The EVerT2 (Effective Verruca Treatments 2) Trial: a randomised controlled trial of needling versus nonsurgical debridement for the treatment of plantar verrucae

F Hashmi, C Fairhurst, S Cockayne, M Cullen, K Bell, E Coleman, M Harrison-Blount, D Torgerson

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Verrucae are a common foot skin pathology which can in some cases persist for many years. Plantar verrucae can be unsightly and painful. There are a range of treatment options including needling.

OBJECTIVES: The EVerT2 trial aimed to evaluate the clinical and cost effectiveness of the needling procedure for the treatment of plantar verrucae, relative to callus debridement.

METHODS: This single centre randomised controlled trial recruited 60 participants (aged 18 years and over with a plantar verruca). Participants were randomised 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 include 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. A cost-effectiveness analysis was carried out from the NHS perspective over 12 weeks.

RESULTS: Sixty eligible patients were randomised (needling group n=29, 48.3%; debridement group n=31, 51.7%) and 53 were included in the primary analysis (needling n=28, 96.6%; debridement n=25, 80.7%). Clearance of the index verruca occurred in 8 (15.1%) participants (needling n=4, 14.3%; debridement n=4, 16.0%, p=0.86). The needling intervention costs were on average £14.33 (95% CI 5.32 to 23.35) more per patient than debridement.

CONCLUSIONS: There is no evidence that the needling technique is more clinically or cost effective than callus debridement. The results show a significant improvement in pain outcomes after needling compared to the debridement treatment alone. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1285-1292
Number of pages8
JournalBritish Journal of Dermatology
Issue number5
Early online date27 Jun 2017
Publication statusPublished - 1 Nov 2017

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  • Journal Article
  • Warts/economics
  • Humans
  • Middle Aged
  • Debridement/economics
  • Male
  • Treatment Outcome
  • Foot Dermatoses/economics
  • Patient Satisfaction
  • Young Adult
  • Musculoskeletal Pain/etiology
  • Cost-Benefit Analysis
  • Adult
  • Female
  • Needles
  • Aged

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