A Randomized Clinical Trial of Using Niosomal Zinc Sulfate Plus Cryotherapy in Comparison With Placebo Along With Cryotherapy in Treatment of Common Wart

Document Type: Original Article

Authors

1 Professor of dermatology, Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran

2 Professor, Department of Pharmaceutics, School of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran

3 Assistant Professor of Dermatology, Department of Dermatology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

4 Resident of Dermatology, Department of Dermatology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

Abstract

Background: There are different treatment modalities for common warts and all of them have side effects. Niosomal drug delivery systems have increased efficacy by enhanced transport of therapeutic agents through stratum corneum with decreased side effects. In this study, we assessed the efficacy of combined 2% niosomal zinc sulfate cream plus cryotherapy compared with combination of placebo plus cryotherapy.
Methods: Sixty patients with verruca vulgaris enrolled in this randomized clinical trial study. Patients were divided in 2 groups. Group A received 2% niosomal zinc sulfate cream and group B received placebo twice a day. Also, patients in both groups were treated with cryotherapy (liquid nitrogen) every other week. Treatment protocols continued for a maximum of 3 months or until total clearance of the lesions.
Results: Mean number of the sessions for complete remission was 4.5±1.38 in group A and 5.36±0.88 in group B and the difference between the two groups was statistically significant. Complete remission was observed in 60% in group A compared with 43.3% in group B that was not statistically significant.
Conclusion: Combination therapy with niosomal zinc plus cryotherapy can lead to faster and greater percentage clearance of the lesions without significant increase in adverse effects in comparison with cryotherapy plus placebo.

Keywords


  1. Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171(4):696-712.
  2. Gerlero P, Hernández-Martín Á. Treatment of warts in children: An update. Actas Dermo-Sifiliográficas (English Edition). 2016; 107(7):551-8.
  3. Zandi S, Rezayian H. Prevalence of warts in boy’s high school students in the city of Kerman [dissertation]. Kerman University of Medical Sciences; 1997. Persian
  4. Bruggink SC, Eekhof JA, Egberts PF, van Blijswijk SC, Assendelft WJ, Gussekloo J. Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study. Ann Fam Med 2013; 11(5):437-41.
  5. Committee on Guidelines of Care, Drake LA, Ceilley RI, Cornelison RL, Dobes WL, Dorner W, Goltz RW, et al. Guidelines of care for warts: human papillomavirus. J Am Acad Dermatol 1995; 32(1):98-103.
  6. Ahmed I, Agarwal S, Ilchyshyn A, Charles-Holmes S, Berth-Jones J. Liquid nitrogen cryotherapy of common warts: cryo-spray vs. cotton wool bud. Br J Dermatol 2001; 144(5):1006-9.
  7. Bagherani N, Smoller BR. An overview of zinc and its importance in dermatology-Part II: The association of zinc with some dermatologic disorders. Glob Dermatol 2016; 3(5): 337-50.
  8. Mohammadi S, Khazaeli P, Shamsi Meymandi S, Aflatoonian M, Khalili Meybodi M, Mehrolhasani N, et al. Comparison of the efficacy of isotretinoin 0.05% niosomal gel versus adapalen 0.1% gel in the treatment of acne vulgaris: A randomized, double-blind clinical trial. Dermatology and Cosmetic 2016; 7(2):66-73. In Persian
  9. Aflatoonian M, Fekri A, Rahnam Z, Khalili M, Pardakhti A, Khazaeli P, et al. The efficacy of combined topical niosomal dapsone gel and intralesional injection of meglumine antimoniate in comparison with intralesional meglumine antimoniate and cryotherapy in the treatment of cutaneous leishmaniasis. Journal of Pakistan Association of Dermatology 2017; 26(4):353-60.
  10. Pardakhty A, Shakibaie M, Daneshvar H, Khamesipour A, Mohammadi-Khorsand T, Forootanfar H. Preparation and evaluation of niosomes containing autoclaved Leishmania major: a preliminary study. Journal of Microencapsulation 2012; 29(3):219-24.
  11. Pardakhty A, Moazeni E, Varshosaz J, Hajhashemi V, Najafabadi AR. Pharmacokinetic study of niosome-loaded insulin in diabetic rats. Daru 2011; 19(6): 404–11.
  12. Al-Gurairi FT, Al-Waiz M, Sharquie KE. Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial. Br J Dermatol 2002; 146(3):423-31.
  13. Moniem EA, Genedy RM, Moussa R. Oral zinc sulfate in the treatment of recalcitrant warts. Egyptian Journal of Dermatology and Venerology 2016; 36(2):34-8.
  14. Yaghoobi R, Sadighha A, Baktash D. Evaluation of oral zinc sulfate effect on recalcitrant multiple viral warts: a randomized placebo-controlled clinical trial. J Am Acad Dermatol 2009; 60(4):706-8.
  15. Hassan I, Bhat T, Altaf H, Sameem F, Masood Q. Role of oral zinc sulphate in warts-a placebo controlled, single-blinded study. Our Dermatol Online 2013; 4(1):24-7.
  16. Sharquie KA, Al-Nuaimy AA. Treatment of viral warts by intralesional injection of zinc sulphate. Ann Saudi Med 2002; 22(1-2):26-8.
  17. Sharquie KE, Khorsheed AA, Al-Nuaimy AA. Topical zinc sulphate solution for treatment of viral warts. Saudi Med J 2007; 28(9):1418-21.
  18. Khattar JA, Musharrafieh UM, Tamim H, Hamadeh GN. Topical zinc oxide vs. salicylic acid-lactic acid combination in the treatment of warts. Int J Dermatol 2007; 46(4):427-30.