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Lagacé F, D’Aguanno K, Prosty C, Laverde-Saad A, Cattelan L, Ouchene L, Oliel S, Genest G, Doiron P, Richer V, Jfri A, O’Brien E, Lefrançois P, Powell M, Moreau L, Litvinov IV, Muntyanu A, Netchiporouk E. The Role of Sex and Gender in Dermatology - From Pathogenesis to Clinical Implications. J Cutan Med Surg 2023; 27:NP1-NP36. [PMID: 37401812 PMCID: PMC10486181 DOI: 10.1177/12034754231177582] [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: 01/05/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Sex and gender have increasingly been recognized as significant risk factors for many diseases, including dermatological conditions. Historically, sex and gender have often been grouped together as a single risk factor in the scientific literature. However, both may have a distinct impact on disease incidence, prevalence, clinical presentation, severity, therapeutic response, and associated psychological distress. OBJECTIVES AND PROJECT DESCRIPTION The mechanisms that underlie differences in skin diseases between males, females, men, and women remain largely unknown. The specific objectives of this review paper are:To highlight the biological differences between males and females (sex), as well as the sociocultural differences between men and women (gender) and how they impact the integumentary system.To perform a literature review to identify important sex- and gender-related epidemiological and clinical differences for various skin conditions belonging to a range of disease categories and to discuss possible biological and sociocultural factors that could explain the observed differences.To discuss dermatological skin conditions and gender-affirming treatments within the transgender community, a population of individuals who have a gender identity which is different than the gender identity they were assigned at birth. FUTURE IMPACT With the rising number of individuals that identify as non-binary or transgender within our increasingly diverse communities, it is imperative to recognize gender identity, gender, and sex as distinct entities. By doing so, clinicians will be able to better risk-stratify their patients and select treatments that are most aligned with their values. To our knowledge, very few studies have separated sex and gender as two distinct risk factors within the dermatology literature. Our article also has the potential to help guide future prevention strategies that are patient-tailored rather than using a universal approach.
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Affiliation(s)
- François Lagacé
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | | | - Connor Prosty
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Alexandra Laverde-Saad
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Leila Cattelan
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Lydia Ouchene
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Sarah Oliel
- Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Genevieve Genest
- Division of Allergy and Immunology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philip Doiron
- Division of Dermatology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Richer
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada
| | - Abdulhadi Jfri
- Department of Dermatology, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Elizabeth O’Brien
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Philippe Lefrançois
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Mathieu Powell
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Linda Moreau
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Ivan V. Litvinov
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Anastasiya Muntyanu
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Faculty of Medicine, McGill University, Montréal, Québec, Canada
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Ana M OR, Silvia GL, Alba GS, Sara ZG, Esther CL. Treatment efficacy of 0.9% saline and mepivacaine infiltration with Dermojet® in eliminating plantar warts. J Cosmet Dermatol 2023. [PMID: 36798042 DOI: 10.1111/jocd.15680] [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: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Plantar warts are benign, epidermal neoformations, viral, and easily transmitted. Although 30% of these warts disappear spontaneously, the American Association of Dermatology recommends treatment if they cause pain or bleeding. OBJECTIVES The aim of this study was to determine the efficacy of Dermojet® infiltration using a solution composed of equal parts of 0.9% saline and 2% mepivacaine in the treatment of plantar warts, and to identify the type of necrosis achieved at 7-10 days after the infiltration (M1 sample) and at 15-17 days (M2 sample). METHOD In this analytical prospective observational study, 102 histories were reviewed by the same researcher. The patients were treated with this technique at four private podiatry clinics. RESULTS A total of 61.8% of the patients were male. The patients' mean age was 26.6 ± 14.10 years. A total percentage of 78.4% of the patients achieved complete elimination of the lesion by the second evaluation and after a single infiltration. Bivariate analysis revealed a significant inverse relationship between treatment efficacy and a history of previous disease (p < 0.001) and the period of evolution of the lesion (p < 0.001; 95% CI [0.78-7.91]). Multivariate linear regression analysis revealed an association with the number of evaluation sessions (p < 0.001) and with previous illnesses (p = 0.014). A total percentage of 82.35% presented partial necrosis in the M1 sample and 76.92% had complete necrosis in the M2 sample. CONCLUSIONS In 78.4% of the patients considered, the plantar warts treated disappeared after a single infiltration. The variables associated with treatment efficacy were the number of follow-up visits and the existence of associated diseases.
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Affiliation(s)
- Oltra-Romero Ana M
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Garcia-Lázaro Silvia
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Gracia-Sánchez Alba
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Zúnica-García Sara
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
| | - Chicharro-Luna Esther
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, Sant Joan d'Alacant, Spain
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Bristow I. Paediatric Cutaneous Warts and Verrucae: An Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16400. [PMID: 36554279 PMCID: PMC9779159 DOI: 10.3390/ijerph192416400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Cutaneous warts are common lesions in children caused by the Human Papilloma Virus (HPV) and for most lesions spontaneously resolve within months of the initial infection, regardless of treatment. The infection is most prevalent in the second decade of life affecting over 40% of children. Studies have demonstrated wart virus carriage on normal skin is higher in children with active lesions and family members. Subtypes HPV 2, HPV 27, HPV 57 and HPV 63 are particularly common in paediatric populations. Warts arising on the plantar surface of the foot (verrucae) can be particularly problematic owing to the location. They may interfere with daily activities causing pain and embarrassment. Plantar lesions have been shown to be more resistant to treatment than warts elsewhere on the skin. Systematic reviews and studies conducted over the last decade have demonstrated little evidence of innovation or effective improvements in treatment of recalcitrant lesions over the last 30 years. However, newer modalities such as immunotherapy (using injected vaccines) and hyperthermia using microwave treatment may hold promise in improving the treatment of these common and therapeutically frustrating lesions.
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Affiliation(s)
- Ivan Bristow
- Private Practice, Lymington, Hampshire SO41 9AH, UK
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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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Acar EM, Uyar B, Elmas ÖF, Özyurt K, Atasoy M, Türsen Ü, Lotti T. Therapeutic efficacy and safety of three different modalities in pediatric patients with plantar warts. Dermatol Ther 2021; 34:e15073. [PMID: 34328650 DOI: 10.1111/dth.15073] [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: 12/15/2020] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022]
Abstract
Human papillomavirus infection is relatively common in communities. Thus, determining an effective and painless treatment method, especially in pediatric patients is of utmost importance. This study aimed to compare the outcomes of three different methods of treating plantar warts in pediatric patients. Children with verruca plantaris treated with a salicylic acid-lactic acid combination once daily (SA/LA 1), a salicylic acid-lactic acid combination applied in three to seven layers under occlusion every 3 days (SA/LA 2), or a combination of 5-fluorouracil (0.5%) and salicylic acid (10%) (SA/5-FU) were evaluated retrospectively. Treatment responses and recurrence rates were also evaluated after a minimum of 4 months. Among the 98 children with verruca plantaris, 19 were treated with SA/LA 1, 53 were treated with SA/LA 2, and 18 were treated with SA/5-FU; the eight patients who received cryotherapy were excluded. The mean treatment duration was significantly shorter in the SA/LA 2 group than in the SA/LA 1 group and the SA/5-FU group. (p = 0.000 for both) Application of a salicylic acid-lactic acid combination in multiple layers under occlusion is a safe, painless, and effective treatment method for plantar warts in children.
