1
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Koç HA, Metin A. Spectrophotometric intracutaneous analysis findings and characteristics in plantar verrues. Photodiagnosis Photodyn Ther 2023; 44:103835. [PMID: 37806609 DOI: 10.1016/j.pdpdt.2023.103835] [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: 08/12/2023] [Revised: 09/22/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Spectrophotometric intracutaneous analysis (SIAscopy) is a non-invasive computerized method that provides insights beyond dermoscopic examination. This study aimed to show the various findings of the plantar verrucae with the SIAscopy evaluation, which displays the chromophores of the skin, melanin, hemoglobin, and collagen. METHODS Plantar verrucae lesions scanned using SIAscopy, and their color, total melanin, dermal melanin, collagen, and blood views were recorded on a computer. These SIAgraphs were examined individually and compared to dermoscopic literature findings. RESULTS The results of color view were in conformity with dermoscopic findings reported in the literature. Among the findings detected for the first time by a SIAscopic examination, a white halo around the vessel in view of total melanin, effacement in the keratinized areas, and whitening in the vascular areas were noted. There was a mottled collagen condensation, which was believed to be induced by dermal papillomatosis in the lesions in the view of collagen, and consequently, as a result of remittent light reflections due to the collagen structure in this area. There was a clarification in the vascular structures that were noticed in the color view in the blood view. It was noted that vascular structures that have not yet been thrombosed under the thickened epidermis could not be detected in color view. CONCLUSION Our study reveals that SIAscopy, a rapid, non-invasive, and easy-to-use examination method similar to dermoscopy, can also diagnose other skin diseases, particularly pathogenetic processes that induce epidermal and papillary dermis changes, apart from pigmented lesions.
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Affiliation(s)
| | - Ahmet Metin
- Pamukkale University School of Medicine, Denizli, Turkey
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2
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Zhu P, Qi R, Yang Y, Huo W, Zhang Y, He L, Wang G, Xu J, Zhang F, Yang R, Tu P, Ma L, Liu Q, Li Y, Gu H, Cheng B, Chen X, Chen A, Xiao S, Jin H, Zhang J, Li S, Yao Z, Pan W, Yang H, Shen Z, Cheng H, Song P, Fu L, Chen H, Geng S, Zeng K, Wang J, Tao J, Chen Y, Wang X, Gao X. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med 2022; 15:284-301. [PMID: 36117295 PMCID: PMC9825897 DOI: 10.1111/jebm.12494] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
AIM Cutaneous warts caused by human papillomavirus are benign proliferative lesions that occur at any ages in human lives. Updated, comprehensive and systematic evidence-based guidelines to guide clinical practice are urgently needed. METHODS We collaborated with multidisciplinary experts to formulate this guideline based on evidences of already published literature, focusing on 13 clinical questions elected by a panel of experts. We adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to form classification of recommendations as well as the improved Delphi method to retain respective recommendations with a consensus degree of over 80%. RESULTS Our guideline covered aspects of the diagnosis and treatment of cutaneous warts such as diagnostic gold standard, transmission routes, laboratory tests, treatment principle, clinical cure criterion, definitions, and treatments of common warts, flat warts, plantar warts, condyloma acuminatum, and epidermodysplasia verruciformis. Recommendations about special population such as children and pregnant women are also listed. In total, 49 recommendations have been obtained. CONCLUSIONS It is a comprehensive and systematic evidence-based guideline and we hope this guideline could systematically and effectively guide the clinical practice of cutaneous warts and improve the overall levels of medical services.
