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Veasey JV, Elia VC, Ribeiro AE, Lellis RF. Overdosage of PPD immunotherapy causing tuberculosis-like skin lesions ⋆. An Bras Dermatol 2024; 99:629-631. [PMID: 38644070 PMCID: PMC11221158 DOI: 10.1016/j.abd.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 04/23/2024] Open
Affiliation(s)
- John Verrinder Veasey
- Dermatology Clinic, Hospital da Santa Casa de São Paulo, São Paulo, SP, Brazil; Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.
| | | | - Ana Estela Ribeiro
- Dermatology Clinic, Hospital da Santa Casa de São Paulo, São Paulo, SP, Brazil
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Gharib K, Taha A, Elradi M. Intralesional acyclovir versus intralesional Hepatitis-B vaccine in treatment of resistant plantar warts: a randomized controlled trial. Arch Dermatol Res 2024; 316:325. [PMID: 38822848 PMCID: PMC11144145 DOI: 10.1007/s00403-024-03001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 04/16/2024] [Accepted: 04/26/2024] [Indexed: 06/03/2024]
Abstract
Treating plantar warts is still a challenging problem with a long list of diverse treatment options that none of them seems to be definitive. To evaluate the effectiveness of intralesional acyclovir versus intralesional Hepatitis-B vaccine (HBV) in treatment of multiple resistant plantar warts. Forty-eight patients with resistant plantar warts completed the study with no dropouts. They were randomized into 3 groups; group(A) receiving intralesional HBV, group (B) receiving intralesional acyclovir and group (C) receiving intralesional saline as a control group over 5 biweekly sessions or until wart clearance. Clinical outcome was assessed through sequential digital lesion photographing upon each visit. Treatment related adverse reactions were recorded. 43.8%, 37.5% & 18.7% of Groups A, B &C respectively showed a complete response. pain was obvious in 100% and 56.3% of cases receiving intralesional acyclovir and HBV respectively. Up to the 6 month follow up period, none of the complete responders in all groups returned with a recurrence. Both acyclovir and HBV showed comparable efficacy and seem to be promising options for treating plantar warts being safe, affordable, and theoretically safe in immunocompromised cases.
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Affiliation(s)
- Khalid Gharib
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig, Egypt
| | - Aya Taha
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig, Egypt
| | - Mona Elradi
- Dermatology, Venereology & Andrology Department, Zagazig University Hospitals, Zagazig, Egypt.
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Mullen SA, Myers EL, Brenner RL, Nguyen KT, Harper TA, Welsh D, Keffer S, Mueller J, Whitley MJ. Systematic Review of Intralesional Therapies for Cutaneous Warts. JID INNOVATIONS 2024; 4:100264. [PMID: 38585192 PMCID: PMC10990969 DOI: 10.1016/j.xjidi.2024.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/12/2023] [Accepted: 01/05/2024] [Indexed: 04/09/2024] Open
Abstract
Intralesional therapies are used for recalcitrant warts, but no Food and Drug Administration-approved treatment exists nor is there consensus regarding the most efficacious therapy. Therefore, this systematic review aims to summarize efficacy and adverse events reported in 62 randomized controlled trials (RCTs) of intralesional therapies for cutaneous warts. The most studied intralesional therapies included measles, mumps, rubella (MMR) vaccine (n = 24 studies), purified protein derivative (PPD) (n = 19 studies), vitamin D3 (n = 15 studies), and Candida antigen (n = 14 studies). Most studies included adult and pediatric patients or adults alone, with only 4 studies on pediatric patients alone. MMR vaccine was the most studied treatment (n = 853 patients). MMR had a complete response rate of 27-90%. The next most common treatment, PPD, had a complete response rate of 45-87%. Other treatments included Candida antigen and vitamin D3, with complete response rates of 25-84% and 40-96%, respectively. The most frequent side effects were injection-site reactions and flu-like symptoms. This systematic review represents a useful summary of intralesional therapy RCTs for clinician reference. This study also highlights the lack of large multi-institutional RCTs, despite many patients being treated for this widespread problem.
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Affiliation(s)
- Sarah A. Mullen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emma L. Myers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rebecca L. Brenner
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kim T. Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tara A. Harper
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Darby Welsh
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Storm Keffer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jenna Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Melodi Javid Whitley
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
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4
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Xu Y, Wang Y, Huang K, Huang W, Zhao S, Jiang Z. Topical antimitotic treatments for plantar warts are more beneficial: A Bayesian network meta-analysis of randomized controlled trials. J Evid Based Med 2024; 17:37-53. [PMID: 38243639 DOI: 10.1111/jebm.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/10/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Plantar warts are common infectious cutaneous growths causing severe physiological and psychological discomforts in patients and heaving global financial burdens. However, paucity of clear-cut guidelines for plantar warts, selecting appropriate treatments for plantar warts remains challenging. The objective of the study is to evaluate the efficacy and safety of common treatments for plantar warts. METHODS PubMed, EMbase, and The Cochrane Library were searched from inception to March 1, 2023 for randomized controlled trials (RCTs) of plantar warts. The primary outcome (complete response) and secondary outcome (recurrence and pain) were extracted and combined using Bayesian network meta-analysis (NMA) with random-effect and fixed-effect models. RESULTS Totally, 33 RCTs were included in the systematic review and quantitative NMA. In NMA of complete response, topical application of 1% cantharidin, 20% podophylotoxin, 30% salicylic acid (CPS), microneedles plus bleomycin (MNB), and intralesional bleomycin injection (INB) were the only three treatments significantly superior to no treatment (NT) and CPS was of the highest possibility to be the top-ranked treatment (SUCRA = 0.9363). However, traditional warts treatments, salicylic acid (SA) and cryotherapy were not superior to NT. CONCLUSIONS The NMA has produced evidence for using CPS, MNB, and INB, which are all topical antimitotic treatments, to improve the management of plantar warts. The classic treatment modalities for plantar warts, including SA and cryotherapy, may play a less important role in the clinical practice of plantar warts.
