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Le M, Conte S, Hsu JTS, Li MK. Energy-Based Devices for the Treatment of Cutaneous Verrucae: A Systematic Review. Dermatol Surg 2024; 50:345-353. [PMID: 38551277 DOI: 10.1097/dss.0000000000004069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Warts are one of the most common benign neoplasms caused by human papillomavirus infection and often pose a therapeutic challenge. OBJECTIVE To summarize the current evidence on the safety and efficacy of laser and energy-based devices for the treatment of cutaneous verrucae. METHODS A comprehensive systematic review of the literature on laser and energy-based devices for the treatment of cutaneous verrucae was performed. RESULTS A total of 904 unique studies were identified, of which 109 were included in this review. The most commonly used lasers as a single treatment modality for verrucae included the long-pulsed Nd:Yag (n = 20) and pulsed dye (n = 18) lasers. Other modalities included the CO2 ablative laser (n = 10), photodynamic therapy (n = 11), local hyperthermia (n = 11), microwave therapy (n = 2), and nanopulse stimulation (n = 1). Other studies combined energy-based modalities with additional treatments, such as retinoids, imiquimod, and intralesional bleomycin. Overall, such devices were generally well-tolerated, with only a mild side effect profile. CONCLUSION Overall, the use of laser and energy-based devices is a safe and well-tolerated option for cutaneous verrucae that is relatively less invasive than surgical interventions. Future studies using more consistent outcome assessment tools will be valuable to help clinicians develop device-specific protocols and treatment regimens to ensure replicable and effective outcomes.
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Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University, Québec, Canada
| | - Santina Conte
- Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Jeffrey T S Hsu
- Oak Dermatology, Itasca, Illinois
- Department of Dermatology, University of Illinois, Chicago, Illinois
| | - Monica K Li
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia
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Piccione M, Belloni Fortina A, Ferri G, Andolina G, Beretta L, Cividini A, De Marni E, Caroppo F, Citernesi U, Di Liddo R. Xeroderma Pigmentosum: General Aspects and Management. J Pers Med 2021; 11:1146. [PMID: 34834498 PMCID: PMC8624855 DOI: 10.3390/jpm11111146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 01/25/2023] Open
Abstract
Xeroderma Pigmentosum (XP) is a rare genetic syndrome with a defective DNA nucleotide excision repair. It is characterized by (i) an extreme sensitivity to ultraviolet (UV)-induced damages in the skin and eyes; (ii) high risk to develop multiple skin tumours; and (iii) neurologic alterations in the most severe form. To date, the management of XP patients consists of (i) early diagnosis; (ii) a long-life protection from ultraviolet radiation, including avoidance of unnecessary UV exposure, wearing UV blocking clothing, and use of topical sunscreens; and (iii) surgical resections of skin cancers. No curative treatment is available at present. Thus, in the last decade, in order to prevent or delay the progression of the clinical signs of XP, numerous strategies have been proposed and tested, in some cases, with adverse effects. The present review provides an overview of the molecular mechanisms featuring the development of XP and highlights both advantages and disadvantages of the clinical approaches developed throughout the years. The intention of the authors is to sensitize scientists to the crucial aspects of the pathology that could be differently targeted. In this context, the exploration of the process underlining the conception of liposomal nanocarriers is reported to focus the attention on the potentialities of liposomal technology to optimize the administration of chemoprotective agents in XP patients.
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Affiliation(s)
- Monica Piccione
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| | - Anna Belloni Fortina
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, 35128 Padova, Italy; (A.B.F.); (F.C.)
| | - Giulia Ferri
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Gloria Andolina
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Lorenzo Beretta
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Andrea Cividini
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Emanuele De Marni
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Francesca Caroppo
- Pediatric Dermatology Unit, Department of Medicine DIMED, University of Padova, 35128 Padova, Italy; (A.B.F.); (F.C.)
| | - Ugo Citernesi
- I.R.A. Istituto Ricerche Applicate S.p.A., 20865 Usmate Velate, Italy; (G.F.); (G.A.); (L.B.); (A.C.); (E.D.M.); (U.C.)
| | - Rosa Di Liddo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
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Conforti C, Vezzoni R, Giuffrida R, Fai A, Fadda S, Marangi GF, Persichetti P, Piccolo D, Segreto F, Zalaudek I, Dianzani C. An overview on the role of CO 2 laser in general dermatology. Dermatol Ther 2021; 34:e14692. [PMID: 33351990 DOI: 10.1111/dth.14692] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/18/2020] [Accepted: 12/11/2020] [Indexed: 12/27/2022]
Abstract
Among different laser types, the carbon dioxide (CO2 ) laser remains one of the most used by dermatologists. Its usefulness has been demonstrated both for therapeutic and cosmetic purposes. This review aims to provide an overview of the applications of CO2 laser in dermatology, focusing on the treatment of infective, neoplastic, and antiaesthetic lesions.