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Affiliation(s)
- Peiyao Zhu
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Rui‐Qun Qi
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Yang Yang
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Wei Huo
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Yuqing Zhang
- Department of Clinical Epidemiology and Evidence‐Based MedicineThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
| | - Li He
- Department of DermatologyFirst Affiliated Hospital of Kunming Medical UniversityKunmingP.R. China
| | - Gang Wang
- Department of DermatologyXijing HospitalFourth Military Medical UniversityXi'an, ShaanxiP. R. China
| | - Jinhua Xu
- Department of DermatologyHuashan HospitalFudan UniversityShanghaiP.R. China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and VenereologyShandong First Medical University & Shandong Academy of Medical SciencesJinanP.R. China
| | - Rongya Yang
- Department of DermatologyGeneral Hospital of Beijing Military Command of PLADongcheng DistrictBeijingP.R. China
| | - Ping Tu
- Department of Dermatology and VenerologyPeking University First HospitalBeijingP.R. China
| | - Lin Ma
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingP.R. China
| | - Quanzhong Liu
- Department of DermatologyTianjin Medical University General HospitalTianjinP.R. China
| | - Yuzhen Li
- Department of DermatologySecond Affiliated Hospital of Harbin Medical UniversityHarbinP.R. China
| | - Heng Gu
- Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingP.R. China
| | - Bo Cheng
- Department of DermatologyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouP.R. China
| | - Xiang Chen
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaP.R. China
| | - Aijun Chen
- Department of DermatologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingP.R. China
| | - Shengxiang Xiao
- Department of DermatologyThe Second Affiliated HospitalSchool of MedicineXi'an Jiaotong UniversityXi'anP.R. China
| | - Hongzhong Jin
- Department of DermatologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeDongcheng DistrictBeijingP.R. China
| | - Junling Zhang
- Department of DermatologyTianjin Academy of Traditional Chinese Medicine Affiliated HospitalTianjinP.R. China
| | - Shanshan Li
- Department of DermatologyThe First Hospital of Jilin UniversityChangchunJilin ProvinceP.R. China
| | - Zhirong Yao
- Department of DermatologyXinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiP.R. China
| | - Weihua Pan
- Department of DermatologyShanghai Key Laboratory of Molecular Medical MycologySecond Affiliated Hospital of Naval Medical UniversityShanghaiP.R. China
| | - Huilan Yang
- Department of DermatologyGeneral Hospital of Southern Theatre Command of PLAGuangzhouP.R. China
| | - Zhu Shen
- Department of DermatologyInstitute of Dermatology and VenereologySichuan Academy of Medical Sciences and Sichuan Provincial People's HospitalChengduP.R. China
| | - Hao Cheng
- Department of Dermatology and VenereologySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhouP.R. China
| | - Ping Song
- Department of DermatologyGuang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingP.R. China
| | - Lingyu Fu
- Department of Clinical Epidemiology and Evidence‐Based MedicineThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
| | - Hongxiang Chen
- Department of DermatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Songmei Geng
- Department of DermatologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP.R. China
| | - Kang Zeng
- Department of DermatologyNanfang HospitalSouthern Medical UniversityGuangzhouP.R. China
| | - Jianjian Wang
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouP.R. China
| | - Juan Tao
- Department of DermatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Yaolong Chen
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouP.R. China
- World Health Organization Collaborating Center for Guideline Implementation and Knowledge TranslationLanzhouP.R. China
- GIN AsiaLanzhouP.R. China
| | - Xiuli Wang
- Institute of PhotomedicineShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiP.R. China
| | - Xing‐Hua Gao
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
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3
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Huo W, Gao YL, Wang HY, Bi GJ, Qiao S, Cai YF, Qi RQ, Yang Y, Lan J, Yao ZR, Han XP, Zhang JZ, Gao TW, Yang S, Gu H, Wu RN, Lu HG, Zeng FQ, Chen X, Qiao Y, Gao XH. Local Hyperthermia Versus Cryotherapy for Treatment of Plantar Warts: A Prospective Multi-centre Non-randomized Concurrent Controlled Clinical Trial. Acta Derm Venereol 2022; 102:adv00655. [PMID: 35083495 PMCID: PMC9558746 DOI: 10.2340/actadv.v102.1082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Cryotherapy is one of the most common treatments for warts; however, pain during treatment and relatively high recurrence rates limit its use. Local hyperthermia has also been used successfully in the treatment of plantar warts. The aim of this study was to compare the clinical effectiveness of local hyperthermia vs cryotherapy for the treatment of plantar warts. This multi-centre, open, 2-arm, non-randomized concurrent controlled trial included 1,027 patients, who received either cryotherapy or local hyperthermia treatment. Three months after treatment, local hyperthermia and cryotherapy achieved complete clearance rates of 50.9% and 54.3%, respectively. Recurrence rates were 0.8% and 12%, respectively. Pain scores during local hyperthermia were significantly lower than for cryotherapy. Both local hyperthermia and cryotherapy demonstrated similar efficacy for clearance of plantar warts; while local hyperthermia had a lower recurrence rate and lower pain sensation during treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xing-Hua Gao
- Department of Dermatology, the FirstHospital of China Medical University, Shenyang, Liaoning, China.
