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A randomized controlled study on the efficacy and safety of zinc oxide 20% ointment versus salicylic acid 15% + lactic acid 15% ointment in the treatment of patients with verruca vulgaris in a tertiary hospital

Hazel C. Hao, Daisy King-Ismael


test abstract

Objective: To determine the efficacy and safety of topical zinc oxide ointment versus topical salicylic acid + lactic acid ointment as treatment among patients with verruca vulgaris.

Methods: This randomized, double-blind, 6-week study involved 29 patients with verruca vulgaris in a tertiary center who received zinc oxide 20% ointment or salicylic acid 15% + lactic acid 15% ointment applied daily and occluded with Leukoplast™ tape. Evaluation was done every two weeks.

Results: There was significant decrease in number of warts in the zinc oxide group (p=0.004), while it was not significant in the salicylic acid+lactic acid group (p=0.392). Comparison between the two groups was not significant (p>0.05). Both zinc oxide (P=0.000) and salicylic acid+lactic acid groups (P=0.025) had significant decrease in size of warts from baseline to 6th week of observation. No significant differences were observed between the two groups in terms of adverse events such as erythema (P>0.05), edema (P>0.05), tenderness (P>0.05), and scaling (P>0.05); however, itching was significantly higher at 4th week in the salicylic acid+lactic acid group B (16.7%). Among the zinc oxide group, 100% would recommend the treatment, while only 71.4% would recommend salicylic acid+lactic acid. The satisfaction levels of zinc oxide group were also statistically higher than salicylic acid+lactic acid group (p=0.000).

Conclusion: Zinc oxide 20% ointment is a safe and effective option for the treatment of verruca vulgaris especially among patients that would prefer non-traumatic measures in the removal of their warts.

Keywords: Verruca vulgaris, zinc oxide, salicylic acid, lactic acid


1. Wenner R, Askari S, Cham P, Kedrowski D, Liu A, Warshaw E. Duct tape for the treatment of common warts in adults: a double-blind randomized

controlled trial. Arch Dermatol 2007; 143: 309-313. DOI: 10.1001/archderm.143.3.309.

2. Boull C and Groth D. Update: treatment of cutaneous viral warts in children. Pediatr Dermatol. 2011; 28(3): 217-229. DOI: 10.1111/j.1525-1470.2010.01378.x.

3. Sterling JC, Gibbs S, Haque Hussain SS, Mustapa MF, Handfield-Jones, SE, British Association of Dermatologists’ guidelines for the management of cutaneous warts 2014. Brit J Dermatol. 2014; 171:696-712. DOI: 10.1111/bjd.13310.

4. Shahmoradi Z, Assaf F, Al Said H, Khosravani P, Hosseini S. Topical pyruvic acid 70% versus topical salicylic acid 16.7% compound in treatment of plantar warts: a randomized controlled trial. Adv Biomed Res 2015; 4:113. DOI: 10.4103/2277-9175.157833.

5. Lipke M. An armamentarium of wart treatments. J Clin Med Res 2006; 4(4): 273-293.4. DOI: 10.3121/cmr.4.4.273.

6. Kruter L, Saggar V, Akhavan A, Patel P, Umanoff N, Viola K, Stebbins W, Smith E, Akhavan A, Cohen J, Cohen S. Intralesional Bleomycin for Warts: Patient Satisfaction and Treatment Outcomes. J Cut Med Surg 2015; 19(5): 470-476. DOI: 10.1177/1203475415576860.

7. Gupta M, Mahajan V, Mehta K, and Chauhan P. Zinc therapy in dermatology: a review. Dermatol Res Prac 2014; 1-11. DOI: 10.1155/2014/709152. 8. Prasad A. Zinc in human health: effect of zinc on immune cells. Mol Med 2008; 14(506) 353-357. DOI: 10.2119/2008-00033.Prasad.

9. Moniem E, Genedy R, Moussa R. Oral zinc sulfate in treatment of recalcitrant warts. Egypt J Dermatol Venereol 2016; 36:34-38. DOI:10.4103/1110-6530.202637.

10. Mun J, Kim S, Jung D. Oral zinc sulfate treatment for viral warts: an open-label study. J Dermatol 2011; 38: 541–545. DOI: 10.1111/j.1346-8138.2010.01056.x.

11. Sharquie K, Khorsheed A, Al-Nuaimy A. Topical zinc sulphate solution for treatment of viral warts. Saudi Med J 2007; 28(9): 1418–1421.

12. Khattar J, Musharra U, Tamim H, and Hamadeh G. Topical zinc oxide vs salicylic acid-lactic acid combination in the treatment of warts. Int J Dermatol 2007; 46(4): 427–430. DOI: 10.1111/j.1365-4632.2006.03138.x.

13. Papakonstantinou E, Raap U. Alternative uses of dermoscopy in general dermatology. J Surg Dermatol 2017; 2(2): 67-74.

14. Banihashemi M, Pezeshkpor F, Yazdanpanah M, Family S. Eficacy of 80% phenol solution in comparison with cryotherapy in the treatment of common warts of hands. Singapore Med J 2008; 49 (12): 1035-1037.

15. Sinha S, Relhan V, and Garg V. Immunomodulators in warts: unexplored or ineffective. Indian J Dermatol. 2015 MarApr; 60(2): 118–129. DOI: 10.4103/0019-5154.152502.

16. Sharma S, Barman K, Sarkar R, Manjhi M, and Garg V. Eficacy of oral zinc therapy in epidermodysplasia verruciformis with squamous cell carcinoma. Indian Dermatol 2014; 5:55–58. DOI: 10.4103/2229-5178.126034.

17. Sharquie K, Al-Nuaimy A, Treatment of viral warts by intralesional injection of zinc sulphate. Ann Saudi Med; 22(1-2): 26–28, 2002. DOI: 10.5144/0256-4947.2002.26.

18. Wester R, Maibach H. Topical drug delivery: percutaneous absorption. In: Shah P, Maibach H, editors. Topical drug bioavailability, bioequivalence, and penetration. New York: Plenum Press; 1993. p. 3-15.

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A randomized controlled study on the efficacy and safety of zinc oxide 20% ointment versus salicylic acid 15% + lactic acid 15% ointment in the treatment of patients with verruca vulgaris in a tertiary hospital