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EVerT2- An RCT of needling vs. nonsurgical debridement for the treatment of a Verruca

‌There was uncertainty about the use of needling treatment of plantar verrucae. We found no evidence that the needling technique is more clinically or cost‐effective than callus debridement. However, the results show a significant improvement in pain outcomes after needling compared with the debridement treatment alone.

Why did we do this research?

Verrucae are a common foot skin pathology, which can in some cases persist for many years. Plantar verrucae can be unsightly and painful. There is uncertainty around the optimal treatment of verrucae and a need for high‐quality trials to evaluate therapies. We aimed to evaluate the Falknor needling technique compared to callus debridement for the treatment of plantar verrucae.

What did we do?

In our single‐centre randomized controlled trial we recruited 60 participants. Participants were randomized 1 : 1 to the intervention group (needling) or the control group (debridement of the overlying callus). The primary outcome was clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes included recurrence of the verruca, clearance of all verrucae, number of verrucae, size of the index verruca, pain and participant satisfaction at 12 and 24 weeks. 

Who was involved?

Participants were recruited from the University of Salford Podiatry Clinic. Patients were eligible if they were aged 18 years or above and had a plantar verruca on weight‐bearing skin that, in the opinion of the podiatrist, was suitable for both treatments.

What did we find?

We found no evidence that the needling technique is more clinically or cost‐effective than callus debridement. However, the results showed a significant improvement in pain outcomes after needling compared with the debridement treatment alone.

Publications

• Hashmi F, Fairhurst C, Cockayne S, et al. (2017), The EVerT2 (Effective Verruca Treatments 2) trial: a randomized controlled trial of needling vs. nonsurgical debridement for the treatment of plantar verrucae. Br J Dermatol, 177: 1285-1292. https://doi.org/10.1111/bjd.15751  
• Hashmi F, Torgerson D, Fairhurst C, et al. EVerT2—needling versus non-surgical debridement for the treatment of verrucae: study protocol for a single-centre randomised controlled trial. BMJ Open 2015;5:e009406. https://doi.org10.1136/bmjopen-2015-009406