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Affiliation(s)
- Emine Müge Acar
- Dermatology Clinic, Kırşehir Training and Research Hospital, Kırşehir, Turkey
| | - Belkız Uyar
- Department of Dermatology and Venerology, Düzce University Faculty of Medicine, Düzce, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology and Venerology, Kırıkkale, University Faculty of Medicine, Kırıkkale, Turkey
| | - Kemal Özyurt
- Department of Dermatology and Venerology, Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Mustafa Atasoy
- Department of Dermatology and Venerology, Kayseri State Hospital, Kayseri, Turkey
| | - Ümit Türsen
- Department of Dermatology and Venerology, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Torello Lotti
- Department of Dermatology and Venereology, University of Rome G. Marconi, Rome, Italy
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Vaidya A, Yadav S, Vaidya A. A Study on the Clinical and Hormonal Profile of Polycystic Ovarian Syndrome Patients Attending a Tertiary Care Hospital: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2020; 58:875-888. [PMID: 34506401 PMCID: PMC7775009 DOI: 10.31729/jnma.5694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Polycystic ovarian syndrome is the most common endocrinological disorder in women of reproductive age and has a considerable metabolic, reproductive, and cardiovascular consequences. This study was designed to provide an overview of the presentation of he clinical profile and hormonal presentation of the patients with polycystic ovarian syndrome attending a tertiary care hospital. METHODS A descriptive cross-sectional study was conducted between September 14, 2019 to October 16, 2019 on patients presenting to a tertiary care hospital, after obtaining ethical clearance from Institutional Review Committee (Dated 03/09/2019) and informed consent from the patient or patient relatives. Data entry and analysis were done in Microsoft Excel 10. The data was statistically analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. RESULTS The study included 100 PCOS patients. The mean age of the patients was 24.9±4.52 years and the most common group was 26-34 years. The most common presenting symptom was menstrual irregularity which was seen in 86 (86%) of the patients, followed by weight gain in 55 (55%) of the patients. Thirty percent (30 in number) of the patients were overweight, while eleven (11%) of the patients had grade I obesity. LH/FSH ratio was more than or equal to 2 in eighty-three percent 83 (83%) of the patients. CONCLUSIONS Polycystic ovarian syndrome has varying clinical manifestations, most commonly affecting the young women of reproductive age group. The commonest presenting complaint in the current study was menstrual abnormality. Majority of the patients had deranged hormonal profile which can lead to an increased risk of cardiovascular disease and type 2 DM. Thus, awareness regarding PCOS is important for early diagnosis and to prevent its sequalae to various complications.
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Affiliation(s)
- Achala Vaidya
- Department of Obstetrics and Gynaecology, Norvic International Hospital, Kathmandu, Nepal
| | - Sweta Yadav
- Department of Obstetrics and Gynaecology, Norvic International Hospital, Kathmandu, Nepal
| | - Anshu Vaidya
- Department of Obstetrics and Gynaecology, Norvic International Hospital, Kathmandu, Nepal
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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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Sjökvist O, Smolle C, Jensson D, Huss F. A full-thickness chemical burn to the hand using formic acid-based anti-wart treatment: a case report and literature review. Scars Burn Heal 2020; 6:2059513119897888. [PMID: 32076576 PMCID: PMC7003174 DOI: 10.1177/2059513119897888] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Chemical burns are comparably rare but often result in full-thickness skin defects with frequent involvement of underlying structures. Hands are the most commonly affected injury site and impaired functional outcome is common. We present a case of an unusual chemical burn to the dorsum of the hand of a child secondary to application of a topical anti-wart treatment containing formic acid. CASE REPORT An 11-year-old girl was referred to our outpatient department with a full-thickness injury resulting from a chemical burn having used a topical formic acid solution in the treatment of common warts. On examination, a 20-mm circular full-thickness defect was noted to the dorsum of the hand. The extensor tendons were not involved and there were no signs of infection. She required surgical debridement and local flap coverage. The postoperative recovery was unremarkable. CONCLUSION Through a comprehensive literature review, four common topical solutions used in anti-wart treatment were identified to be associated with burns. Together with our case, this highlights the importance of careful patient education in the usage of common topical over-the-counter treatments.
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Affiliation(s)
- Olivia Sjökvist
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
| | - Christian Smolle
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
| | - David Jensson
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Sweden
| | - Fredrik Huss
- Burn Center, Department of Plastic and Maxillofacial Surgery, Uppsala University Hospital, Sweden
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Sweden
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Giant Squamous Cell Papilloma of the Eyelid-Diagnostic and Therapeutic Challenges. Case Rep Ophthalmol Med 2019; 2019:5830493. [PMID: 31781447 PMCID: PMC6875255 DOI: 10.1155/2019/5830493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/17/2019] [Indexed: 12/05/2022] Open
Abstract
Squamous cell papilloma (SCP) is generally a human papillomavirus (HPV) induced exophytic or endophytic proliferation on the surface of the skin, oral cavity, larynx, esophagus, cervix, vagina, and anal canal. The endophytic type SCP can cause differential diagnostic difficulties with keratoacanthoma, inverted follicular keratosis, and squamous cell carcinoma; however, these lesions are not associated with HPV infection. The authors present a female patient who noticed an extremely rapidly growing tumor destructing the left lower eyelid. The histological analysis of the biopsy sample revealed a virus-induced squamoproliferative lesion. The eyelid affected was completely removed, and the histological examination resulted in a HPV induced endophytic squamous cell papilloma. The tarsus and the conjunctiva were replaced by a chondromucosal graft harvested from the nasal septum, while the skin defect could be closed directly. Restoration of the eyelid function has been achieved with satisfying functional and cosmetic results.
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Liu Y, Li H, Pi R, Yang Y, Zhao X, Qi X. Current strategies against persistent human papillomavirus infection (Review). Int J Oncol 2019; 55:570-584. [PMID: 31364734 DOI: 10.3892/ijo.2019.4847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 07/16/2019] [Indexed: 11/06/2022] Open
Abstract
Human papillomavirus (HPV) is the most common sexually transmitted infection, exhibiting a tropism for the epidermis and mucosae. The link between persistent HPV infection and malignancies involving the anogenital tract as well as the head and neck has been well‑established, and it is estimated that HPV‑related cancers involving various anatomical sites account for 4.5% of all human cancers. Current prophylactic vaccines against HPV have enabled the prevention of associated malignancies. However, the sizeable population base of current infection in whom prophylactic vaccines are not applicable, certain high‑risk HPV types not included in vaccines, and the vast susceptible population in developing countries who do not have access to the costly prophylactic vaccines, put forward an imperative need for effective therapies targeting persistent infection. In this article, the life cycle of HPV, the mechanisms facilitating HPV evasion of recognition and clearance by the host immune system, and the promising therapeutic strategies currently under investigation, particularly antiviral drugs and therapeutic vaccines, are reviewed.
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Affiliation(s)
- Yu Liu
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Hongyi Li
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ruyu Pi
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yang Yang
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xia Zhao
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaorong Qi
- Department of Gynecology and Obstetrics, Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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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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Liu J, Li H, Yang F, Ren Y, Xia T, Zhao Z, Cao X, Wang Z, Yin M, Lu S. Epidemiology and Clinical Profile of Cutaneous Warts in Chinese College Students: A Cross-Sectional and Follow-Up Study. Sci Rep 2018; 8:15450. [PMID: 30337549 PMCID: PMC6194033 DOI: 10.1038/s41598-018-33511-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/26/2018] [Indexed: 11/09/2022] Open
Abstract
In this study, the hands and feet of 15,384 undergraduate and postgraduate students in 3 colleges in Beijing were examined for the presence of cutaneous warts at college-entry, and those diagnosed with warts were followed up 2-3 years later. We identified totally 215 (1.4%; 95% CI, 1.2-1.6%) students with warts. The prevalence was significantly higher in male than in female students (2.0% vs. 0.9%, P < 0.0001). Of the 215 patients, 66.9% and 62.1% had only one wart and 98.3% and 93.2% had warts <1 cm in diameter, on the hands and feet, respectively. Of the 130 patients with a follow-up visit, 78 did not receive any treatment (44 recovered within 2 years). Patients aged 21-25 compared to those aged ≤20 were more likely to be free of warts (hazard ratio = 1.76; 95% CI, 1.07-2.89), while lower father's education (hazard ratio = 0.19; 95% CI, 0.04-0.98) and poor sleep quality (hazard ratio = 0.41; 95% CI, 0.18-0.92) decreased the likelihood of resolution. The prevalence of warts is 1.4% in college students. The majority of patients have warts <1 cm and approximately 2/3 patients has one wart. Slightly over half of patients recover spontaneously within 2 years. Patients' age, sleep quality, and paternal education may affect the resolution.
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Affiliation(s)
- Jianjun Liu
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Hongtian Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, 100191, China
| | - Fan Yang
- Department of Dermatology, The Second People's Hospital of Wuqing, Tianjin, 301700, China
| | - Yingyun Ren
- Department of Dermatology, The Third People's Hospital of Foshan, Foshan, 528000, China
| | - Tianbao Xia
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Zigang Zhao
- Department of Dermatology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaojia Cao
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Zekun Wang
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Mengmeng Yin
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Shichao Lu
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China.