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Affiliation(s)
- Yantao Xu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Ying Wang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Kai Huang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Weihong Huang
- Mobile Health Ministry of Education-China Mobile Joint Laboratory, Xiangya Hospital Central South University, Changsha, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Zixi Jiang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
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5
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Liu X, Qi M. The effectiveness of different immunotherapies in the treatment of condyloma acuminatum: a network meta-analysis of randomized clinical trials. Front Med (Lausanne) 2023; 10:1260139. [PMID: 38111698 PMCID: PMC10726203 DOI: 10.3389/fmed.2023.1260139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/06/2023] [Indexed: 12/20/2023] Open
Abstract
Background The treatment of condyloma acuminatum (CA), especially the very persistent and recurrent CA, is currently the focus of our research. Immunotherapies have recently been shown to be well-tolerated and effective in treating warts, particularly refractory warts. However, there is still a lack of corresponding evidence-based medical evidence on the effectiveness of different immunotherapies in treating warts. The difference between network meta-analysis and meta-analysis is that network meta-analysis can be used to compare multiple treatments by combining direct and indirect evidence to assess the interrelationship between all treatments. We intend to compare the efficacy of different treatments for CA using a network meta-analysis. Methods PubMed, Cochrane Library and Embase from inception to June 1st, 2023 were searched using a computer. All articles on immunotherapies for CA were included. Stata MP17.0 software was used for data analyses. Results A total of 8 randomly-controlled trials involving 493 patients were included. Result showed that all treatment measures had a significant efficacy compared with the regular saline group (BCG (bacillus Calmette-Guérin vaccine) OR = 96.00, 95%CI: 10.35-890.58; MMR (measle, mumps and rubella vaccine) OR = 29.69, 95%CI: 7.47-118.04; Candida antigens OR = 27.34, 95%CI: 8.64-86.52; PPDs (purified protein derivatives) OR = 23.33, 95%CI: 6.75-80.60; VD3 OR = 21.36, 95%CI: 4.34-105.16 and purified protein derivatives (general) OR = 13.14, 95%CI: 3.38-51.12). The area under the curve (SUCRA) ranking results showed that the bacillus Calmette-Guérin vaccine had the highest total efficiency, which was 88.2%, with the rest in the order of measle, mumps and rubella vaccine, which was 68.9%, Candida antigens, which was 63.6%, purified protein derivatives, which was 52.9%, vitamin D3, which was 49.0%, purified protein derivatives (general), which was 27.4%, and saline, which was 0%. Conclusion In summary, we found that the bacillus Calmette-Guérin vaccine was superior to other treatments in terms of efficacy according to the SUCRA value.
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Affiliation(s)
| | - Manli Qi
- Department of Dermatology, Tianjin Union Medical Center, Tianjin, China
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Nofal A, Nofal H, Alwirshiffani E, ElGhareeb MI. Treatment response and tolerability of intralesional quadrivalent versus bivalent human papillomavirus vaccine for recalcitrant warts: A randomized controlled trial. J Am Acad Dermatol 2023; 89:1051-1052. [PMID: 37422014 DOI: 10.1016/j.jaad.2023.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 05/26/2023] [Accepted: 06/04/2023] [Indexed: 07/10/2023]
Affiliation(s)
- Ahmad Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hagar Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Biotechnology Program, School of Sciences and Engineering, the American University in Cairo, Cairo, Egypt.
| | - Esam Alwirshiffani
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Mohamed I ElGhareeb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Mahmoud AY, Neagu D, Scrimieri D, Abdullatif ARA. Early diagnosis and personalised treatment focusing on synthetic data modelling: Novel visual learning approach in healthcare. Comput Biol Med 2023; 164:107295. [PMID: 37557053 DOI: 10.1016/j.compbiomed.2023.107295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023]
Abstract
The early diagnosis and personalised treatment of diseases are facilitated by machine learning. The quality of data has an impact on diagnosis because medical data are usually sparse, imbalanced, and contain irrelevant attributes, resulting in suboptimal diagnosis. To address the impacts of data challenges, improve resource allocation, and achieve better health outcomes, a novel visual learning approach is proposed. This study contributes to the visual learning approach by determining whether less or more synthetic data are required to improve the quality of a dataset, such as the number of observations and features, according to the intended personalised treatment and early diagnosis. In addition, numerous visualisation experiments are conducted, including using statistical characteristics, cumulative sums, histograms, correlation matrix, root mean square error, and principal component analysis in order to visualise both original and synthetic data to address the data challenges. Real medical datasets for cancer, heart disease, diabetes, cryotherapy and immunotherapy are selected as case studies. As a benchmark and point of classification comparison in terms of such as accuracy, sensitivity, and specificity, several models are implemented such as k-Nearest Neighbours and Random Forest. To simulate algorithm implementation and data, Generative Adversarial Network is used to create and manipulate synthetic data, whilst, Random Forest is implemented to classify the data. An amendable and adaptable system is constructed by combining Generative Adversarial Network and Random Forest models. The system model presents working steps, overview and flowchart. Experiments reveal that the majority of data-enhancement scenarios allow for the application of visual learning in the first stage of data analysis as a novel approach. To achieve meaningful adaptable synergy between appropriate quality data and optimal classification performance while maintaining statistical characteristics, visual learning provides researchers and practitioners with practical human-in-the-loop machine learning visualisation tools. Prior to implementing algorithms, the visual learning approach can be used to actualise early, and personalised diagnosis. For the immunotherapy data, the Random Forest performed best with precision, recall, f-measure, accuracy, sensitivity, and specificity of 81%, 82%, 81%, 88%, 95%, and 60%, as opposed to 91%, 96%, 93%, 93%, 96%, and 73% for synthetic data, respectively. Future studies might examine the optimal strategies to balance the quantity and quality of medical data.