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4
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Applying particle swarm optimization-based decision tree classifier for wart treatment selection. COMPLEX INTELL SYST 2022. [DOI: 10.1007/s40747-021-00348-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractWart is a disease caused by human papillomavirus with common and plantar warts as general forms. Commonly used methods to treat warts are immunotherapy and cryotherapy. The selection of proper treatment is vital to cure warts. This paper establishes a classification and regression tree (CART) model based on particle swarm optimisation to help patients choose between immunotherapy and cryotherapy. The proposed model can accurately predict the response of patients to the two methods. Using an improved particle swarm algorithm (PSO) to optimise the parameters of the model instead of the traditional pruning algorithm, a more concise and more accurate model is obtained. Two experiments are conducted to verify the feasibility of the proposed model. On the hand, five benchmarks are used to verify the performance of the improved PSO algorithm. On the other hand, the experiment on two wart datasets is conducted. Results show that the proposed model is effective. The proposed method classifies better than k-nearest neighbour, C4.5 and logistic regression. It also performs better than the conventional optimisation method for the CART algorithm. Moreover, the decision tree model established in this study is interpretable and understandable. Therefore, the proposed model can help patients and doctors reduce the medical cost and improve the quality of healing operation.
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5
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The status of treatment for plantar warts in 2021: No definitive advancements in decades for a common dermatology disease. Clin Dermatol 2021; 39:688-694. [PMID: 34809773 DOI: 10.1016/j.clindermatol.2021.05.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Plantar warts are among the most common skin conditions and are classically resistant to treatment. To perform an evidence-based evaluation of the efficacy and safety of available treatment options for plantar warts, we conducted a systematic review of PubMed and Cochrane databases to identify large interventional and observational studies involving more than 100 patients who were treated for plantar warts from inception to October 2020. We identified only nine contributions meeting our inclusion criteria (N ≥ 100), representing 1,657 adult and pediatric patients with plantar warts. Treatments included in this review were topical keratolytic agents, cryotherapy, laser therapies, and intralesional and systemic treatments. Our evidence-based review of the larger studies suggests keratolytic agents and destructive treatments, in particular salicylic acid and cryotherapy, remain the primary treatments for plantar warts. Treatment with pulsed dye laser had the lowest rate of recurrence. Newer treatments and intralesional treatments were not represented owing to lack of large studies involving these modalities.
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6
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Ghorzang E, de Koning MNC, Bouwes Bavinck JN, Gussekloo J, Quint KD, Goeman JJ, Feltkamp MCW, Bruggink SC, Eekhof JAH. HPV type-specific distribution among family members and linen in households of cutaneous wart patients. J Eur Acad Dermatol Venereol 2021; 36:119-125. [PMID: 34547117 PMCID: PMC9293406 DOI: 10.1111/jdv.17684] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/16/2021] [Indexed: 11/28/2022]
Abstract
Background Common and plantar warts are caused by human papillomaviruses (HPV). Mode of transmission of wart HPVs within families is largely unknown. Objective To demonstrate similarity of HPV type(s) among wart cases, family members and household linen. Methods In a cross‐sectional study, swabs taken from 123 warts and foreheads of 62 index patients and 157 family members and from 58 kitchen towels and 59 bathroom mats were tested for DNA of 23 cutaneous wart‐associated HPV types. Generalized estimating equations (GEE) were used to estimate the chance of detecting the same HPV type as was found in the index patients on the family contacts and on the kitchen towels and bathroom mats. Results HPV1, HPV2, HPV27 and HPV57 were the most prevalent types in the warts of the index patients. Altogether, 60 (42.3%) of the 142 family members without warts had HPV DNA on their foreheads. When HPV1 and HPV2 were found in the warts, these types were also frequently (>50%) found on the foreheads of index patients and their family members, as well as on the kitchen towels and the bathroom mats. HPV27 and HPV57 were less frequently found (<25%) on foreheads and linen. No associations were found for age, sex and site of HPV DNA presence. Conclusion Dissemination of skin wart‐causing HPV types, from wart cases to household contacts and linen, such as kitchen towels and bathroom mats, is more likely for HPV1 and HPV2 than for HPV27 and HPV57. The role of towels and bathroom mats in HPV transmission deserves further investigation. Linked Commentary A. Kreuter and U. Wieland. J Eur Acad Dermatol Venereol 2022; 36: 11–12. https://doi.org/10.1111/jdv.17820.