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Seo HM, Park HK, Kim TL, Kim JS. What factors affect the duration of treatment with diphenylcyclopropenone immunotherapy for common warts? Dermatol Ther 2018; 31:e12740. [PMID: 30203625 DOI: 10.1111/dth.12740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/09/2018] [Accepted: 08/12/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Hyun-Min Seo
- Department of Dermatology, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | | | - Tae Lim Kim
- Department of Dermatology, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
| | - Joung Soo Kim
- Department of Dermatology, Hanyang University Guri Hospital, Gyeonggi-do, Republic of Korea
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Meyers JM, Grace M, Uberoi A, Lambert PF, Munger K. Inhibition of TGF-β and NOTCH Signaling by Cutaneous Papillomaviruses. Front Microbiol 2018; 9:389. [PMID: 29568286 PMCID: PMC5852067 DOI: 10.3389/fmicb.2018.00389] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 02/20/2018] [Indexed: 12/12/2022] Open
Abstract
Infections with cutaneous papillomaviruses have been linked to cutaneous squamous cell carcinomas that arise in patients who suffer from a rare genetic disorder, epidermodysplasia verruciformis, or those who have experienced long-term, systemic immunosuppression following organ transplantation. The E6 proteins of the prototypical cutaneous human papillomavirus (HPV) 5 and HPV8 inhibit TGF-β and NOTCH signaling. The Mus musculus papillomavirus 1, MmuPV1, infects laboratory mouse strains and causes cutaneous skin warts that can progress to squamous cell carcinomas. MmuPV1 E6 shares biological and biochemical activities with HPV8 E6 including the ability to inhibit TGF-β and NOTCH signaling by binding the SMAD2/SMAD3 and MAML1 transcription factors, respectively. Inhibition of TGF-β and NOTCH signaling is linked to delayed differentiation and sustained proliferation of differentiating keratinocytes. Furthermore, the ability of MmuPV1 E6 to bind MAML1 is necessary for wart and cancer formation in experimentally infected mice. Hence, experimental MmuPV1 infection in mice will be a robust and valuable experimental system to dissect key aspects of cutaneous HPV infection, pathogenesis, and carcinogenesis.
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Affiliation(s)
- Jordan M Meyers
- Program in Virology, Harvard Medical School, Boston, MA, United States.,Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Miranda Grace
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
| | - Aayushi Uberoi
- McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Paul F Lambert
- McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Karl Munger
- Department of Developmental, Molecular and Chemical Biology, Tufts University School of Medicine, Boston, MA, United States
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15
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Dalimunthe DA, Siregar R, Tanjung C. Comparative Clinical Efficacy between Electrodesiccation with Curettage and Application of 80% Phenol Solution in Treatment of Common Warts. Open Access Maced J Med Sci 2018; 6:326-329. [PMID: 29531597 PMCID: PMC5839441 DOI: 10.3889/oamjms.2018.074] [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: 09/30/2017] [Revised: 11/24/2017] [Accepted: 11/25/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Common warts are skin diseases caused by human papillomavirus. Several treatment modalities available for common warts, two of them are electrodesiccation with curettage and application of 80% phenol solution. AIM This study aims to compare clinical efficacy between these two modalities. MATERIAL AND METHODS Open clinical trial was conducted at Dr Pirngadi General Hospital Medan and H. Adam Malik General Hospital Medan from February to June 2013 on 17 patients with multiple common warts. Both treatments began and applied simultaneously on the same day on each patient. RESULTS Cure rate was higher in electrodesiccation with curettage (76.5%, 100%) compared to the application of 80% phenol solution (11.8%, 64.7%) on three weeks and six weeks of follow up. Statistical analysis showed a significant difference of common warts cure rate between electrodesiccation with curettage and application of 80% phenol solution after three weeks (p < 0.001) and six weeks (p = 0.018) of treatment. CONCLUSION As a conclusion, electrodesiccation with curettage has higher cure rate than the application of 80% phenol solution on the treatment of common warts. Further study is needed to find out the best concentration and time interval for application of phenol solution to improve its clinical efficacy as an alternative treatment of choice for common warts.
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Affiliation(s)
- Dina Arwina Dalimunthe
- Department of Dermatology and Venereology, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
| | - Remenda Siregar
- Department of Dermatology and Venereology, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
| | - Chairiyah Tanjung
- Department of Dermatology and Venereology, Faculty of Medicine, Sumatera Utara University, Medan, Indonesia
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Fichman Y, Levi A, Hodak E, Halachmi S, Mazor S, Wolf D, Caplan O, Lapidoth M. Efficacy of pulsed dye laser treatment for common warts is not influenced by the causative HPV type: a prospective study. Lasers Med Sci 2017; 33:773-777. [PMID: 29218494 DOI: 10.1007/s10103-017-2413-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/04/2017] [Indexed: 01/17/2023]
Abstract
Verruca vulgaris (VV) is a prevalent skin condition caused by various subtypes of human papilloma virus (HPV). The most common causes of non-genital lesions are HPV types 2 and 4, and to a lesser extent types 1, 3, 26, 29, and 57. Although numerous therapeutic modalities exist, none is universally effective or without adverse events (AE). Pulsed dye laser (PDL) is a favorable option due to its observed efficacy and relatively low AE rate. However, it is not known which verrucae are most likely to respond to PDL, or whether the causative viral subtype influences this response. The objective of this prospective blinded study was to assess whether the HPV subtype was predictive of response to PDL. For that matter, 26 verrucae from 26 immunocompetent patients were biopsied prior to treatment by PDL. HPV coding sequences were isolated and genotyped using PCR analysis. Patients were treated by PDL (595 nm wavelength, 5 mm spot size, 1.5 ms pulse duration, 12 J/cm2 fluence) once a month for up to 6 months, and clinical response was assessed. Binary logistic regression analysis and linear logistic regression analysis were used in order to evaluate statistical significance. Different types of HPV were identified in 22 of 26 tissue samples. Response to treatment did not correlate with HPV type, age, or gender. As no association between HPV type and response to PDL therapy could be established, it is therefore equally effective for all HPV types and remains a favorable treatment option for all VV.
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Affiliation(s)
- Yoseph Fichman
- Plastic Surgery Department, Rabin Medical Center, Petach Tikva, Israel
| | - Assi Levi
- Photodermatoses Clinic, Laser Unit, Dermatology Department, Rabin Medical Center, Petach Tikva, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Emmilia Hodak
- Photodermatoses Clinic, Laser Unit, Dermatology Department, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Sigal Mazor
- Department of Community Dentistry, School of Dental Medicine, Hebrew University-Hadassah Medical Center, Jerusalem, Israel
| | - Dana Wolf
- Clinical Virology Unit, Department of Clinical Microbiology & Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology & Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Moshe Lapidoth
- Photodermatoses Clinic, Laser Unit, Dermatology Department, Rabin Medical Center, Petach Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Choi JY, Park JH, Oh SH, Lee JH, Lee JH, Lee DY, Yang JM. Efficacy of Punch Reduction Prior to Cryotherapy in Patients with Viral Warts: A Case-Control Study in a Single Tertiary Center. Ann Dermatol 2017; 29:200-205. [PMID: 28392648 PMCID: PMC5383746 DOI: 10.5021/ad.2017.29.2.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/02/2016] [Accepted: 08/08/2016] [Indexed: 11/14/2022] Open
Abstract
Background Cutaneous warts are a common complaint to visit dermatologic clinic and its course is variable, ranging from spontaneous resolution to a chronic condition refractory to treatment. Objective To evaluate the efficacy and safety of punch biopsy for cutaneous warts. Methods Thirty-nine patients who received punch biopsy for warts were reviewed through charts and photos. Among them, 15 were matched with cryotherapy-only controls in terms of size and location of the wart. We compared the number and cost of treatments between the two groups. Results Eleven of the total 39 patients were treated with cryotherapy in addition to punch biopsy and the average number of treatments was 4.1±3.3 (mean±standard deviation). In a case-control study, the ratio value of cost was 2.9±3.6 in the experimental group and was 5.9±4.1 in controls (p<0.05). Conclusion Punch biopsies can decrease the number and cost of treatment by reducing the size of warts and inducing local inflammation to accelerate resolution. Therefore, punch reduction should be considered as a viable measure to treat warts.