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Affiliation(s)
- Ahsanullah Yunas Mahmoud
- Faculty of Engineering and Informatics, University of Bradford, Bradford, England, United Kingdom.
| | - Daniel Neagu
- Faculty of Engineering and Informatics, University of Bradford, Bradford, England, United Kingdom
| | - Daniele Scrimieri
- Faculty of Engineering and Informatics, University of Bradford, Bradford, England, United Kingdom
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Chaudhary M, Brar A, Agarwal P, Chavda V, Jagati A, Rathod SP. A Study of Comparison and Evaluation of Various Intralesional Therapies in Cutaneous Warts. Indian Dermatol Online J 2023; 14:487-492. [PMID: 37521234 PMCID: PMC10373804 DOI: 10.4103/idoj.idoj_492_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/15/2023] [Accepted: 03/12/2023] [Indexed: 08/01/2023] Open
Abstract
Background The study compares the efficacy of four immunotherapeutic agents, measles mumps and rubella (MMR), purified protein derivative (PPD), Candida extract, and vitamin D3, in the treatment of multiple cutaneous warts. Aim and Objectives To observe the clinical responses and safety of different intralesional immunotherapeutic agents and compare their efficacy. Materials and Methods Hundred patients with multiple (>5) cutaneous warts were enrolled in the study and randomized into four groups: Group A: MMR, Group B: PPD, Group C: Candida extract, and Group D: Vitamin D. Target wart was selected, and the intralesional injections were given at three weekly intervals for a maximum of three doses. Response was observed in target and distant warts three months after the last injection. Results Intralesional vitamin D3 had the highest efficacy, while MMR had the lowest efficacy in clearance of target wart. Intralesional Candida extract had the highest efficacy, while vitamin D3 had the lowest efficacy in clearance of distant warts. Intralesional Candida extract was the most effective treatment for both local and distant warts. Side effects were minimal and transitory in nature. Conclusion Intralesional immunotherapy is a safe, affordable, and efficacious treatment for warts.
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Affiliation(s)
- Malay Chaudhary
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Arwinder Brar
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Pooja Agarwal
- Department of Dermatology, S.V.P. Hospital, Near Ellis-Bridge, Paladi, Ahmedabad, Gujarat, India
| | - Vruti Chavda
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Ashish Jagati
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Santoshdev P. Rathod
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
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Lahoria U, Singh S, Bhardwaj A, Budania A, Chhajed N, Rajagopal SV, Singh S. A prospective randomized controlled study of Mycobacterium Indicus Pranii vaccine, Measles Mumps Rubella vaccine and Vitamin D3 in extragenital cutaneous warts. J Cosmet Dermatol 2023; 22:1400-1409. [PMID: 36762385 DOI: 10.1111/jocd.15564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 02/11/2023]
Abstract
DESIGN Interventional, prospective, four arm randomized control. SETTING Outpatient department, Department of Dermatology, Venereology and Leprology, AIIMS Jodhpur (Rajasthan), India. PARTICIPANTS Two hundred patients. METHODS The intervention administered in the groups were normal saline (A), vitamin D3 (B), MIP (C), and MMR (D). The injections were given into the largest wart at 2-weekly intervals until complete clearance or for a maximum of seven sittings. Post-treatment clearance of the injected wart and the distant wart was compared on the basis of change in wart number, percentage clearance, and mean time to complete clearance. Side effects were recorded. RESULTS A total of 197 patients were recruited. The mean percentage improvement in the injected and non-injected warts was 68.4% and 66.8%, respectively. Intention to treat analysis (ITT) showed that complete clearance of lesions in injected wart occurred in placebo, vit D3 , MMR, and MIP arms in 64%, 66%, 58%, and 55% patients, respectively (p > 0.05), while in the non-injected warts in 62%, 64%, 52%, and 53%, respectively (p > 0.05). The mean time to achieve complete clearance of wart was fastest in MIP at 7.1 weeks followed by MMR at 7.2 weeks, VIT D3 at 7.4 weeks and in placebo group 7.8 weeks (p > 0.05). Side effects noted were fever, pain, erythema, and swelling which was highest in VIT D3 group (p < 0.05). CONCLUSION The efficacy of immunotherapies was comparable to placebo with minimal side effects.