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Affiliation(s)
- E Ghorzang
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - M N C de Koning
- Viroclinics-DDL, DDL Diagnostic Laboratory, Rijswijk, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - K D Quint
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J J Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - M C W Feltkamp
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - S C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - J A H Eekhof
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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7
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Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: A review. Dermatol Ther 2020; 33:e14034. [PMID: 32683782 DOI: 10.1111/dth.14034] [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] [Received: 05/06/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
Viral warts or verruca are very common skin infections in children. Although benign, lesions can be extensive, painful, bleed, or lead to cosmetic disfigurement. Although spontaneous resolution can occur, parents often bring their children for treatment, especially when they are symptomatic. Many publications have assessed the efficacy and safety of treatment of warts in adults. However, treatment in children can be challenging due to their immune responses and lower threshold for pain. We review the current literature on the methods, efficacy, and side effect profile of common treatment modalities for cutaneous viral warts in children. There is evidence that salicylic acid and cryotherapy are effective, and although cryotherapy is more effective, there is a higher risk of side effects such as pain and blistering. Combination treatment with salicylic acid and cryotherapy may reduce these side effects. Although there is limited data, other treatment options such as cantharidin, immunotherapy and other mechanical therapies, for example, carbon dioxide lasers, may also be considered, especially for recalcitrant lesions.
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Affiliation(s)
| | | | - Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seng Bin Ang
- Duke-NUS Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
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8
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Albalat W, Attwa E, Ebrahim HM. Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study. J DERMATOL TREAT 2020; 33:857-863. [PMID: 32543980 DOI: 10.1080/09546634.2020.1782821] [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: 10/24/2022]
Abstract
Background: Recalcitrant plantar warts are representing a therapeutic challenge. Intralesional cryotherapy (ILC) has emerged as a promising therapeutic option in recalcitrant plantar warts treatment.Objective: To compare the clinical efficacy, safety and tolerability of (ILC) versus Cryotherapy spray (Cryo-sp) for treatment of recalcitrant plantar warts.Methods: One hundred-thirty patients with recalcitrant plantar warts were assigned equally to two groups. Group A received ILC and group B treated with Cryo-SP. Both groups received one session at 2 weeks intervals until complete clearance or for a maximum of 5 sessions. The main outcome was complete clearance of warts guided by dermoscopy. Follow-up was carried out for 6 months after the treatment.Results: Complete clearance occurred in 80.3% in group A compared to 50.8% in group B with a highly significant difference between both groups (p < .001). The clearance rate was faster in group A (1.5 ± 0.40) than group B (4 ± 1.3) (p < .001). The adverse effects were mild in group A than group B (p < .001). The recurrence rate was 2% in group A versus 23.3% in group B (p < .007).patients satisfaction was higher in ILC (p < .001).Conclusion: Intralesional cryotherapy is more effective, requiring few sessions with a low recurrence rate than cryo-sp.
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Affiliation(s)
- Waleed Albalat
- Department of Dermatology, Venereology and Andrology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Enayat Attwa
- Department of Dermatology, Venereology and Andrology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| | - Howyda Mohamed Ebrahim
- Department of Dermatology, Venereology and Andrology, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
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9
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Zhang S, Xu X, Liu Y, Xue R, Li C, Chen P, Zhang X, Liang J. Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study. Dermatol Ther 2020; 33:e13390. [PMID: 32268448 DOI: 10.1111/dth.13390] [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: 11/28/2019] [Revised: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Most available options for the treatment of warts are limited by the potential for scarring, pain, lack of response, or recurrences, and the patients are often unable to tolerate and accept those experiences. The aim of this study was to evaluate the clinical efficacy and safety of oral systemic acitretin monotherapy in patients with extensive/recalcitrant cutaneous warts. The patients were given a dose of acitretin of 0.8 mg kg-1 day-1 , and the clinical efficacy and safety of acitretin was assessed every 2 weeks for 2 months. A total of 14 patients (12 males and 2 females) were included, with an age of 14-60 years (mean 33 ± 14.7 years) and a course of 4-48 months (mean 21.6 ± 13.4 months). After 2 months of acitretin treatment, 42.9% (6/14) of patients (including warts of the feet, legs, and hands) exhibited complete response, 28.6% (4/14) excellent response, and 28.6% (4/14) good response. All patients demonstrated significant improvement, and the drug was well tolerated, with no patients discontinuing therapy due to side effects. Common mild side effects included dry skin and cheilitis. There were no recurrences during a follow-up period of 6 months. Acitretin monotherapy is an effective, safe, and well-tolerated treatment for patients with extensive/recalcitrant cutaneous warts who are unsuitable for or unwilling to accept traditional treatment methods.