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Affiliation(s)
- Ju Yeon Choi
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Hye Park
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hwan Oh
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Hee Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joo-Heung Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Youn Lee
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Mo Yang
- Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Zandi S, Ahmad Zadeh R, Yousefi SR, Gharibi F. Promising New Wart Treatment: A Randomized, Placebo-Controlled, Clinical Trial. IRANIAN RED CRESCENT MEDICAL JOURNAL 2016; 18:e19650. [PMID: 27761268 PMCID: PMC5056593 DOI: 10.5812/ircmj.19650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/10/2014] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
Abstract
Background Warts are common dermatological lesion caused by skin epithelial cells’ infection with human Papillomavirus (HPV). Objectives This study aimed to assess the efficacy of a new method for the treatment of dermal warts. Patients and Methods In this clinical trial study, 60 patients (older than 10 years) with dermal warts living in Baneh city, west of Iran, were allocated into the intervention and control groups using the block randomized method in 2012. In the intervention group, outer layers of the dermal wart carved using scalpel and HD tablet set on it and covered with adhesive. In the second and third days, it was repeated again. All stages in the intervention group were similar to the placebo group. Placebo was prepared by a pharmacologist, which was similar to the HD tablet. In both groups, patients were examined one week and one month after taking the last tablet by the physician in terms of improvement or lack of improvement. Data were analyzed by SPSS software version 18 using chi-square test, Fisher’s exact test, Mann-Whitney test and ANOVA for repeated measures. Results In the first week after the intervention, warts were changed in 93.3% of the cases; however, no changes were recorded in the control group. One month after follow-up, the mean was 0.4 ± 0.7 in the intervention group and 5.5 ± 4.9 in the control group (P = 0.0001). Based on ANOVA for repeated measures and t-test, the average number of warts, before, one week and one month after the intervention was statistically significant for both intervention (P = 0.009) and control groups (P = 0.0001). Conclusions This method is recommended for the treatment of dermal warts, owing to the effectiveness, short duration of treatment, and low cost of topical treatment for dermal warts using HD tablets.
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Affiliation(s)
- Shokrollah Zandi
- Kurdistan University of Medical Sciences, Sanandaj, IR Iran
- Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Shokrollah Zandi, Deputy of Research, Kurdistan University of Medical Sciences, P. O. BOX: 66186-34683, Sanandaj, IR Iran. Tel: +98-9128107205, E-mail:
| | | | - Sayedeh Reyhaneh Yousefi
- Department of Obstetrics and Gynecology, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
| | - Fardin Gharibi
- Deputy of Research, Kurdistan University of Medical Sciences, Sanandaj, IR Iran
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19
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López López D, Vilar Fernández JM, Losa Iglesias ME, Álvarez Castro C, Romero Morales C, García Sánchez MM, Becerro de Bengoa Vallejo R. Safety and effectiveness of cantharidin-podophylotoxin-salicylic acid in the treatment of recalcitrant plantar warts. Dermatol Ther 2016; 29:269-73. [DOI: 10.1111/dth.12356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Daniel López López
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry; Universidade da Coruña; Spain
| | | | | | - Carlos Álvarez Castro
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry; Universidade da Coruña; Spain
| | - Carlos Romero Morales
- Faculty of Health, Exercise and Sport; European University of Madrid; Villaviciosa de Odón, Madrid Spain
| | - María Matilde García Sánchez
- Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry; Universidade da Coruña; Spain
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20
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Yang YL, Sang J, Liao NX, Wei F, Liao W, Chen JH. Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid. Lasers Med Sci 2016; 31:929-36. [PMID: 27059226 DOI: 10.1007/s10103-016-1925-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 03/18/2016] [Indexed: 11/25/2022]
Abstract
The facial flat wart (verruca plana) is one of the most common reasons for dermatology and primary care visits. Although there are many therapeutic modalities, no single therapy has been proven to be completely curative. Case reports and uncontrolled studies suggested that photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) can effectively treat recalcitrant facial flat warts. A total of 12 patients with recalcitrant facial flat warts were enrolled in the study. ALA gel (10 %) was applied topically to lesions and incubated for 3 h. The lesions were irradiated by an LED light of 630 ± 10 nm at dose levels of 60-100 mW/cm. Clinical assessment was conducted before and after every treatment for up to 24 weeks. Among the ten patients completing three sessions of ALA-PDT, five had complete lesions clearance, and the other five patients were significantly improved. At the 24-week follow-up, the average effective rate was 88.8 %, with no recurrences. No significant side effects were reported. A low-dose topical ALA-PDT regimen using 10 % ALA, 3 h incubation, and a red light source for three treatment sessions are suggested as the optimal scheme for the treatment of recalcitrant flat warts on the face in Chinese patients. Superior efficacy is found in elevated or active period lesions with mild side effects.
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Affiliation(s)
- Ya-Li Yang
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Junjun Sang
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ning-Xin Liao
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fang Wei
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wanqin Liao
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiang-Han Chen
- Department of Dermatology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
- Shanghai Key Laboratory of Molecular Medical Mycology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Relationship between acne and psychological burden evaluated by ASLEC and HADS surveys in high school and college students from central China. Cell Biochem Biophys 2015; 71:1083-8. [PMID: 25331674 DOI: 10.1007/s12013-014-0312-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Previously, acne and its effects on psychological well-being have mostly been studied unilaterally in the western population. This study was aimed to investigate bidirectional relationship between acne and stress using Adolescent Self-Rating Life Events Check (ASLEC) and Hospital Anxiety and Depression Scale (HADS) surveys from inhabitants of central China. An on-line survey of 2,284 high school and college students from central China was conducted using three questionnaires posted on Chinese professional survey website, the Questionnaire Web. The prevalence and severity of acne were determined using the Pillsbury grading, whereas, the role of stress in acne formation was ascertained by the ASLEC scale. The HADS was employed to assess the psychological well-being. A total of 50.61 % of high school and college students in central China were found to be suffering from acne for more than 6 months, and 19.72 % of them were graded as having severe acne. Negative life events were found to accelerate the occurrence and exacerbation of the condition. Acne-affected groups showed significantly higher HADS-A (HADS-anxiety) and HADS-D (HADS-depression) scores than the controls (7.31 and 7.28 vs. 4.37 and 3.85, respectively; p < 0.01). Despite the apparent neglect of acne in Chinese high school and college students, a close bidirectional relationship was found to exist between stress and acne. It is incumbent on the healthcare professional to introduce school-based educational programs to help students with knowledge and management of acne and prevent the consequent psychological disorders.
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Shahmoradi Z, Assaf F, Al Said H, Khosravani P, Hosseini SM. Topical pyruvic acid (70%) versus topical salicylic acid (16.7%) compound in treatment of plantar warts: A randomized controlled trial. Adv Biomed Res 2015; 4:113. [PMID: 26261815 PMCID: PMC4513322 DOI: 10.4103/2277-9175.157833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Recurrence rate is considerable with current topical treatments of plantar warts. We compared the efficacy of topical pyruvic acid (70%) with salicylic acid (16.7%) compound in treating multiple plantar warts. Materials and Methods: In this randomized controlled trial, 60 patients with multiple plantar warts were equally randomized to receive either pyruvic acid 70% or compound salicylic acid solution (salicylic acid 16.7%, lactic acid 16.7%, and collodion 100%) that was topically applied twice a day for 4 weeks. Patients were visited every 2 weeks for 1 month after starting treatment and then every 1 month for another 2 months. The number and size of warts, treatment complications (pain, burning, scar, pigmentation, and crust), and recurrence were evaluated. Results: Warts’ number was decreased by −13.12 ± 25.6% with pyruvic acid and by −23.0 ± 28.0% with compound salicylic acid (P = 0.159) after treatment. Warts’ size was decreased by −43.47 ± 57.0% with pyruvic acid and by −37.40 ± 32.76% with compound salicylic acid (P = 0.615) after treatment. There was no difference between the two groups in cumulative incidence of treatment complications (P > 0.05). Also, there was no difference between the two groups in recurrence rate at 2 months (10 vs. 16.7%, P = 0.500) or at 3 months after treatment (3.3 vs. 6.7%, P = 0.335). Conclusion: Topical pyruvic acid and compound salicylic acid had the same efficacy and complications in treating plantar warts. Decision for choosing the treatment can be made based on the costs and individual factors as well as patients preferences.