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Affiliation(s)
- Utkrist Lahoria
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Singh
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Bhardwaj
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anil Budania
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neelam Chhajed
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
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Awad SM, Gomaa AS, Hassan HA, Tawfik YM. Efficacy of Cryotherapy Combined With Intralesional Purified Protein Derivative (PPD) Versus Intralesional PPD Monotherapy in the Treatment of Multiple Common Warts. J Cutan Med Surg 2023; 27:117-125. [PMID: 36705474 DOI: 10.1177/12034754231152224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Intralesional antigen immunotherapy represents a promising therapeutic approach for the treatment of different types of warts, particularly if multiple and/or recalcitrant. AIM to investigate the efficacy and safety of combined cryotherapy with intralesional purified protein derivative (PPD) immunotherapy in the treatment of multiple common warts. METHODS Fifty patients were randomly divided into two groups (25 patients each): Group A: receiving intralesional PPD immunotherapy for the largest wart, while group B: receiving cryotherapy for all warts plus intralesional PPD for the largest wart. Treatments were performed every 2 weeks for a maximum of four sessions. Photographs were taken at baseline and at each visit and clinical response was evaluated by the reduction in number and size of warts. Adverse effects were recorded. RESULTS There was a significant reduction in size and number of warts in both groups (P < .001), with no significant difference between the two groups. Complete clearance of the lesions was observed in 48% of patients in group A and 44% in group B (P = .39). Higher rates of near complete/complete response were achieved after fewer sessions (2, 3 sessions) in group B (P = .002). Blistering was common after cryotherapy. Higher rate of hypopigmentation was noticed after combined treatment than after PPD monotherapy (56%, 8% respectively; P < .001), which resolved gradually. CONCLUSION Both intralesional PPD alone and combined cryotherapy with PPD are safe and effective in clearing of common warts. Cryotherapy may be a successful adjunct to intralesional PPD immunotherapy that helps in reducing the number of treatment sessions.The study protocol was registered at ClinicalTrials.gov with ID: NCT04288817.
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Affiliation(s)
- Sara M Awad
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed S Gomaa
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Hiba A Hassan
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Yasmin M Tawfik
- 68866 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Ju HJ, Park HR, Kim JY, Kim GM, Bae JM, Lee JH. Intralesional immunotherapy for non-genital warts: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2022; 88:724-737. [DOI: 10.25259/ijdvl_1369_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/01/2022] [Indexed: 12/30/2022]
Abstract
Background
Intralesional immunotherapy has been reported to be effective for warts and to show good safety profiles, but this has not yet been systematically studied.
Aims
To determine the efficacy and safety of intralesional immunotherapy for treating non-genital warts.
Methods
We comprehensively searched the MEDLINE, Embase, Web of Science and Cochrane Library databases from the times of their inception to January 3, 2020. The primary outcome was the rate of complete response of all lesions. The distant complete response rate of warts located in an anatomically different body part and the recurrence rate were also analyzed.
Results
A total of 54 prospective studies was ultimately included. The immunotherapeutic agents used were Mycobacterium w vaccine, measles, mumps and rubella vaccine, purified protein derivative, Candida antigen, interferon, bacillus Calmette-Guérin vaccine and others. The pooled rate of complete response among all patients with non-genital warts treated using intralesional immunotherapy was 60.6% (95% confidence interval 54.8–66.5%). The pooled recurrence rate was 2.0% (95% confidence interval, 1.1–2.9%). All reported adverse events were mild and transient.
Limitations
The heterogeneity among studies
Conclusion
Intralesional immunotherapy is suggested for use in patients with multiple warts, given its promising results, good safety profile and low recurrence rate.
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Al-Qassabi AM, Al Kindi A. Intralesional Immunotherapy with Measles-Mumps-Rubella Vaccine for Recalcitrant Facial Warts: A Report of Two Cases. Oman Med J 2022; 37:e353. [PMID: 35356369 PMCID: PMC8941530 DOI: 10.5001/omj.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/29/2020] [Indexed: 11/03/2022] Open
Abstract
Warts are common benign skin tumors caused by human papilloma viruses. Recalcitrant facial warts tend to be cosmetically embarrassing to patients and difficult to treat for doctors. Recently, intralesional immunotherapy by antigens like Bacille Calmette-Guerin vaccine, candida antigen, and measles, mumps, and rubella (MMR) vaccine has shown promising efficacy. Here, we report two cases of Omani men who presented with recalcitrant facial warts that resolved completely with a single intralesional injection of the MMR vaccine.
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Mohta A, Jain S, Mehta R, Arora A. Intralesional purified protein derivative of tuberculin versus intralesional mycobacterium W vaccine in treatment of recalcitrant extragenital warts: A randomized, single-blinded, comparative study. Indian J Dermatol 2022; 67:26-30. [PMID: 35656274 PMCID: PMC9154150 DOI: 10.4103/ijd.ijd_521_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wan Ahmad Kammal WSL, Jamil A, Md Nor N. Efficacy and safety of intralesional tuberculin purified protein derivative versus cryotherapy in the treatment of warts: An assessor-blinded, randomized controlled trial. Dermatol Ther 2021; 34:e15080. [PMID: 34351693 DOI: 10.1111/dth.15080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/20/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
Cryotherapy is a standard treatment for warts. Tuberculin immunotherapy is a novel therapeutic option. We compared the efficacy and safety of cryotherapy versus tuberculin immunotherapy in a randomized, assessor-blinded study. 15 patients were treated with intralesional tuberculin and 15 patients received cryotherapy every 2 weeks until complete wart resolution or a maximum of six sessions. Wart diameter, total number of warts and adverse effects were documented. Complete clearance of treated warts was achieved in 13(86.7%) and 11(73.3%) of patients with immunotherapy and cryotherapy respectively. Immunotherapy showed greater wart size reduction (51.88 ± 89.36 mm) than cryotherapy (32.99 ± 36.19 mm), (p = 0.46). Immunotherapy resulted in 64% reduction in total number of warts compared to 23.2% with cryotherapy, p < 0.01. More blisters developed with cryotherapy (46.7%) than immunotherapy (6.7%), (p = 0.01). Compartment syndrome-like features complicate immunotherapy in 1 patient. Tuberculin immunotherapy and cryotherapy are equally effective in treating warts. Immunotherapy has added benefit with resolution of distant warts. Safety profiles were similar except for blisters which were more common with cryotherapy.
