Comparative evaluation of oral valacyclovir versus oral zinc sulfate in the treatment of cutaneous verruca: a hospitalbased, prospective clinical study

Background: Cutaneous verrucae (warts) are benign epithelial proliferations caused by human papillomavirus (HPV). HPV acts by upregulating epithelial cell replication and downregulating host immune responses. Hence, treatment could be aimed at the virus (via antiviral drugs like valacyclovir) or the immune system (via immunomodulators like zinc sulfate). It is important to identify which pathogenesis should be preferably targeted for safe and effective therapy. We aimed to compare the efficacy and safety of oral valacyclovir versus oral zinc sulfate in the treatment of cutaneous verruca. Methods: Fifty patients clinically diagnosed with warts were randomly divided into two groups: Group A (n = 25), treated with oral valacyclovir (1000 mg/day), and Group B (n = 25), treated with oral zinc sulfate (400 mg/day). All patients were evaluated using a Visual Analogue Scale (VAS) and the Physician’s Global Assessment (PGA) and were followed up for 12 weeks. The results were analyzed using R software version 3.6.0. Results: A significant decrease in the number of warts from baseline to the fifth follow-up visit was noted in Group A (P < 0.05) but not in Group B (P > 0.05). Both the groups showed a significant improvement visit-wise (P < 0.05) with respect to both VAS and PGA scores, but Group A (25.00 ± 28.58 and 1.60 ± 1.61; P < 0.05) showed marked improvement compared to Group B (60.40 ± 8.89 and 2.96 ± 0.35; P < 0.05). Conclusion: Oral valacyclovir is more efficacious than oral zinc sulfate in the treatment of cutaneous verrucae. Both are equally safe.