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Affiliation(s)
- Sanquan Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Xiao Xu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Yumei Liu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Changxing Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
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10
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Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenital cutaneous warts - clinical presentation, diagnosis and treatment. J Dtsch Dermatol Ges 2020; 17:613-634. [PMID: 31241843 DOI: 10.1111/ddg.13878] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self-limiting condition, a wait-and-see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps-measles-rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.
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Affiliation(s)
| | | | | | - Tilo Biedermann
- Department of Dermatology and Allergology, Munich Technical University, Munich, Germany
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11
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Nguyen AL, Quint KD, Bouwes Bavinck JN, Erceg A, de Kort WJA, Körver JEM. Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution. Dermatol Ther 2019; 32:e13143. [PMID: 31664756 PMCID: PMC6916542 DOI: 10.1111/dth.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/18/2019] [Accepted: 10/26/2019] [Indexed: 11/30/2022]
Abstract
Patients often request treatment of their burdensome cutaneous warts. However, a safe and effective treatment for cutaneous warts is lacking. This study evaluates treatment outcome, side effects, and patient satisfaction after topical application of cantharidin 1% podophyllin 2% salicylic acid 30% (CPS1) solution in a large series of children and adults with cutaneous warts. Fifty‐two children and 83 adults with warts, treated with CPS1 solution between October 2012 and October 2014, were included. Complete clearance of warts occurred in 86.5% of children and 62.7% of adults treated with CPS1 solution (p < .01). Resolution of warts was partial in 3.9 and 24.1% and absent in 9.6 and 13.2% of children and adults respectively. Side effects were present in 41.2% of children and 46.3% of adults (p = .7). Most common side effects were blistering, pain, and burning sensation. No serious adverse events occurred. On a 10‐point scale, median patient satisfaction score was 9.0 (interquartile range 7.8–10.0) and 8.0 (interquartile range 5.1–9.7) for children and adults respectively (p < .01). CPS1 solution is a safe and promising treatment modality with a high clearance and high patient satisfaction rate for the management of cutaneous warts, particularly in children.
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Affiliation(s)
- Anh Ly Nguyen
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands.,Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | | | - Angelina Erceg
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - Wim J A de Kort
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - John E M Körver
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
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12
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Zhao Y, Sridhar S, Guo L, Lau SKP, Xu Y, Woo PCY. Successful treatment of plantar warts using topical Zijinding, a traditional Chinese medicine preparation: A case series. J Cosmet Dermatol 2019; 19:946-950. [PMID: 31479180 PMCID: PMC7155113 DOI: 10.1111/jocd.13102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 04/19/2019] [Accepted: 07/23/2019] [Indexed: 11/30/2022]
Abstract
Introduction Plantar warts are associated with high transmissibility and morbidity. Among the available therapeutic options, none is uniformly effective or virucidal. Salicylic acid is the first‐line therapy but approximately one‐third of lesions could not resolve and become recalcitrant despite repeated treatment. Cryotherapy is widely accessible with low cost but may be complicated by pain, blister formation, hemorrhage, infection, excessive granulation tissue formation, and hyper‐/hypo‐pigmentation. Hence, alternative treatment modalities are essential. Methods Three patients with debilitating plantar warts refractory or intolerant to cryotherapy were treated with a course of Zijinding (a traditional Chinese medicine preparation) paste prepared with white vinegar. Results All three patients showed excellent clinical response with Zijinding application with evolution of lesions to scabs and subsequently healthy skin within 1.5 to 5 months of treatment. Treatment was well tolerated and had no significant side effects with excellent compliance recorded for all three patients. There was no relapse for at least 10 months after stopping the treatment. Conclusion Topical Zijinding could be a promising alternative modality for the treatment of plantar warts. Further clinical trials on the comparison of Zijinding and other treatment modalities of plantar warts are warranted. Further studies are required to investigate the mechanism of action of Zijinding and to isolate the active ingredient.