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Affiliation(s)
- Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatima Assaf
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Al Said
- Department of Biochemistry, Faculty of Sciences, EDST-PRASE, Lebanese University, Hadath-Beirut, Lebanon
| | - Parastoo Khosravani
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayyed Mohsen Hosseini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Mucocutaneous warts in Middle Anatolia, Turkey: clinical presentations and therapeutic approaches. Postepy Dermatol Alergol 2015; 32:179-83. [PMID: 26161058 PMCID: PMC4495115 DOI: 10.5114/pdia.2015.48054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/22/2014] [Accepted: 09/11/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Viral warts are common skin condition caused by the human papilloma virus. Aim To determine the clinical features of warts and therapeutic approaches to warts and compare them with the literature. Material and methods A cross-sectional survey was conducted on 362 consecutive patients presenting to a dermatology clinic in Ankara, Middle Anatolia, Turkey. Age, gender, anatomic localization, clinical types, number of warts, and medical therapy histories were recorded. Results In our study 139 (38.4%) children and 223 (61.6%) adults had warts. Warts were seen in 191 men, and 171 women. The mean age was 24.7 ±13.5. In all groups the incidence and the number of warts were higher in men. Clinical types of warts were vulgar, anogenital, plantar, verruca plana, filiform, and mosaic. Thirty-six (9.9%) of 362 cases had more than one type. The locations of warts were as follows extremities (n = 233, 64.4%), anogenital (n = 86, 23.7%) and head and neck (n = 73, 20.2%). The incidence of anogenital warts was statistically higher in men than women (p < 0.05). Topical medical treatment was the first choice (n = 60, 57.1%). Conclusions In our study, the incidence and the number of warts were higher in men, which is different than in previous reports. The anogenital wart (AW) was ranked second in all types of warts. According to this finding, we can say that the frequency of AW has been increased in Turkey. To our knowledge recently there have been no studies investigating the clinical features of viral warts in all ages in the literature.
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Ahn CS, Huang WW. Imiquimod in the treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol 2014; 15:387-99. [PMID: 25186654 DOI: 10.1007/s40257-014-0093-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cutaneous warts are highly prevalent lesions caused by the infection of keratinocytes by different types of human papillomaviruses. Although cutaneous warts are capable of resolving spontaneously, these infections can persist for long periods of time by evading the host immune system, and, as a result, many patients choose to seek treatment. Imiquimod is an immune response modifier that is approved as a topical cream for the treatment of anogenital warts by the US Food and Drug Administration. However, the efficacy of imiquimod in the treatment of cutaneous warts has not been well established. OBJECTIVE The purpose of this article is to systematically review the published literature regarding the efficacy of imiquimod in the treatment of cutaneous warts, and to evaluate the quality and outcomes of these studies. METHODS A literature search was performed through clinical queries PubMed (National Library of Medicine) database and the Cochrane database. All completed studies written in English and published through May 2014 were considered. Studies evaluating the use of imiquimod for anogenital warts were excluded. There were no other restrictions based on patient age, sex, ethnicity, or skin type. The studies were evaluated and assessed based on study design, patient population, treatment regimen, clinical outcome, and adverse events. RESULTS A total of 393 records were identified in the initial search; 23 full-text articles were assessed for eligibility and included in the review. Of these studies, six publications reported on immunocompromised individuals only. The highest quality study identified was a grade B, level 3 case-control cohort study in which patients with multiple warts had certain warts treated with imiquimod and others left untreated to serve as a control. The remaining studies identified were level 4 non-controlled case series (grade C) and level 5 case reports (grade D). In immunocompetent patients enrolled in non-controlled studies, the combined rate of patients achieving complete response to therapy was 44%, ranging from 27 to 89%. However, there was variation in the dose frequency and application among these studies. In immunosuppressed patients, two studies and four case reports were identified. Clinical improvement was seen in 33-50% of patients, with no patients experiencing complete clinical clearance. CONCLUSION There have been several studies demonstrating the successful use of imiquimod to treat recalcitrant cutaneous warts, either alone or as combination therapy. However, these studies are limited in number, include small populations, and are non-controlled. Further studies are needed to determine the efficacy of imiquimod, dose frequency and application, and optimal combination with other therapeutic measures such as paring, salicylic acid, or other destructive procedures.
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Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171:696-712. [PMID: 25273231 DOI: 10.1111/bjd.13310] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J C Sterling
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 OQQ, U.K
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Henshaw EB, Olasode OA, Ogedegbe EE, Etuk I. Dermatologic conditions in teenage adolescents in Nigeria. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:79-87. [PMID: 24966708 PMCID: PMC4041180 DOI: 10.2147/ahmt.s62231] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Skin disorders are common in adolescents, and the impact on quality of life can be enormous, particularly when viewed against the backdrop of the visibility of skin diseases and the psychologically vulnerable period of adolescence. However, few studies have documented the magnitude of skin disorders in this subset of individuals. We therefore estimated the point prevalence and pattern of dermatologic conditions in adolescents attending various secondary schools in Calabar, Southern Nigeria. Methods Using a structured questionnaire, relevant sociodemographic information was obtained from 1,447 teenage adolescents from eight secondary schools. Thereafter, a whole body examination was conducted to determine the presence and types of skin disorders seen. Results Skin diseases were seen in 929 students. The point prevalence was higher in males (72.1%) than in females (58.3%). Private schools had a higher prevalence than public schools. The six most common dermatoses were acne vulgaris, pityriasis versicolor, nevi, tinea, miliaria, and keloid/hypertrophic scars, and accounted for over 80% of the dermatoses seen. Conclusion The point prevalence of dermatoses in senior secondary school adolescents was 64.2%. Although a large number of skin disorders were observed, only a handful accounted for a significant proportion of the diseases seen. This increases the ease of training community health workers in the recognition and treatment of common skin diseases. Age, race, and climatic factors are important determinants of skin diseases in adolescents in Nigeria.
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Affiliation(s)
- Eshan B Henshaw
- Dermatology Unit, Department of Internal Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Olayinka A Olasode
- Department of Dermatology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | | | - Imaobong Etuk
- Department of Pediatrics, University of Calabar, Calabar, Cross River State, Nigeria
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Female gender and acne disease are jointly and independently associated with the risk of major depression and suicide: a national population-based study. BIOMED RESEARCH INTERNATIONAL 2014; 2014:504279. [PMID: 24678508 PMCID: PMC3942337 DOI: 10.1155/2014/504279] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 01/02/2014] [Indexed: 01/30/2023]
Abstract
Acne is a common disease in adolescence with female preponderance. It could cause poor self-esteem and social phobia. Previous studies based on questionnaires from several thousands of adolescents showed that acne is associated with major depression and suicide. However, the gender- and age-specific risk of depression and suicide in patients with acne remain largely unknown. Using a database from the National Health Insurance, which included 98% of the population of Taiwan in 2006, we identified patients of acne, major depression, and suicide based on ICD-9-CM codes. Totally 47111 patients with acne were identified (16568 males and 30543 females) from 1 million subjects. The youths of 7–12 years had the highest prevalence of acne (14.39%). Major depression was more common in those with acne (0.77%) than controls (0.56% , P < 0.0001) regardless of gender. Multiple logistic regression showed an increased risk of major depression in women without acne (OR = 1.85, 95% CI 1.75–1.96). The risk is additive in women with acne (OR = 2.78, 95% CI 2.43–3.17). Similar additive risk of suicide was noticed in women with acne. In conclusion, acne and gender, independently and jointly, are associated with major depression and suicide. Special medical support should be warranted in females with acne for the risk of major depression and suicide.
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Li Q, Jiao B, Zhou F, Tan Q, Ma Y, Luo L, Zhai J, Luan Q, Li C, Wang G, Gao T. Comparative study of photodynamic therapy with 5%, 10% and 20% aminolevulinic acid in the treatment of generalized recalcitrant facial verruca plana: a randomized clinical trial. J Eur Acad Dermatol Venereol 2013; 28:1821-6. [PMID: 24267796 DOI: 10.1111/jdv.12319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 10/11/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Generalised recalcitrant facial verruca plana responds poorly to current therapeutic options, including cryotherapy, topical drugs and carbon dioxide (CO2 ) laser. Case reports and uncontrolled studies suggested that topical photodynamic therapy (PDT) is effective choice of treatment free from potential complications associated with invasive therapies. AIMS To investigate the efficacy and safety of PDT with different concentrations of photosensitiser in the treatment of verruca plana. MATERIALS & METHODS The two sides of a subject's face were separately randomized to receive aminolevulinic acid (ALA) of 5%, 10% or 20% concentration. All patients were irradiated with 633-nm red light for 339 J/cm(2) total dose. Complete response (CR) rate was assessed on Week 4, 8, and 16 respectively. RESULTS The mean overall clearance rate was 74.1%, 68.8%, and 64.6% on Week 4, 8, and 12, respectively, in the 110 treated sides. The CR rate was lower in the 5%-ALA group than in the 10%-ALA group (14.3% vs. 33.3%, p < 0.05) and 20%-ALA group (14.3% vs. 26.3%, p < 0.05) after 12 weeks. The mean severity of pain measured by visual analogue scale (VAS) scoring was 3.8 (range: 2 to 10, depending on the lesion location). The overall recurrence rate was 16.7% (4/24) on Week 12. Hyperpigmentation was observed in 61% (67/110) of all treated sides. On Week 4, 8, and 16, hyperpigmentation was more developed in the 20%-ALA group than in the other two groups (p < 0.05). DISCUSSION In terms of complete clearance rate, the 5% ALA-PDT group was significantly inferior to the 10% and 20% ALA-PDT groups at each follow-up. In contrast, the 20% ALA group showed a higher incidence rate of transient hyperpigmentation than the other two groups. CONCLUSIONS This randomised clinical trial suggests that PDT with ALA of 10% concentration offers better efficacy and safety than 5% or 20% concentration for generalised recalcitrant facial verruca plana.
