TOPICAL 10% POTASSIUM HYDROXIDE AND 30% TRICHLOROACETIC ACID IN TREATMENT OF PLANE WARTS: A COMPARATIVE EVALUATION

Abstract

INTRODUCTION: Warts are benign proliferations of the skin and mucosa caused due to the infection of human papilloma virus. Commonly warts on the hands and feet are caused by HPV serotype 1, 2, 4, 27 and 57. The incidence of warts increases during childhood to reach a peak in adolescence and early adulthood then declines rapidly through the 20s and more gradually thereafter. Trichloroacetic acid is a topical destructive agent which causes hydrolysis of cellular proteins leading to cell death. It is used in treatment of common, cervical, genital, and anal warts. Potassium hydroxide (KOH) is a strong metallic base KOH acts by its keratolytic effects that lead to the destruction of virus-infected cells causing resolution of warts. MATERIAL AND METHODS: All patients included were in the range of 4 to 13 years attending the outpatient department of paediatrics and dermatology. Patients were randomized in to two groups of 42 each. The diagnosis of plane warts was made clinically and by physical examination. Location, size and number of warts were recorded. Topical application of 10% KOH to Group A and 30% TCA to Group B was received by the physician once weekly. The patient was observed for 30 min for any side effects, itching, rashes or eruptions. This therapy was continued for 3 months (12 weeks) once weekly under physician supervision.  The average size of all the warts in case of multiple warts was calculated for assessing response. Patients were classified as complete responders, moderate responders and mild responders. If there is no response to treatment then called as no responders. All patients were assessed after 12 weeks. Patients and their parents were assessed for the treatment response on the scale of excellent, good, and satisfactory. RESULTS: 42 patients were treated with 10% KOH in group A and 42 in Group B by 30% TCA. Age of the patient was in the range of 5 to 14 years. Duration of warts was from 1 month to 3 years. There were 19 male and 23 female in 10% KOH group while 20 male and 22 female in 30% TCA group. In 10 % KOH group 1 (2.4%) and in 30% TCA group 7 (16.7%) were non-responders. 11 (26.2%) and 17 (40.5%) were mild responders in 10 % KOH group and 30% TCA group respectively. In 10 % KOH group 16 (38.1%) and in 30% TCA group 13 (31.0%) were moderate responders. 14 (33.3%) and 5 (11.9%) were complete responders in 10 % KOH group and 30% TCA group respectively. The result was statistically significant. Patient and their parents subjective response was obtained after 12 weeks of the treatment. In 10% KOH group 17 (40.5%), 12 (28.6%), 12 (28.6%) and 1 (2.4%) responses were excellent, good, satisfactory and poor respectively while in 30% KOH group 6 (14.3%), 17 (40.5%), 11 (26.2%) and 8 (19.0%) showed excellent, good, satisfactory and poor respectively.  CONCLUSION: 10% KOH solution can be effectively used for plane wart treatment in children as it is less irritant and has fewer side effects also in children, it can be easily administered.