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Affiliation(s)
- Ying Zhao
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Siddharth Sridhar
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Lina Guo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Susanna K P Lau
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Yingchun Xu
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.,Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, China
| | - Patrick C Y Woo
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,State Key Laboratory of Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Research Centre of Infection and Immunology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Carol Yu Centre for Infection, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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13
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Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenitale kutane Warzen – Klinik, Diagnose und Therapie. J Dtsch Dermatol Ges 2019; 17:613-636. [DOI: 10.1111/ddg.13878_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München
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14
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Ghiasi MM, Zendehboudi S. Decision tree-based methodology to select a proper approach for wart treatment. Comput Biol Med 2019; 108:400-409. [DOI: 10.1016/j.compbiomed.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
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15
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Rijsbergen M, Niemeyer-van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen ES, de Koning M, Beck S, Bouwes Bavinck JN, Feiss G, Burggraaf J, Rissmann R. A randomized controlled proof-of-concept trial of digoxin and furosemide in adults with cutaneous warts. Br J Dermatol 2019; 180:1058-1068. [PMID: 30580460 PMCID: PMC6850412 DOI: 10.1111/bjd.17583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Background Topical ionic contraviral therapy (ICVT) with digoxin and furosemide inhibits the potassium influx on which DNA viruses rely for replication. Therefore, ICVT was hypothesized to be a potential novel treatment for cutaneous warts. Objectives To assess the clinical efficacy, safety and tolerability of ICVT in adults with cutaneous warts. The secondary objective was to gain insight into the underlying working mechanism of ICVT. Methods Treatment with ICVT was assessed for efficacy, safety and tolerability in a single‐ centre, randomized, double‐blind, placebo‐controlled phase IIA trial. Eighty adult patients with at least two cutaneous warts (plantar or common) were randomized to one of four treatments: digoxin + furosemide (0·125%), digoxin (0·125%), furosemide (0·125%) or placebo. The gel was administered once daily for 42 consecutive days. Predefined statistical analysis was performed with a mixed‐model ancova. The trial was registered at ClinicalTrials.gov with number NCT02333643. Results Wart size and human papillomavirus (HPV) load reduction was achieved in all active treatment groups. A statistically significant reduction in wart diameter of all treated warts was shown in the digoxin + furosemide treatment group vs. placebo (−3·0 mm, 95% confidence interval −4·9 to −1·1, P = 0·002). There was a statistically significant reduction in the HPV load of all treated warts in the digoxin + furosemide group vs. placebo (−94%, 95% confidence interval −100 to −19, P = 0·03). With wart size reduction, histologically and immunohistochemically defined viral characteristics disappeared from partial and total responding warts. Conclusions This study demonstrates the proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. What's already known about this topic? Cutaneous warts are caused by the human papillomavirus (HPV). Ionic contraviral therapy (ICVT) might be a potential treatment for cutaneous warts. A previous phase I/II open‐label study demonstrated the safety and efficacy of ICVT.
What does this study add? Proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. Topical ICVT demonstrates a favourable safety profile, with the effects most pronounced when it is combined in a formulation for common warts. Wart size reduction was related to HPV load reduction measured by quantitative polymerase chain reaction (qPCR) in swabs. qPCR is a valuable disease biomarker for drug development in cutaneous warts.
https://doi.org/10.1111/bjd.17803 available online https://www.bjdonline.com/article/
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Affiliation(s)
- M Rijsbergen
- Center for Human Drug Research, Leiden, the Netherlands
| | | | - G Hogendoorn
- Center for Human Drug Research, Leiden, the Netherlands
| | - S Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - C Lemoine
- Center for Human Drug Research, Leiden, the Netherlands
| | - E S Klaassen
- Center for Human Drug Research, Leiden, the Netherlands
| | - M de Koning
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - S Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, U.S.A
| | - J Burggraaf
- Center for Human Drug Research, Leiden, the Netherlands
| | - R Rissmann
- Center for Human Drug Research, Leiden, the Netherlands
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16
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Ringin SA. The Effectiveness of Cutaneous Wart Resolution with Current Treatment Modalities. J Cutan Aesthet Surg 2019; 13:24-30. [PMID: 32655247 PMCID: PMC7335473 DOI: 10.4103/jcas.jcas_62_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-venereal warts are a frequent dermatological presentation with potential spontaneous regression in immunocompetent adults and children within 2 years. Evidence shows that conventional wart treatments are not a guaranteed treatment modality and can carry concerns regarding safety. The aim of this literature review was to identify the most effective treatments for wart resolution to guide clinical practice while identifying areas for further research. A systematic literature review was performed to determine the current treatment modalities for non-anogenital cutaneous warts in immunocompetent individuals and their effectiveness. Articles were categorized into one of eight groups depending on anatomical location, population age, or recalcitrant status with ranked levels of evidence. This literature review highlights a variety of treatments for non-venereal warts shown to be effective. In this instance where optimal evidence-based treatments are not available, clinical experience determines the most appropriate clinical practice. Further reproducible immunotherapy research on wart resolution is required to enable clear comparisons of these treatment modalities to conventional methods. Future clinical practice will require the human papillomavirus type to target the wart treatment accordingly; however, further research is required to determine these correlations.
