Authors' reply

摘要

The study that Cockayne and colleagues cite is a large randomised trial that compares salicylic acid and cryotherapy as first line treatments for plantar warts. They found equal efficacy forthese two treatments-a conclusion supported by a recent Cochrane review. Forsymptomatic plantarwarts, we advise salicyclic acid as first line treatment because it is generally well tolerated and easily accessible in primary care. Cockayne and colleagues question the use of cryotherapy to treatwarts because of lackof confirmed efficacy and patient discomfort. We advise using cryotherapy exclusively as a second line therapy for warts that have not resolved with salicylic acid. Our practice is to apply three cycles of cryotherapy in combination with ongoing salicylic acid treatment and paring before cryotherapy. This differs from Torgerson and colleagues' study, which used cryotherapy as first line treatment for patients not previously treated with salicylic acid, and it was used in isolation, in the absence of salicylic acid. Furthermore, paringwas used "accordingto the site's usual practice," ratherthan universally, and the number of cycles of cryotherapy was not specified. In our experience, cryotherapy is well tolerated and can be successful in patients forwhom salicylic acid in isolation has notworked.