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Affiliation(s)
- Claudio Conforti
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Roberta Vezzoni
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Roberta Giuffrida
- Department of Clinical and Experimental Medicine, Dermatology, University of Messina, Messina, Italy
| | - Annatonia Fai
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Sara Fadda
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Giovanni Francesco Marangi
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Paolo Persichetti
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | | | - Francesco Segreto
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Iris Zalaudek
- Dermatology and Venereology Department, University of Trieste, Ospedale Maggiore di Trieste, Trieste, Italy
| | - Caterina Dianzani
- Plastic and Reconstructive Surgery Department, Dermatology Section, Campus Bio-Medico, University of Rome, Rome, Italy
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Puviani M, Manfredini M, Eisendle K. The SILVER study. Efficacy of topical nitric-zinc complex solution in the treatment of resistant warts: A postmarketing evaluation. Dermatol Ther 2019; 32:e12940. [PMID: 30990239 DOI: 10.1111/dth.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/06/2019] [Accepted: 04/13/2019] [Indexed: 11/29/2022]
Abstract
The treatment of cutaneous viral warts caused by human papillomavirus (HPV) infection is often subject to local recurrence and a long clinical and treatment course. Our aim was to analyze real-life data on the treatment of difficult-to-treat warts from a multicenter postmarketing surveillance assessment on the efficacy, tolerability, and safety of a commercially available nitric-zinc complex solution (NZCS). Dermatologists from 14 Italian centers completed a questionnaire about their clinical experience on treatment of "difficult-to-treat" warts, which included warts in the plantar, periungual, anogenital and aesthetically sensitive areas. The questionnaire was designed to obtain detailed information on wart treatment and compare NZCS efficacy with previous treatments. Of 106 questionnaires returned, 83 reported NZCS use; 67 had previous treatments (23 cryotherapy, 2 electrocoagulation, 12 other topical application, and 30 combined treatment, such as laser, cryotherapy, and/or electrocoagulation). NZCS had superior efficacy to that of previous treatments (p < .0001), resulting in 84.1% with a full or partial clearance (vs. 44.8% for previous treatments), and had better local tolerability (p < .0001). NZCS showed better efficacy and tolerability than other previous wart treatments.
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Affiliation(s)
- Mario Puviani
- Department of Dermatology, Dermatologic Surgery Unit, Nuovo Ospedale Civile, Modena, Italy
| | - Marco Manfredini
- Department of Dermatology, Dermatologic Surgery Unit, Nuovo Ospedale Civile, Modena, Italy
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Bolzano, Italy.,IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano, Italy
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Moon DS, Choi WY, Yoon NR, Kim DM. Granulomatous hepatitis in a healthy adult after bacillus Calmette-Guérin injection into a plantar wart. JAAD Case Rep 2017; 3:566-569. [PMID: 29159252 PMCID: PMC5683750 DOI: 10.1016/j.jdcr.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Do Sik Moon
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Na-Ra Yoon
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Mahajan RS, Shah AC, Nagar A, Freny BE. Treatment of facial lesions of multicentric reticulohistiocytosis by carbon dioxide laser. J Cutan Aesthet Surg 2013; 6:161-3. [PMID: 24163535 PMCID: PMC3800293 DOI: 10.4103/0974-2077.118423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The carbon dioxide (CO2) laser is a versatile tool that has applications in ablative lasing and caters to the needs of routine dermatological practice as well as the esthetic, cosmetic, and rejuvenation segments. We report a case of multicentric reticulohistiocytosis with cosmetically disfiguring confluent papules over the scalp, forehead, nasolabial folds, chin, and retroauricular region. We used CO2 laser in superpulse mode for ablating the lesions in three sittings. The lesions regressed completely and no recurrence was observed over a regular follow-up of 8 months.
