A comparative study of tangential or vertical application of spray cryotherapy in warts treatment

Background and Design: Cryotherapy is an easy -to -apply and effective method in the treatment of warts. Numerous studies have been conducted on the effectiveness of cryotherapy in treating warts. However, in the literature, there is no comparative study on the treatment success, side effects, and superiority of vertical or tangential application to each other in spray cryotherapy. This study aims to compare both methods and to determine the ideal method for increasing patient compliance and treatment success in cryotherapy. Materials and Methods: Between December 2014 and March 2016, 25 volunteer patients with 173 warts on both hands were applied spray cryotherapy with the vertical method in one hand and tangential method in the other. The patients were evaluated in terms of both treatment success and side effects at three-week intervals. Results: The two methods did not differ in therapeutic efficacy (p>0.05). There was no difference between the two methods in terms of bullae (p=0.515) and hypopigmentation (p=0.709) formation. When the pain scores of two spray methods warts were compared according to warts diameters, the tangential application's pain score was lower in warts smaller than 2.5 mm (p=0.031). There was no significant difference in warts of other diameters (between 2.6-5.0 mm and greater than 5.0 mm) (p>0.05). Warts requiring three sessions of treatment (20/173) were compared in each session for pain scores. Regardless of the method, a significant decrease in pain score was found in each consecutive session (p<0.05). Conclusion: This is the first study to compare spray cryotherapy's vertical or tangential application to the lesion. Based on the data of this study, tangential spray application is more comfortable than vertical application. Cryotherapy may be a more widely used method if tangential spray freezing becomes common.