez JL. Efficacy of cryotherapy for plantar warts: A systematic review and meta-analysis. Dermatol Ther. 2022; 35(6): e15480. DOI: https://doi.org/10.1111/dth.15480 .
Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med. 2022; 15(3): 284–301. DOI: https://doi.org/10.1111/jebm.12494
Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012; 9: CD001781. DOI: https://doi.org/10.1002/14651858.cd001781.pub3
Rahmatullah J, Ghafoor R, Anwer MA. Intralesional bleomycin versus cryotherapy for treatment of cutaneous warts: A randomized controlled trial. J Pak Med Assoc. 2023; 73(10): 1949-1953. DOI: https://doi.org/10.47391/jpma.6372
Khan S, Zeeshan HM, Mushtaq F. Efficacy of 10% potassium hydroxide in palmoplantar warts. Pak J Med Health Sci. 2017; 11(2): 553–5. Available from: https://pjmhsonline.com/2017/april_june/pdf/553.pdf
Omidian M, Shohani S, Pazyar N. Treatment of common warts: Comparing cryotherapy (liquid nitrogen) and 15% potassium hydroxide. J Chem Pharm Res. 2015;7(9):947–50. Available from: https://www.jocpr.com/articles/treatment-of-common-warts-comparing-cryotherapy-liquid-nitrogen-and-15-potassium-hydroxide.pdf
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Copyright (c) 2026 Dr. Aroon Kumar, Prof. Atiya Rahman, Dr Madiha Hanif, Dr Janta Maheshwari, Dr Sidra Anwer, Dr Izza Adnan
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