Efficacy and Safety of Topical Methotrexate Gel 1% in Combination with Microneedling versus Cryotherapy for the Treatment of Cutaneous Warts: A Prospective Randomized Controlled Trial.

Background: Cutaneous warts continue to represent a therapeutic challenge due to treatment resistance and inconvenience of most modalities. Topical methotrexate (MTX) with improved delivery methods may be a viable tool against certain localized dermatologic conditions. Regarding cutaneous warts, MTX either topical or intralesional is one of the promising lines of treatment.

Objectives: To investigate the efficacy and safety of topical MTX hydrogel 1% combined with microneedling in the treatment of cutaneous warts compared with traditional cryotherapy.

Methods: Sixty-eight patients with common or plantar warts were enrolled in this study. Patients were divided randomly into two groups, Group A, included 34 patients received topical MTX hydrogel 1% combined with microneedling. Group B, included 34 patients received cryotherapy. All patients were followed up for 3 months after finishing treatment to detect any recurrence.

Results: Regarding size after treatment, the complete resolution of warts was higher in group B (64.7%) than in group A (52.9%) with no statistically significant difference between both groups. The difference between both groups in clinical response did not reach statistical significance. There was no statistically significant difference between groups A and B regarding pain and erythema (p = 0.278, 0.512 respectively).The rate of blistering and hypopigmentation were significantly higher in group B than in group A (p < 0.001, 0.045 respectively). During the three-month follow-up period, no recurrence was found in either group.

Conclusions: Topical MTX hydrogel 1% combined with microneedling is an effective and safe therapeutic option in the treatment of common and plantar warts.