Needling vs Nonsurgical Debridement in Plantar Verrucae: Which is Best?

No evidence was found to show that needling increases clearance rates or is more cost-effective than callus debridement for plantar verrucae, according to research published in the British Journal of Dermatology.

The single-center, randomized, controlled EVerT2 (Effective Verruca Treatments) trial evaluated the clinical and cost-effectiveness of a needling procedure compared with the use of callus nonsurgical debridement for the treatment of plantar verrucae. A total of 53 patients (≥18 years of age) were randomly assigned to either the intervention group (needling: n=28) or the control group (callus debridement: n=25).

The primary outcome of the trial was clearance of the index verruca at 12 weeks’ postrandomization, as determined by blinded assessment by a podiatrist. Secondary outcomes at 12 and 24 weeks included recurrence of the verrucae, clearance of all verrucae, number of verrucae, size of the index verruca, level of pain, and patients’ satisfaction with treatment. In addition, a National Health Service (NHS) cost-effectiveness analysis was conducted over 12 weeks.

The median number of verrucae at 12 weeks was 1.5 in the needling group vs 2 in the debridement group. Overall, clearance of the index verruca was observed in 15.1% (8 of 53) of participants (needling, 14.3%; debridement, 16.0%). The NHS analysis showed that on average, costs associated with the needling intervention were £14.33 (USD $17.13) more per patient than nonsurgical debridement (95% CI, 5.32-23.35). Notably, participants in the needling group reported significantly lower levels of pain at 12 weeks and 24 weeks (P =.07 and P =.03, respectively).

The investigators found no evidence that the needling technique increases clearance rates or is more cost effective than callus debridement in patients with plantar verrucae. However, compared with callus debridement, needling was shown to significantly improve patients’ pain outcomes.

Reference

Hashmi F, Fairhurst C, Cockayne S, et al. The EVerT2 (Effective Verruca Treatments) trial: a randomised controlled trial of needling versus nonsurgical debridement for the treatment of plantar verrucae [published online June 27, 2017]. Br J Dermatol. doi: 10.1111/bjd.15751