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Affiliation(s)
- Q Li
- Department of Dermatology at Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Bruggink SC, Eekhof JAH, Egberts PF, van Blijswijk SCE, Assendelft WJJ, Gussekloo J. Natural course of cutaneous warts among primary schoolchildren: a prospective cohort study. Ann Fam Med 2013; 11:437-41. [PMID: 24019275 PMCID: PMC3767712 DOI: 10.1370/afm.1508] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Because cutaneous warts resolve spontaneously and available treatments often fail, family physicians and patients may consider a wait-and-see policy. We examined the natural course of cutaneous warts and treatment decisions in a prospective observational cohort of primary schoolchildren. METHODS We inspected the hands and feet of children aged 4 to 12 years from 3 Dutch primary schools for the presence of warts at baseline and after a mean follow-up of 15 months. Parental questionnaires at follow-up provided information on inconvenience caused by warts and any treatments used. RESULTS Of the 1,134 eligible children, 1,099 (97%) participated, of whom 366 (33%) had cutaneous warts at baseline. Among these children with warts, loss to follow-up was 9% and the response rate to the parental questionnaires was 83%. The complete resolution rate was 52 per 100 person-years at risk (95% CI, 44-60). Younger age (hazard ratio = 1.1 per year decrease; 95% CI, 1.0-1.2) and non-Caucasian skin type (hazard ratio = 2.0; 95% CI, 1.3-2.9) increased the likelihood of resolution. During follow-up, 38% of children with warts at baseline treated their warts: 18% used over-the-counter treatment only, 15% used a family physician-provided treatment only, and 5% used both. Children were more likely to initiate treatment if the warts measured at least 1 cm in diameter (odds ratio = 3.2; 95% CI, 1.9-5.3) and especially if parents reported that the warts caused inconvenience (odds ratio = 38; 95% CI, 16-90). CONCLUSIONS One-half of primary schoolchildren with warts will be free of warts within 1 year. Young age and non-Caucasian skin type enhance resolution. Children with large or inconvenient warts are more likely to start treatment. These findings will be useful in the process of shared decision making with parents and children.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Bruggink SC, Eekhof JAH, Egberts PF, van Blijswijk SCE, Assendelft WJJ, Gussekloo J. Warts transmitted in families and schools: a prospective cohort. Pediatrics 2013; 131:928-34. [PMID: 23610204 DOI: 10.1542/peds.2012-2946] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Cutaneous warts are common in primary schoolchildren; however, knowledge on the routes of transmission of human papillomavirus (HPV) causing warts is scarce. This study examines the association between the degree of HPV exposure and incidence of warts in primary schoolchildren to support evidence-based recommendations on wart prevention. METHODS In this prospective cohort study, the hands and feet of all children in grades 1 to 7 (aged 4-12 years) of 3 Dutch primary schools were inspected for the presence of warts at baseline and after 11 to 18 months of follow-up. Data on the degree of HPV exposure included information obtained from parental questionnaires: preexistent warts, warts in family, prevalence of warts at baseline in the class, and use of public places (eg, swimming pools). RESULTS Of the 1134 eligible children, 97% participated; the response rate from parental questionnaires was 77%, and loss to follow-up was 9%. The incidence for developing warts was 29 per 100 person-years at risk (95% confidence interval [CI] 26-32). Children with a white skin type had an increased risk of developing warts (hazard ratio [HR] 2.3, 95% CI 1.3-3.9). Having family members with warts (HR 2.08, 95% CI 1.52-2.86) and wart prevalence in the class (HR 1.20 per 10% increase, 95% CI 1.03-1.41) were independent environmental risk factors. CONCLUSIONS The degree of HPV exposure in the family and school class contributes to the development of warts in schoolchildren. Preventive recommendations should focus more on limiting HPV transmission in families and school classes, rather than in public places.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.
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Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl. Case Rep Pediatr 2013; 2013:704532. [PMID: 23710402 PMCID: PMC3654719 DOI: 10.1155/2013/704532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/28/2013] [Indexed: 11/18/2022] Open
Abstract
A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome.
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Antonsson A, Waterboer T, Bouwes Bavinck JN, Abeni D, de Koning M, Euvrard S, Feltkamp MCW, Green AC, Harwood CA, Naldi L, Nindl I, Pfister HJ, Proby CM, Quint WG, Stockfleth E, Weissenborn SJ, Pawlita M, Neale RE. Longitudinal study of seroprevalence and serostability of 34 human papillomavirus types in European organ transplant recipients. Virology 2012; 436:91-9. [PMID: 23174506 DOI: 10.1016/j.virol.2012.10.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 09/26/2012] [Accepted: 10/29/2012] [Indexed: 01/22/2023]
Abstract
Organ transplant recipients (OTR) are at increased risk of cutaneous squamous cell carcinoma, which may be related to reactivation of human papillomavirus (HPV) infections. Measurement of change in HPV antibodies after transplantation would help to explore this hypothesis. We measured antibodies to 34 HPV types on up to six occasions over 18 months in 441 OTRs from five European countries. At baseline (mean 24 days after transplantation), 80% of all OTRs were seropositive to at least one HPV type. The beta HPV genus had the highest seroprevalence (45%). For most HPV genera baseline seroprevalence peaked between 40 and 59 years old. Most OTRs retained their serostatus over time and antibody levels were stable. Seroprevalence in immunosuppressed OTRs is stable in the 18 months immediately after transplantation. Thus there is no short-term evidence that immunosuppression leads to new or reactivated skin infection with HPV sufficient to induce antibodies.
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Affiliation(s)
- Annika Antonsson
- Department of Population Health, Queensland Institute of Medical Research, Brisbane, Australia.
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Abstract
BACKGROUND Viral warts are a common skin condition, which can range in severity from a minor nuisance that resolve spontaneously to a troublesome, chronic condition. Many different topical treatments are available. OBJECTIVES To evaluate the efficacy of local treatments for cutaneous non-genital warts in healthy, immunocompetent adults and children. SEARCH METHODS We updated our searches of the following databases to May 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2010), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched reference lists of articles and online trials registries for ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of topical treatments for cutaneous non-genital warts. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data; a third author resolved any disagreements. MAIN RESULTS We included 85 trials involving a total of 8815 randomised participants (26 new studies were included in this update). There was a wide range of different treatments and a variety of trial designs. Many of the studies were judged to be at high risk of bias in one or more areas of trial design.Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.A meta-analysis of cryotherapy versus placebo for warts at all sites favoured neither intervention nor control (RR 1.45, 95% CI 0.65 to 3.23). Subgroup analysis for different sites, hands (RR 2.63, 95% CI 0.43 to 15.94) and feet (RR 0.90, 95% CI 0.26 to 3.07), again suggested better outcomes for hands than feet. One trial showed cryotherapy to be better than both placebo and SA, but only for hand warts.There was no significant difference in cure rates between cryotherapy at 2-, 3-, and 4-weekly intervals.Aggressive cryotherapy appeared more effective than gentle cryotherapy (RR 1.90, 95% CI 1.15 to 3.15), but with increased adverse effects.Meta-analysis did not demonstrate a significant difference in effectiveness between cryotherapy and SA at all sites (RR 1.23, 95% CI 0.88 to 1.71) or in subgroup analyses for hands and feet.Two trials with 328 participants showed that SA and cryotherapy combined appeared more effective than SA alone (RR 1.24, 95% CI 1.07 to 1.43).The benefit of intralesional bleomycin remains uncertain as the evidence was inconsistent. The most informative trial with 31 participants showed no significant difference in cure rate between bleomycin and saline injections (RR 1.28, 95% CI 0.92 to 1.78).Dinitrochlorobenzene was more than twice as effective as placebo in 2 trials with 80 participants (RR 2.12, 95% CI 1.38 to 3.26).Two trials of clear duct tape with 193 participants demonstrated no advantage over placebo (RR 1.43, 95% CI 0.51 to 4.05).We could not combine data from trials of the following treatments: intralesional 5-fluorouracil, topical zinc, silver nitrate (which demonstrated possible beneficial effects), topical 5-fluorouracil, pulsed dye laser, photodynamic therapy, 80% phenol, 5% imiquimod cream, intralesional antigen, and topical alpha-lactalbumin-oleic acid (which showed no advantage over placebo).We did not identify any RCTs that evaluated surgery (curettage, excision), formaldehyde, podophyllotoxin, cantharidin, diphencyprone, or squaric acid dibutylester. AUTHORS' CONCLUSIONS Data from two new trials comparing SA and cryotherapy have allowed a better appraisal of their effectiveness. The evidence remains more consistent for SA, but only shows a modest therapeutic effect. Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with SA. Only one trial showed cryotherapy to be better than both SA and placebo, and this was only for hand warts. Adverse effects, such as pain, blistering, and scarring, were not consistently reported but are probably more common with cryotherapy.None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy. Two trials of clear duct tape demonstrated no advantage over placebo. Dinitrochlorobenzene (and possibly other similar contact sensitisers) may be useful for the treatment of refractory warts.