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Affiliation(s)
- Rashmi S Mahajan
- Department of Dermatology, Sumandeep Vidhyapeeth, Piparia, Vadodara, Gujarat, India
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Majid I, Imran S. Immunotherapy with intralesional Candida albicans antigen in resistant or recurrent warts: a study. Indian J Dermatol 2013; 58:360-5. [PMID: 24082180 PMCID: PMC3778775 DOI: 10.4103/0019-5154.117301] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy with skin-test antigens has been used as a viable therapeutic option in such recalcitrant cases. AIM The aim of the study was to evaluate the response of resistant or recurrent warts to intralesional Candida albicans antigen immunotherapy. MATERIALS AND METHODS A total of 40 patients with resistant or recurrent warts who showed a positive test reaction to C. albicans antigen were given intralesional injections of purified C. albicans antigen solution in a single wart at 3-weekly intervals for a total of three doses. The patients were monitored for resolution of the injected wart as well as other untreated warts. The patients who responded positively were then followed up for any relapses over the next 6 months. Adverse events, if any, were also documented. RESULTS Of the 40 patients enrolled in the study, 34 completed the total treatment protocol of three injections and 6 months of follow-up. In these 34 patients, 19 (56%) showed a complete resolution of warts at all places on the body. In addition, two patients (6%) showed a partial or complete resolution of the treated wart, but there was no effect on the untreated warts. Thirteenpatients (38%) failed to show any response to the treatment regimen. In all patients showing resolution of all the warts, there were no relapses at any site over the next 6 months of follow-up. The most common adverse effect seen was pain during the intralesional injection. CONCLUSIONS Intralesional Candida immunotherapy seems to be an effective treatment option in more than half of the patients who fail to show a positive response to destructive modes of treatment or in whom there are multiple recurrences. LIMITATIONS The small sample size and lack of control group are the main limitations of the study.
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Affiliation(s)
- Imran Majid
- Departments of Dermatology and Venereology, Government Medical College, Srinagar, India
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Salem A, Nofal A, Hosny D. Treatment of common and plane warts in children with topical viable Bacillus Calmette-Guerin. Pediatr Dermatol 2013; 30:60-3. [PMID: 22958215 DOI: 10.1111/j.1525-1470.2012.01848.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Treatment of verrucae in children is difficult and may be painful using traditional methods, especially if they are multiple or on the face. The objective of the current study was to evaluate the efficacy and safety of topical application of viable Bacillus Calmette-Guérin (BCG) in a paste formula as a new immunotherapeutic modality in the treatment of common and plane warts in children. The present study included 80 children with common and plane warts at different sites on the body. They were divided into two groups. Group A (40 patients) received topical viable BCG and group B (40 patients) received topical saline as control. All patients and controls had received a previous vaccination of BCG. BCG was applied once weekly for six consecutive weeks. Patients who had partial or no response received another course of treatment for another 6 weeks. Follow-up was at 6 months to detect any recurrences. A highly significant difference was found between the therapeutic response of common and plane warts to BCG and saline (placebo) (p < 0.001). Complete response was achieved in 65% of children with common warts and 45% of patients with plane warts. No response was detected in the control group. No recurrences or side effects were observed in the BCG group. Topical immunotherapeutic BCG is a new, effective, safe treatment option for children with common and plane warts.
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Affiliation(s)
- Ahmed Salem
- Department of Dermatology and Venereology, Zagazig University, Zagazig, Egypt.
