TABLE 2.

Energy based therapies for viral warts

TREATMENT MODALITY	MECHANISM OF ACTION	RESPONSE	ADVERSE EFFECTS
Radiofrequency ablation12	Tissue destruction with various waveforms of alternating electric current whose frequencies fall within the range of radiofrequency (500–4000khz)	The overall cure rate ranges between 33% and 80% depending on the number of sessions and the type of warts. Recurrence rate of 9% reported.	Pain, hypopigmentation, secondary infection, scarring
Electrosurgery12	Utilizes galvanic or direct current for generation of heat and destruction of tissue.	Overall success rate of 56–80%. Recurrence rate of 41% reported.	Pain, hypopigmentation, secondary infection, scarring
Cryotherapy6,7,12 (Liquid nitrogen at -196°C by open spray method and -20°C by dipstick method)	Necrotic destruction of HPV infected keratinocytes besides inducing local inflammation that triggers an effective cell mediated immune response	Cure rate ranges from 44–47%. Recurrence rate of 58% reported as treatment end-point cannot be clearly determined.	Pain, blistering, hypopigmentation or hyperpigmentation, scarring.
Carbon dioxide lasers6,8	Aim at blood vessels that are rampant in briskly growing warts. The destruction of microvasculature is mediated by selective photothermolysis of oxyhemoglobin.	Remission rates of 49.5%, 63%, and 64% have been reported	Intraoperative and post-treatment pain, crust formation, scarring, pigmentary change.
Photodynamic therapy 6,7	Uses aminolevulinic acid (ALA) as the photosensitizing agent. Upon stimulation by light, accumulated	Cure rates of 56% and 75% have been reported. Used in few controlled trials, results are variable.	Minor pain, itching, mild hypopigmentation.

HPV: human papilloma virus