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Affiliation(s)
- Chun Shing Kwok
- Norwich Medical School, University of East Anglia, Norwich, UK
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Abstract
Human papillomaviruses (HPVs) are small double-stranded DNA viruses that infect the epithelia of skin or mucosa. Cutaneous HPV is ubiquitous and many children have skin warts at some stage during childhood and a high proportion of the adult population have asymptomatic skin HPV infections. While a subset of mucosal HPV types are involved in cervical cancer, the role for cutaneous HPV types in skin cancer is still under debate. There is some evidence that the skin HPV types have mechanisms to induce skin cancer, but the role of HPV infection has never been proved in larger epidemiological studies and is not well understood. Cutaneous HPV serology has been employed more commonly during the last decade to help find a link between cutaneous HPV and skin cancer. This review covers the findings from cutaneous HPV serology studies published during the last decade and discusses differences in seroprevalence and risk factors.
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Affiliation(s)
- Annika Antonsson
- Queensland Institute of Medical Research, Cancer Control Group, Population Health Department, Herston, Brisbane, Australia.
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Stamuli E, Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang'ombe AR, Turner G, Thomas K, Curran M, Hashmi F, McIntosh C, McLarnon N, Torgerson DJ, Watt I. Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial). J Foot Ankle Res 2012; 5:4. [PMID: 22369511 PMCID: PMC3348086 DOI: 10.1186/1757-1146-5-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 02/27/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. METHODS A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. RESULTS Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. CONCLUSIONS Cryotherapy is more costly and no more effective than salicylic acid. TRIAL REGISTRATION Current Controlled Trials ISRCTN18994246 [controlled-trials.com] and National Research Register N0484189151.
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Affiliation(s)
- Eugena Stamuli
- Department of Health Sciences, York Trials Unit, University of York, ARRC Building, York YO10 5DD, UK.
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Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang'ombe AR, Stamuli E, Turner G, Thomas K, Curran M, Denby G, Hashmi F, McIntosh C, McLarnon N, Torgerson D, Watt I. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. BMJ 2011; 342:d3271. [PMID: 21652750 PMCID: PMC3109952 DOI: 10.1136/bmj.d3271] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. DESIGN A multicentre, open, two arm randomised controlled trial. SETTING University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. PARTICIPANTS 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. INTERVENTIONS Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. MAIN OUTCOME MEASURES Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. RESULTS There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI -8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients' preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference -3.15% (-16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). CONCLUSIONS Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts. TRIAL REGISTRATION Current Controlled Trials ISRCTN18994246, National Research Register N0484189151.
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Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, UK.
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Dunnihoo ME, Kitterman RT, Tran D. Angiokeratoma presenting as plantar verruca: a case study. J Am Podiatr Med Assoc 2011; 100:502-4. [PMID: 21084538 DOI: 10.7547/1000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
One of the more frequent pathologic conditions that podiatric physicians are confronted with is plantar verrucae. Plantar verrucae have been studied extensively in terms of morphological features and incidence in the population at large and in patients with human immunodeficiency virus infection. Solitary angiokeratomas can be morphologically similar to plantar verrucae, presenting as hyperkeratotic pedunculated lesions. We present a unique case study of a 40-year-old man with human immunodeficiency virus with a painful solitary angiokeratoma masquerading as plantar verrucae. The lesion demonstrated clinical signs consistent with those highlighted in the literature for verrucae, namely, showing as red and black lacunae, punctuated hyperkeratotic epidermis. We propose that solitary angiokeratomas should be an important part of a podiatric physician's differential diagnosis in the lower extremity owing to the similarity of morphological features with plantar verrucae.
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Jenkins DW, Cooper K, O'Connor R, Watanabe L, Wills C. Prevalence of podiatric conditions seen in Special Olympics athletes: Structural, biomechanical and dermatological findings. Foot (Edinb) 2011; 21:15-25. [PMID: 21130642 DOI: 10.1016/j.foot.2010.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/21/2010] [Accepted: 10/22/2010] [Indexed: 02/04/2023]
Abstract
BACKGROUND Podiatric conditions are frequently seen in persons with intellectual disabilities. Unfortunately, many are not detected or addressed. This study attempts to determine the prevalence of a variety of selected podiatric conditions in Special Olympics athletes and compare the findings to studies of a similarly matched general population. METHODS Screenings from 1580 Special Olympics athletes participating in a sampling of United States competitions in 2004-2006 were used for the analysis. The athletes voluntarily underwent a foot screening which followed the standardized Special Olympics Fit Feet protocol. RESULTS The most commonly identified conditions included overpronated gait, abducted gait, restriction in both the ankle and the first metatarsal phalangeal joint, pes planus, metatarsus adductus, brachymetatarsia, hallux abducto valgus, onychomycosis, onychocryptosis and tinea pedis. DISCUSSION/CONCLUSION The prevalence of all the structural conditions was notably higher than a similarly matched general population and both conditions and biomechanical/gait findings associated with ligamentous laxity like pes planus and hallux abducto valgus had especially high prevalence rates. Restricted motion in the ankle and first metatarsal phalangeal joint was surprising and may indicate some athletes have intellectual disabilities with contractures. The higher rates of dermatophyte related conditions may reflect increased exposure from the athletic competition environment, immunocompromise, issues with hygiene or both. Higher rates of onychocryptosis in the athletes may be due to ill fitting shoes and/or hygiene issues.
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Affiliation(s)
- David W Jenkins
- Arizona School of Podiatric Medicine, College of Health Sciences - Midwestern University Glendale, USA.
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Chen W, Mempel M, Traidl-Hofmann C, Al Khusaei S, Ring J. Gender aspects in skin diseases. J Eur Acad Dermatol Venereol 2011; 24:1378-85. [PMID: 20384686 DOI: 10.1111/j.1468-3083.2010.03668.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Gender differences in medicine have been recognized in anatomy, physiology, as well as in epidemiology and manifestations of various diseases. With respect to skin disorders, males are generally more commonly afflicted with infectious diseases while women are more susceptible to psychosomatic problems, pigmentary disorders, certain hair diseases, and particularly autoimmune as well as allergic diseases. Significantly, more female sex-associated dermatoses can be identified than the male sex-associated dermatoses. Dermatoses in the genital area differ between men and women. Gender differences also exist in the occurrence and prognosis of certain skin malignancies. The mechanisms underlying gender differences in skin diseases remain largely unknown. Differences in the skin structure and physiology, effect of sex hormones, ethnic background, sociocultural behaviour and environmental factors may interact to exert the influences. A better understanding of gender differences in human health and diseases will allow the development of novel concepts for prevention, diagnosis and therapy of skin diseases.
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Affiliation(s)
- W Chen
- Department of Dermatology and Allergy, Helmholtz Zentrum Munchen/TUM, ZAUM-Center for Allergy and Environment, Technische Universität München, Germany.