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Affiliation(s)
- Sarah A Ringin
- Department of Medicine, University of Notre Dame, Sydney, NSW, Australia
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17
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Abdel Meguid AM, Abdel Motaleb AA, Abdel Sadek AMI. Cryotherapy vs trichloroacetic acid 90% in treatment of common warts. J Cosmet Dermatol 2018; 18:608-613. [DOI: 10.1111/jocd.12805] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/17/2018] [Accepted: 09/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Azza Mahfouz Abdel Meguid
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Assiut University Assiut Egypt
| | - Amira Ali Abdel Motaleb
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Assiut University Assiut Egypt
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18
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Silling S, Akgül B. Treatment success in cutaneous warts: morphology and human papillomavirus type matter. Br J Dermatol 2018; 178:30-31. [PMID: 29357586 DOI: 10.1111/bjd.16056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- S Silling
- National Reference Centre for Papilloma and Polyomaviruses, University of Cologne, Fürst-Pückler-Str. 56, Cologne, 50935, Germany.,Institute of Virology, University of Cologne, Fürst-Pückler-Str. 56, Cologne, 50935, Germany
| | - B Akgül
- Institute of Virology, University of Cologne, Fürst-Pückler-Str. 56, Cologne, 50935, Germany
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19
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Hogendoorn GK, Bruggink SC, Hermans KE, Kouwenhoven STP, Quint KD, Wolterbeek R, Eekhof JAH, de Koning MNC, Rissmann R, Burggraaf J, Bouwes Bavinck JN. Developing and validating the Cutaneous WARTS (CWARTS) diagnostic tool: a novel clinical assessment and classification system for cutaneous warts. Br J Dermatol 2017; 178:527-534. [PMID: 28949011 DOI: 10.1111/bjd.15999] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical appearance of cutaneous warts is highly variable and not standardized. OBJECTIVES To develop and validate a reproducible clinical tool for the standardized assessment of cutaneous warts to distinguish these lesions accurately. METHODS Nine morphological characteristics were defined and validated regarding intra- and interobserver agreement. Based on literature and semistructured interviews, a systematic dichotomous assessment tool, the Cutaneous WARTS (CWARTS) diagnostic tool was developed. The validation consisted of two independent parts performed with photographs from the recent WARTS-2 trial. In part A, the CWARTS diagnostic tool was tested by 28 experienced physicians who assessed photographs of 10 different warts to investigate interobserver concordance. In part B, morphological characteristics were validated by masked and independent scoring of 299 photographs by six different observers. Part B also entailed reassessment of the photographs after at least 1 week. The primary outcome measurement was the intraclass correlation coefficient (ICC). RESULTS Presence of black dots (capillary thrombosis) had the greatest ICC (0·85) for interobserver agreement in part A, followed by arrangement (0·65), presence of border erythema (0·64) and sharpness of the border (0·60). In part B, results were similar for interobserver agreement with presence of black dots having the highest ICC (0·68), followed by border erythema (0·64), arrangement (0·58) and colour (0·55). For intraobserver agreement, presence of black dots had the highest agreement (0·70), followed by presence of border erythema (0·694) and colour (0·59). CONCLUSIONS Wart phenotype can be reliably assessed using the CWARTS diagnostic tool.