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Affiliation(s)
| | - Adawiyah Jamil
- Dermatology Unit, Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
| | - Norazirah Md Nor
- Dermatology Unit, Department of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Centre, Kuala Lumpur, Malaysia
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Sarsik SM, Soliman SH. Psoriasis Exacerbation after Candida Antigen Immunotherapy Injection. Skin Appendage Disord 2021; 7:212-215. [PMID: 34055910 DOI: 10.1159/000512568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 10/23/2020] [Indexed: 12/24/2022] Open
Abstract
Background Immunotherapy as wart treatment has been proposed as a successful and well-tolerated treatment option. However, as their action is not confined to the site of injection, the activation of the immune system in a way may alter the immune state of the patient. Case Presentation A case of 29-year-old patient who experienced psoriasis exacerbation and psoriatic arthritis within days following Candida antigen immunotherapy injection for resistant filiform wart management. Conclusion Candida antigen injection may cause psoriasis exacerbation, as TNFα and subsequent T-helper 1 induction is crossroad in both psoriasis and Candida antigen immunotherapy. Therefore, we report this case to state that besides the effectiveness of Candida antigen for wart therapy, caution should be considered if used in patients who are susceptible to psoriasis with meticulous follow-up or better to apply an alternative treatment option.
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Affiliation(s)
- Sameh Magdy Sarsik
- Dermatology and Venereology department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sarah Hamdy Soliman
- Dermatology and Venereology department, Faculty of Medicine, Tanta University, Tanta, Egypt
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16
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Salman S, S A Shehata M, Ibrahim AM, Awad M, Sarsik S, El-Shirbiny H, Fathi M, Agha NY, Anis R, Abdel Daim MM. Efficacy of retinoids alone or in combination with other remedies in the management of warts: A systematic review and network meta-analysis. Dermatol Ther 2021; 34:e14793. [PMID: 33480148 DOI: 10.1111/dth.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
The use of combined systemic retinoids and intralesional immunotherapy in the management of warts is still debatable without straightforward evidence. Through network meta-analysis, the current study evaluated the efficacy and safety of systemic retinoids alone or combined with other remedies in the treatment of warts. We searched six literature databases for clinical trials that compared systemic retinoids to local treatments or placebo in wart management. Outcomes were calculated as odds ratios (OR) with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses (with a frequentist approach). Network meta-analysis of eight trials showed that oral acitretin plus intralesional Candida Ag (OR = 367.71), INF-α plus oral isotretinoin (OR = 223.77), oral acitretin (OR = 117), Candida Ag (OR = 91.93), oral isotretinoin (OR = 62.26) and topical isotretinoin (OR = 17.69) had higher complete recovery rates than placebo. Regarding the P-score, oral acitretin plus intralesional Candida Ag had the highest efficacy in achieving complete response (P-score = 0.88), followed by INF-α plus oral isotretinoin (P-score = 0.79), then oral acitretin (P-score = 0.60). Variable baseline characteristics and lack of data on some outcomes. The current study shows the efficacy for systemic retinoids in the treatment of warts, especially reluctant or recurrent types. Moreover, combinations of systemic retinoids with intralesional immunotherapy yield higher rates of complete clearance with lower recurrence.
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Affiliation(s)
- Samar Salman
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University Hospital, Tanta University, Tanta, Egypt
| | | | | | - Mina Awad
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Sameh Sarsik
- Faculty of Medicine, Department of Dermatology and Venereology, Tanta University Hospital, Tanta University, Tanta, Egypt
| | | | - Mohamed Fathi
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | | | - Ruba Anis
- Kasr Al-Ainy Medical School, Cairo University, Cairo, Egypt
| | - Mohamed M Abdel Daim
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia.,Pharmacology Department, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, Egypt
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Nofal A, El-Arab RE, Nasr M, Alakad R. Intralesional Measles, Mumps, and Rubella Vaccine Versus Intralesional Candida Antigen in the Treatment of Common and Plantar Warts. J Cutan Med Surg 2021; 25:377-383. [PMID: 33533654 DOI: 10.1177/1203475421991130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited. OBJECTIVE To evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts. METHODS Sixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. RESULTS The overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period. CONCLUSION Intralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.