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Ho WL, Chan KC. Seborrheic keratosis of the external auditory canal. EAR, NOSE & THROAT JOURNAL 2012; 90:E26-7. [PMID: 22033969 DOI: 10.1177/014556131109001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Wan-Ling Ho
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, and School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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10
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Human Papillomavirus and Warts. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Klein A, Bäumler W, Landthaler M, Babilas P. Laser thermal therapy of benign skin tumours: Review and update. Int J Hyperthermia 2011; 27:762-70. [DOI: 10.3109/02656736.2011.599049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Culbertson GR. 532-nm diode laser treatment of seborrheic keratoses with color enhancement. Dermatol Surg 2008; 34:525-8; discussion 528. [PMID: 18248487 DOI: 10.1111/j.1524-4725.2007.34098.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Seborrheic keratoses (SKs) are benign cutaneous tumors of the epidermis. Localization in the head and neck areas can produce an unsightly appearance. Recurrence after curettage, shave excision, cryoablation, or chemical peel can be common. OBJECTIVE The objective was to determine if laser ablation with the 532-nm laser and color enhancement is effective in removing SKs. MATERIALS AND METHODS A total of 326 patients who presented with 1,567 benign SKs were treated with the DioLite (Iridex Corp.) and VersaPulse cosmetic (Coherent Inc.) 532-nm diode lasers with color enhancement using a red marker or ferric subsulfate. The DioLite was set at 27 to 30 J with a 2- to 3-mm spot size, and a 10-ms pulse width was used for ablation. The VersaPulse was set at a lower energy of 9.5 to 12 J/cm(2) with a 3-mm spot size, 3- to 6-Hz repetition rate, and 10-ms pulse duration for ablation. All patients were Caucasian. RESULTS Complete resolution of the SKs occurred in 93% of lesions. Seven percent of SKs required a second round of laser treatment for incomplete ablation. There were no cases of hyperpigmentation or hypertrophic scar formation of the skin following laser treatment. Hypopigmentation occurred in 6% of patients and was associated with old, chronic, or recalcitrant lesions.
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Kim MG, Kim WS, Lee JH, Yang JM, Lee ES, Park KH, Lee DY. Carbon dioxide laser de-epithelialization: selective removal of the epidermis with minimal change to the basement membrane zone. Dermatol Surg 2006; 32:329-31. [PMID: 16442065 DOI: 10.1111/j.1524-4725.2006.32065.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
UNLABELLED Revolutionary advances in laser research and technology have led to expanded dermatologic laser applications. With the wide range of lasers now available, a large spectrum of skin conditions in the pediatric population can be successfully treated or, in some cases, completely eradicated. Laser treatment of the pediatric population poses a unique challenge for the clinician on a variety of levels. Physically, the composition of many vascular and pigmented lesions changes as children age making them more resistant to laser therapy. Thus, in many cases, treating lesions at an early age has resulted in clearing in fewer sessions and with decreased complications. Mechanically, lasers and laser settings used for the treatment of adult lesions may have to be adjusted for the smaller vessels and the unpredictable nature of scarring with children's skin. For vascular lesions, the pulsed dye laser is considered the laser of choice for its efficacy and low-risk profile, whereas the Q-switched, pigment-specific lasers are ideal for most childhood pigmented lesions, allowing for single pigment cell destruction. Other conditions such as acne and acne scars, psoriasis, keloids, warts and hypertrichosis that traditionally have been treated with a variety of modalities are now being managed safely with laser surgery. Other issues specific to the pediatric population include the determination of suitable anesthesia, the provision of size-appropriate safety equipment, and the assessment and management of patient and parent anxiety. The use of lasers specifically designed for structural differences in pediatric lesions and the recognition of emotional issues surrounding a young patient during laser surgery are critical components of successful treatment. LEARNING OBJECTIVE At the conclusion of this learning activity, participants should be familiar with the mechanism of laser technology, current trends in the use of lasers for skin lesions in the pediatric population, and the issues specific to treating a patient with laser surgery.
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Affiliation(s)
- Julie L Cantatore
- Department of Peadiatrics, North Shore-Long Island Jewish Health System, New Hyde Park, New York, USA
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Tanzi EL, Lupton JR, Alster TS. Lasers in dermatology: four decades of progress. J Am Acad Dermatol 2003; 49:1-31; quiz 31-4. [PMID: 12833005 DOI: 10.1067/mjd.2003.582] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Advances in laser technology have progressed so rapidly during the past decade that successful treatment of many cutaneous concerns and congenital defects, including vascular and pigmented lesions, tattoos, scars, and unwanted hair-can be achieved. The demand for laser surgery has increased substantially by patients and dermatologists alike as a result of the relative ease with which many of these lesions can be removed, combined with a low incidence of adverse postoperative sequelae. Refinements in laser technology and technique have provided patients and practitioners with more therapeutic choices and improved clinical results. In this review, the currently available laser systems with cutaneous applications are outlined, with primary focus placed on recent advancements and modifications in laser technology that have greatly expanded the cutaneous laser surgeon's armamentarium and improved overall treatment efficacy and safety.
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Affiliation(s)
- Elizabeth L Tanzi
- Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, USA
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