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Affiliation(s)
| | - S C Bruggink
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - K E Hermans
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - K D Quint
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, the Netherlands
| | - R Wolterbeek
- Medical Statistics and Bioinformatics, Leiden University Medical Centre, Leiden, the Netherlands
| | - J A H Eekhof
- Departments of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | | | - R Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, the Netherlands
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20
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Hogendoorn G, Bruggink S, de Koning M, Eekhof J, Hermans K, Rissmann R, Burggraaf J, Wolterbeek R, Quint K, Kouwenhoven S, Bouwes Bavinck J. Morphological characteristics and human papillomavirus genotype predict the treatment response in cutaneous warts. Br J Dermatol 2017. [DOI: 10.1111/bjd.15758] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- G.K. Hogendoorn
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - S.C. Bruggink
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - M.N.C. de Koning
- DDL Diagnostic Laboratory Visseringlaan 25 2288 ER Rijswijk the Netherlands
| | - J.A.H. Eekhof
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - K.E. Hermans
- Department of Public Health and Primary Care Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - R. Rissmann
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - J. Burggraaf
- Centre for Human Drug Research Zernikedreef 8 2333 CL Leiden the Netherlands
| | - R. Wolterbeek
- Department of Medical Statistics Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - K.D. Quint
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
- Department of Dermatology Roosevelt Clinics Rooseveltstraat 67 2321 BL Leiden the Netherlands
| | - S.T.P. Kouwenhoven
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
| | - J.N. Bouwes Bavinck
- Department of Dermatology Leiden University Medical Centre Albinusdreef 2 2333 ZA Leiden the Netherlands
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21
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van der Kolk T, Dillingh MR, Rijneveld R, Klaassen ES, de Koning MNC, Kouwenhoven STP, Genders RE, Bouwes Bavinck JN, Feiss G, Rissmann R, Burggraaf J. Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts. J Eur Acad Dermatol Venereol 2017; 31:2088-2090. [PMID: 28833595 PMCID: PMC5763383 DOI: 10.1111/jdv.14527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Background DNA viruses such as HPV rely on K+ influx for replication. Both digoxin and furosemide inhibit the K+ influx by interacting with cell membrane ion co‐transporters (Na+/K+‐ATPase and Na+‐K+‐2Cl− co‐transporter‐1, respectively). We therefore hypothesized that these two compounds in a topical formulation may be valuable in the treatment of HPV‐induced warts. This new approach is called Ionic Contra‐Viral Therapy (ICVT). Objective To evaluate systemic exposure, safety and tolerability of ICVT with a combination of furosemide and digoxin after repeated topical application in subjects with common warts. Furthermore, we aimed to evaluate pharmacodynamics effects of ICVT. Methods Twelve healthy subjects with at least four common warts on their hands were included in the study and treated with a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on their lower back to assess safety and systemic exposure. Two warts were treated with 10 mg each and two served as negative controls to obtain preliminary evidence of treatment effect. Results ICVT was well tolerated topically, and there was no evidence of systemic exposure of digoxin or furosemide. There were no clinical relevant safety findings and no serious adverse events (SAEs). A rapid and statistically significant reduction in diameter, height and volume of the warts was already observed at day 14. Conclusion ICVT was found to be safe for administration to humans and 7 days of active treatment showed a statistical significant wart reduction compared to untreated control lesions, clearly indicating pharmacological activity.
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Affiliation(s)
| | - M R Dillingh
- Centre for Human Drug Research, Leiden, The Netherlands
| | - R Rijneveld
- Centre for Human Drug Research, Leiden, The Netherlands
| | - E S Klaassen
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, USA
| | - R Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
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22
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Maruani A. [What's new in pediatric dermatology?]. Ann Dermatol Venereol 2016; 142 Suppl 3:S26-35. [PMID: 26792412 DOI: 10.1016/s0151-9638(16)30004-7] [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: 11/15/2022]
Abstract
The years 2014-2015 have been rich in paediatric dermatology news in varied areas. Randomized controlled trials including children have been performed, especially in the fields of vascular anomalies, infectiology and immuno-allergology; new classifications and guidelines have been established; scientific research has made new discoveries, including the molecular basis of pediatric nevi and melanoma; epidemiologic works on risk factors have highlighted the need for dermatologists to be aware of prevention (sun prevention but also obesity); and finally, the many publications have taken into account psychological issues in children, such as quality of life, pain, observance or acceptance.
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Affiliation(s)
- A Maruani
- Service de dermatologie, unité de dermatologie pédiatrique, hôpital Trousseau, avenue de la République, 37044 Tours Cedex 9 ; université François-Rabelais de Tours, INSERM U930, 37000 Tours, France.
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23
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Abstract
PURPOSE OF REVIEW Warts and molluscum contagiosum are very common viral skin infections, usually presenting in childhood. Despite the large number of people affected by them, high-quality trials of treatment are few and treatment is often chosen on the basis of cost, convenience and tradition. RECENT FINDINGS Over recent years, two further trials of the most commonly used treatments for warts, salicylic acid and cryotherapy, have been performed and for molluscum contagiosum, there is growing evidence for the use of irritants. For both infections, there are new evaluations of immunological approaches to therapy. SUMMARY Strong, high-quality evidence for treatments used very frequently for warts or molluscum is still lacking, but recent publications have helped to strengthen or weaken belief in commonly used therapies and to add weight to the immunological approach to management.
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