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Affiliation(s)
- Ahmad Nofal
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt.,Interactive Dermatology Research Group, Interactive Dermatology Foundation, Cairo, Egypt
| | - Reda Ezz El-Arab
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
| | - Mohamed Nasr
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
| | - Rania Alakad
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt.,Interactive Dermatology Research Group, Interactive Dermatology Foundation, Cairo, Egypt
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18
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Kadnur M, Jartarkar S, Mamatha P, Mishra S, Spoorthy B. A comparative study of therapeutic efficacy of intralesional measles, mumps, and rubella vaccine and intralesional Vitamin D3 in the treatment of recurrent warts. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2021. [DOI: 10.4103/jdds.jdds_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Kaur A, Brar BK, Kumar S, Brar SK, Boparai AS, Puri N. A Randomized Comparative Study of MIP and MMR Vaccine for the Treatment of Cutaneous Warts. Indian J Dermatol 2021; 66:151-158. [PMID: 34188270 PMCID: PMC8208270 DOI: 10.4103/ijd.ijd_700_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate and compare the efficacy of MMR vaccine and MIP vaccine for resolution of Cutaneous warts (Cw). Methods The hospital-based prospective randomized interventional study was done where a total of 60 patients of Cw were divided into two groups of 30 patients each: Group A received 0.1 ml of intralesional injection of MIP vaccine and Group B received 0.5 ml of MMR vaccine. The treatment protocol involved three intralesional injection of vaccines at intervals of 3 weeks (maximum of three injections). The follow-up was done every 4 weeks for at least 24 weeks for the comparison of the two groups. The primary outcomes were the decrease in size of the wart or clearance of primary warts. The secondary outcomes were the improvement in the distant warts and any complications related to the use of vaccines. The data were entered in MS Excel and analyzed using SPSS 17.0 version. A P value of <0.05 was considered statistically significant. Results The baseline demographic and wart characteristics were comparable between the two groups (P > 0.05). As compared to MMR, MIP showed an early (9.41 vs 11.71 weeks, P = 0.027), and a significantly higher complete response (90% vs 76.67%) with P < 0.05. The less duration of the warts was significantly associated with the higher complete response (P < 0.05) in both the groups. The common side effects were erythema/inflammation [19 (63.34%)] in Group A and pain during the injection [19 (63.34%)] in Group B with P < 0.0001. Conclusion In conclusion, MIP intralesional injections have a quicker response and are more efficacious compared to MMR in the treatment of Cw, though each vaccine carries its own sets of side effects.
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Affiliation(s)
- Amandeep Kaur
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Balvinder Kaur Brar
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Sumir Kumar
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | | | - Amarbir Singh Boparai
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Neerja Puri
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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20
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Latif I, Sultan J, Aslam A, Hassan I, Devi R. Role of intralesional vitamin D3 in the treatment of cutaneous warts. J Cutan Aesthet Surg 2021; 14:404-408. [PMID: 35283599 PMCID: PMC8906267 DOI: 10.4103/jcas.jcas_170_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Cutaneous warts are common benign skin lesions caused by human papillomavirus. Various treatment options are available for these but immunotherapy is becoming more and more popular over the past few years. It stimulates cell-mediated immunity causing clearance of warts. Aims and Objectives: The aim is to determine the role of intralesional vitamin D3 in the treatment of warts. Materials and Methods: Consecutive patients with verruca vulgaris attending OPD were included. Around two to three warts were injected first with 0.2 mL of lignocaine (20 mg/mL). After a few minutes, the same warts were injected with 0.2 mL (4 U) of vitamin D3 (15 mg/mL). The injections were given2 weeks apart for a maximum of six sessions, and the patient was followed up 3 months after the last injection. Results: A total of 41 patients of cutaneous warts completed the study. Complete clearance was seen in 27 (65.85%) patients, partial response was seen in 11 (26.83%) patients, and three patients (7.32%) showed no response at all. The mean number of injections required for complete response was four. Recurrence was seen in two patients (4.88%) and one patient had keloid formation at the sight of injection. Limitation: This is a small sample sized study and lacks a control group. Conclusion: Intralesional vitamin D3 is an effective treatment option for common warts.
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21
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Mohammed YF, Ibrahim HS, Elbarbary MA, Elsaie ML. Comparative study of intralesional tuberculin protein purified derivative (PPD) and intralesional measles, mumps, rubella (MMR) vaccine for multiple resistant warts. J Cosmet Dermatol 2020; 20:868-874. [PMID: 33118675 DOI: 10.1111/jocd.13634] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cutaneous warts are frequent conditions that possess much challenge to treat. OBJECTIVE To evaluate safety and efficacy of intralesional injection of tuberculin purified protein derivative (PPD) antigen injection vs MMR (mumps, measles, rubella) antigen for the treatment of multiple warts. METHODS The study included 90 Patients who were divided into three groups (A, B, and C). Each group consisted of (30) patients. Group (A) subjects received intralesional PPD injections. Group (B) subjects received intralesional MMR antigen injection and Group (C) received intralesional saline injection. RESULTS Full clearance of warts was observed in 18 (60%) of patients in group (A) (70%) vs 24 patients (80%) in group (B). Distal warts completely disappeared in 18 (60%) of patients in group A and 12 (40%) of patients in group B. Infrequent side effects including pain, erythema, and minimal induration were reported in both groups. CONCLUSION We established a good safety and efficacy profile for tuberculin PPD and MMR antigens in resistant wart treatment.
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Affiliation(s)
| | - Hany S Ibrahim
- Department of Dermatology, Al Azhar University, Cairo, Egypt
| | | | - Mohamed L Elsaie
- Department of Dermatology, National Research Centre, Giza, Egypt
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22
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Abuo-Rahma GEDA, Mohamed MFA, Ibrahim TS, Shoman ME, Samir E, Abd El-Baky RM. Potential repurposed SARS-CoV-2 (COVID-19) infection drugs. RSC Adv 2020; 10:26895-26916. [PMID: 35515773 PMCID: PMC9055522 DOI: 10.1039/d0ra05821a] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 01/09/2023] Open
Abstract
The global outbreak of COVID-19 viral infection is associated with the absence of specific drug(s) for fighting this viral infection. About 10 million people are already infected, about 500 000 deaths all over the world to date. Great efforts have been made to find solutions for this viral infection, either vaccines, monoclonal antibodies, or small molecule drugs; this can stop the spread of infection to avoid the expected human, economic and social catastrophe associated with this infection. In the literature and during clinical trials in hospitals, several FDA approved drugs for different diseases have the potential to treat or reduce the severity of COVID-19. Repurposing of these drugs as potential agents to treat COVID-19 reduces the time and cost to find effective COVID-19 agents. This review article summarizes the present situation of transmission, pathogenesis and statistics of COVID-19 in the world. Moreover, it includes chemistry, mechanism of action at the molecular level of the possible drug molecules which are liable for redirection as potential COVID-19 therapeutic agents. This includes polymerase inhibitors, protease inhibitors, malaria drugs, lipid lowering statins, rheumatoid arthritis drugs and some miscellaneous agents. We offer research data and knowledge about the chemistry and biology of potential COVID-19 drugs for the research community in this field.
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Affiliation(s)
- Gamal El-Din A Abuo-Rahma
- Department of Medicinal Chemistry, Faculty of Pharmacy, Minia University 61519 Minia Egypt +20 1003069431
| | - Mamdouh F A Mohamed
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Sohag University 82524 Sohag Egypt
| | - Tarek S Ibrahim
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, King Abdulaziz University Jeddah 21589 Saudi Arabia
- Department of Pharmaceutical Organic Chemistry, Faculty of Pharmacy, Zagazig University Zagazig 44519 Egypt
| | - Mai E Shoman
- Department of Medicinal Chemistry, Faculty of Pharmacy, Minia University 61519 Minia Egypt +20 1003069431
| | - Ebtihal Samir
- Physical Chemistry, Department of Analytical Chemistry, Faculty of Pharmacy, Deraya University Minia 11566 Egypt
| | - Rehab M Abd El-Baky
- Department of Microbiology and Immunology, Faculty of Pharmacy, Minia University 61519 Minia Egypt
- Department of Microbiology and Immunology, Faculty of Pharmacy, Deraya University Minia 11566 Egypt
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Significantly Improved COVID-19 Outcomes in Countries with Higher BCG Vaccination Coverage: A Multivariable Analysis. Vaccines (Basel) 2020; 8:vaccines8030378. [PMID: 32664505 PMCID: PMC7563451 DOI: 10.3390/vaccines8030378] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/03/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
The COVID-19 pandemic that started in China has spread within 3 months to the entire globe. We tested the hypothesis that the vaccination against tuberculosis by Bacille Calmette–Guérin vaccine (BCG) correlates with a better outcome for COVID-19 patients. Our analysis covers 55 countries complying with predetermined thresholds on the population size and number of deaths per million (DPM). We found a strong negative correlation between the years of BCG administration and the DPM along with the progress of the pandemic, corroborated by permutation tests. The results from multivariable regression tests with 23 economic, demographic, health-related, and pandemic restriction-related quantitative properties, substantiate the dominant contribution of BCG years to the COVID-19 outcomes. The analysis of countries according to an age-group partition reveals that the strongest correlation is attributed to the coverage in BCG vaccination of the young population (0–24 years). Furthermore, a strong correlation and statistical significance are associated with the degree of BCG coverage for the most recent 15 years, but no association was observed in these years for other broadly used vaccination protocols for measles and rubella. We propose that BCG immunization coverage, especially among the most recently vaccinated population, contribute to attenuation of the spread and severity of the COVID-19 pandemic.
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Fawzy MM, Nofal A, Alakad R. Intralesional antigen immunotherapy for the treatment of plane warts: A comparative study. Dermatol Ther 2020; 33:e13807. [PMID: 32530550 DOI: 10.1111/dth.13807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 11/30/2022]
Abstract
Intralesional immunotherapy by different antigens has shown promising efficacy and safety in the treatment of warts. However, the use of these antigens for the treatment of plane warts has been investigated in two studies only. To evaluate the efficacy and safety of three antigens; Measles Mumps, Rubella vaccine (MMR), Candida antigen, and purified protein derivative (PPD) in the treatment of multiple plane warts. The study included 120 patients who were randomly assigned to three groups, 40 patients in each group. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of five sessions. Complete clearance of warts was observed in 55% of the PPD group, in 70% of the Candida antigen group, and in 62.5% of the MMR group. No statistically significant difference in the therapeutic response was found between the three groups. Intralesional antigen immunotherapy seems to be a promising well-tolerated and effective therapeutic option for the treatment of multiple plane warts, with relatively higher efficacy of Candida antigen.
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Affiliation(s)
- Mohamed M Fawzy
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Tanta University, Tanta, Egypt
| | - Ahmad Nofal
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Zagazig University, Zagazig, Egypt
| | - Rania Alakad
- Faculty of Medicine, Department of Dermatology, Venereology, and Andrology, Zagazig University, Zagazig, Egypt
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Feng C, Li W, Wang X, Zhang H, Si L, Chen Z, Bai M. A systematic review evaluating the efficacy and safety of a combination of ablative treatment and self administered treatment versus ablative treatment alone for external anogenital warts. Int J Dermatol 2020; 59:1210-1216. [PMID: 32297994 DOI: 10.1111/ijd.14863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/13/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND External anogenital warts are proliferative lesions. Till now, there is no consensus on the standard treatment of external anogenital warts. The combination of ablative therapy and self-administered treatment has been reported to achieve sustained complete clearance than ablative therapy. The aim of this review was to compare the efficacy on achieving complete clearance of warts between the combination of ablative therapy with self-administered therapy and ablative therapy alone. METHODS We conducted a systematic review to evaluate the efficacy and safety of the combination of ablative therapy and self-administered treatment for external anogenital warts. The Cochrane Central Register of Controlled Trials, Medline, Embase and Science Citation Index Expanded, China National Knowledge Infrastructure and Wanfang were searched. RESULTS Of 1138 initially identified publications, 37 studies in English and Chinese were included. The combination of ablative therapy and self-administered treatment therapy showed significantly high complete clearance rates at 4, 8, 12, or 24 weeks after treatment compared to ablative therapy alone. In a subgroup analysis based on the treatment duration of imiquimod cream therapy, 4 and 8 weeks of imiquimod 5% cream plus CO2 laser produced similar efficacy on clearance. The combination therapy is tolerable for patients. CONCLUSIONS In conclusion, this review provided evidence to support the use of the combination of ablative therapy and self-administered treatment for external anogenital warts to maintain sustained clearance.
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Affiliation(s)
- Cheng Feng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Li
- Cancer Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Hailin Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Loubin Si
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhixiong Chen
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ming Bai
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Salman S, Salem ML. Routine childhood immunization may protect against COVID-19. Med Hypotheses 2020; 140:109689. [PMID: 32240961 PMCID: PMC7270579 DOI: 10.1016/j.mehy.2020.109689] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Samar Salman
- Department of Dermatology and Venereology, Tanta University Hospital, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Mohamed Labib Salem
- Department of Zoology, Faculty of Science, Immunology and Biotechnology Unit, Center of Excellence in Cancer Research, Tanta University Teaching Hospital, Tanta University, Tanta, Egypt
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Leerunyakul K, Thammarucha S, Suchonwanit P, Rutnin S. A comprehensive review of treatment options for recalcitrant nongenital cutaneous warts. J DERMATOL TREAT 2020; 33:23-40. [PMID: 32116076 DOI: 10.1080/09546634.2020.1737635] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: The treatment of recalcitrant nongenital cutaneous warts has always been challenging for dermatologists as they often recur and relapse. Multiple treatment options have been investigated to improve the outcome. This review provides an overview of the current treatment modalities and summarizes the efficacy and side effects of each treatment option for recalcitrant nongenital cutaneous warts.Methods: A PubMed search was performed through July 2019 to include all English language reports investigating the treatment for recalcitrant nongenital cutaneous warts, regardless of design.Results: A total of 144 studies were included in this review. The treatment options for recalcitrant nongenital cutaneous warts can be divided into three groups: destructive treatment, immunotherapy, and cytotoxic agents. Although both destructive therapies and cytotoxic agents demonstrated high complete response rates, immunotherapy, which is a minimally invasive method, was superior in terms of the clearance of distant warts. Intralesional mumps-measles-rubella injections and purified protein derivatives currently demonstrate high efficacy with well-established clinical evidence.Conclusions: Many upcoming treatment modalities, especially immunotherapy, are promising. However, more comparative studies are required to verify the efficacy and safety profile.
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Affiliation(s)
- Kanchana Leerunyakul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Thammarucha
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kaimal S, Gopinath H, Premalatha V. Intralesional immunotherapy with purified protein derivative (PPD) for cryotherapy-resistant warts. Int J Dermatol 2020; 59:726-729. [PMID: 32112396 DOI: 10.1111/ijd.14839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/22/2019] [Accepted: 02/11/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Cryotherapy and immunotherapeutic modalities elicit nonspecific immune response against the human papillomavirus. There is a paucity of literature on the effects of a sequential shift to immunotherapy in cryotherapy-resistant warts. AIM To study the efficacy of intralesional purified protein derivative (PPD) immunotherapy in cryotherapy-resistant warts. METHODS Patients with cryotherapy-recalcitrant cutaneous warts were given intralesional injections of PPD into the index warts (oldest or largest) at 2-week intervals until complete clearance or up to a maximum of six injections. The response in the treated index and distant warts was defined as complete, partial, and no response (<25%). Complete responders were followed up for another 3 months to check for recurrence. RESULTS Twenty-eight patients completed the study protocol. Of the eight patients with single warts, four (50%), one (12.5%), and three (37.5%) patients had complete, partial, and no response, respectively. Of the 20 patients with multiple warts, nine (45%) had complete clearance of all warts, two (10%) each had complete and partial response in the index wart, respectively, with no response of the distant warts, and seven (35%) had no response in all warts. Complete response was seen in an average of 3.1 injections (range 1-5). There was no recurrence at the follow-up visit. CONCLUSION Immunotherapy with PPD has potential in producing regional and remote wart regression even in cryotherapy-resistant warts. It is a safe and economical modality in children, multiple warts, and difficult-to-treat warts.
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Affiliation(s)
- Sowmya Kaimal
- Department of Dermatology, Venereology and Leprosy, St. Johns Medical College and Hospital, Bangalore, India
| | - Hima Gopinath
- Department of Dermatology, All India Institute of Medical Sciences, Andhra Pradesh, India
| | - Venkatesh Premalatha
- Department of Dermatology, Venereology and Leprosy, St. Johns Medical College and Hospital, Bangalore, India
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Response to “Purified protein derivative as intralesional immunotherapy for treatment of warts: Selection of the appropriate population is crucial”. J Am Acad Dermatol 2019; 81:e103. [DOI: 10.1016/j.jaad.2019.05.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 11/22/2022]
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Nazarian RS, McLellan BN. Purified protein derivative as intralesional immunotherapy for treatment of warts: Selection of the appropriate population is crucial. J Am Acad Dermatol 2019; 81:e101. [DOI: 10.1016/j.jaad.2019.05.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
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