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Antonsson A, Green AC, Mallitt KA, O'Rourke PK, Pandeya N, Pawlita M, Waterboer T, Neale RE. Prevalence and stability of antibodies to 37 human papillomavirus types--a population-based longitudinal study. Virology 2010; 407:26-32. [PMID: 20723959 DOI: 10.1016/j.virol.2010.07.046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/17/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
Information about serostability of cutaneous HPV types over time is very limited. We investigated seroprevalence and serostability of 37 different HPV types over 4½ years in an Australian population-based study. Sera and data were analyzed for 390 people who had never been diagnosed with SCC and had blood collected in 1992, 1993 and 1996. Eighty-six percent of participants were seropositive to at least one of the 37 HPV types at baseline. HPV-4 was the type with the highest seroprevalence (41%), followed by HPV-38 and HPV-8 (both 33%). Over 90% of people retained their baseline serostatus during the 4½ year follow-up. Highest serostability was observed for HPV-88 (99.7% stayed seropositive or seronegative), while HPV-65 was least stable with 17% altering their serostatus during follow-up. Seroprevalence to cutaneous HPV types are relatively stable over time, and a single measure can be used as a reasonable marker of long-term antibody status.
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Affiliation(s)
- Annika Antonsson
- Genetics and Population Health Division, Queensland Institute of Medical Research, Brisbane, The University of Queensland, Brisbane, Queensland, Australia
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Cutaneous warts in children before and after renal transplantation. Pediatr Nephrol 2010; 25:941-6. [PMID: 20024587 DOI: 10.1007/s00467-009-1390-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Revised: 10/12/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
Abstract
Cutaneous warts occur in 3.9-4.9% of children in the UK. The incidence is increased in organ transplant recipients and may be increased in patients with chronic kidney disease (CKD), since uraemia reduces the immune system's function. We surveyed the records from our CKD and renal transplant clinic to ensure patients with warts were identified and appropriately treated. Data were collected by questionnaire. The presence of warts, location, treatment, levels of pain and emotional upset were recorded. Nine of 49 (18.4%) pre-transplantation patients (33 male, median age 12.1 years) were currently suffering from warts compared with 17 of 60 (28.3%) post-transplantation patients (34 male, median age 13.9 years). A further 14 pre-transplantation and 16 post-transplantation patients had previously suffered from warts which had resolved. Forty-one patients had sought treatment for warts, mainly from primary care. Five patients, all having received transplants, were seen by a dermatologist. Self-rated levels of pain and emotional upset were generally low, apart from those of four adolescent patients who expressed significant emotional upset. We concluded that cutaneous warts are more common among CKD patients. Appropriate information and treatment are required before and after transplantation. The majority of warts can be treated in primary care, but selected patients with extensive warts that cause distress need early referral for dermatology opinion.
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Wortsman X, Sazunic I, Jemec GBE. Sonography of plantar warts: role in diagnosis and treatment. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:787-793. [PMID: 19470819 DOI: 10.7863/jum.2009.28.6.787] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE The purpose of this presentation is to show the sonographic morphologic characteristics of plantar warts and the scope of sonography in the treatment of these lesions. METHODS We retrospectively reviewed 27 sonographic examinations of the plantar region; 17 corresponded to plantar warts diagnosed by dermatologists in which the diagnoses were medically derived from sonographic examinations after failure of their treatments. The remaining group consisted of 10 healthy individuals. Sonograms were compared with standard histologic findings. RESULTS The sonographic features of normal plantar skin and plantar warts are described, including the shape, echogenicity, pattern of growth, involvement of skin layers, and blood flow in the lesions. CONCLUSIONS Sonography may be considered as reliable support for plantar wart diagnosis and may have a role in the evaluation of plantar wart treatment modalities, allowing monitoring of therapeutic responses, especially in recurrent and difficult cases with persistent symptoms such as pain.
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Affiliation(s)
- Ximena Wortsman
- Department of Radiology, Clinica Servet, Almirante Pastene 150, Providencia, Santiago, Chile.
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Gladsjo JA, Alió Sáenz AB, Bergman J, Kricorian G, Cunningham BB. 5% 5-Fluorouracil cream for treatment of verruca vulgaris in children. Pediatr Dermatol 2009; 26:279-85. [PMID: 19706088 DOI: 10.1111/j.1525-1470.2008.00800.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Warts are a common pediatric skin disease. Most treatments show only modest benefit, and some are poorly tolerated because of pain. 5-fluorouracil interferes with deoxyribonucleic acid and ribonucleic acid synthesis, and is used to treat genital warts in adults. Efficacy, safety, and tolerability of topical 5% 5-fluorouracil for treatment of common warts were examined in an open-label pilot study with pediatric patients. Thirty-nine children who have at least two hand warts applied 5% 5-fluorouracil cream (Efudex, Valeant Pharmaceuticals International) once or twice daily, under occlusion for 6 weeks. Assessment of treatment response and side effects was performed at baseline, treatment completion, and 3- and 6-month follow-ups. Hematology measures, liver function tests, and medication blood levels were reassessed at treatment completion. Eighty-eight percent of treated warts improved after 6 weeks of treatment, and 41% of subjects had complete resolution of at least one wart. Treatment response did not differ between once or twice daily applications. Tolerability and patient satisfaction were excellent. No subject had clinically significant blood levels of 5-fluorouracil. At 6 month follow-up, 87% of complete responders had no wart recurrence. Topical 5% 5-fluorouracil is a safe, effective, and well-tolerated treatment for warts in children.
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van Haalen FM, Bruggink SC, Gussekloo J, Assendelft WJJ, Eekhof JAH. Warts in primary schoolchildren: prevalence and relation with environmental factors. Br J Dermatol 2009; 161:148-52. [PMID: 19438464 DOI: 10.1111/j.1365-2133.2009.09160.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Warts are very common in primary schoolchildren. However, knowledge on wart epidemiology and causes of wart transmission is scarce. OBJECTIVES To determine the prevalence of warts in primary schoolchildren and to examine the relation with environmental factors in order to provide direction for well-founded recommendations on wart prevention. METHODS In this cross-sectional study, the hands and feet of 1465 children aged 4-12 years from four Dutch primary schools were examined for the presence of warts. In addition, the children's parents completed a questionnaire about possible environmental risk factors for warts. RESULTS Thirty-three per cent of primary schoolchildren had warts (participation rate 96%). Nine per cent had hand warts, 20% had plantar warts and 4% had both hand and plantar warts. Parental questionnaires (response rate 76%) showed that environmental factors connected to barefoot activities, public showers or swimming pool visits were not related to the presence of warts. An increased risk of the presence of warts was found in children with a family member with warts [odds ratio (OR) 1.9, 95% confidence interval (CI) 1.3-2.6] and in children where there was a high prevalence of warts in the school class (OR per 10% increase in wart prevalence in school class 1.6, 95% CI 1.5-1.8). CONCLUSIONS One-third of primary schoolchildren have warts. This study does not find support for generally accepted wart prevention recommendations, such as wearing protective footwear in communal showers and swimming pool changing areas. Rather, recommendations should focus on ways to limit the transmission of wart viruses within families and school classes.
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Affiliation(s)
- F M van Haalen
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, Leiden 2300 RC, The Netherlands
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Orozco-Topete R, Villa A, Leyva Santiago J, Scholtes C, Archer-Dubon C, Ysunza A. Warts, malnutrition, and sunshine. Pediatr Dermatol 2008; 25:395-7. [PMID: 18577057 DOI: 10.1111/j.1525-1470.2008.00694.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Viral warts are common in poor rural settings but their relationship to malnutrition has not been studied. We sought to determine the prevalence of warts in children of two communities in Oaxaca, Mexico, and compared it with their nutritional status. Children from Santa Catarina Yahuio and Santiago Laxopa of the state of Oaxaca were examined. Localization, number, and type of verruca were noted. Date of birth, height, and weight were obtained to determine nutritional status. A total of 213 children (116 girls and 97 boys), 107 in Yahuio and 106 in Laxopa, were studied. Mean age was 10.24 years. Thirty children (14.1%) had warts and 80% (24/30) of these lived in Yahuio (p = 0.0002). Almost half were teenagers. Most lesions were on sun-exposed areas. First degree malnutrition was found in 24.5%; second degree in 23.6% and third degree in 14.2%. A higher frequency of warts than previously reported was found. Malnutrition was prevalent in both groups but did not correlate positively with verruca. Verruca were more frequent in females, adolescents, sun-exposed areas, and higher altitude. We believe that the higher altitude of Yahuio facilitates greater exposure to ultraviolet light-induced immune suppression.
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Affiliation(s)
- Rocío Orozco-Topete
- Dermatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
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Yang YC, Cheng YW, Lai CS, Chen W. Prevalence of childhood acne, ephelides, warts, atopic dermatitis, psoriasis, alopecia areata and keloid in Kaohsiung County, Taiwan: a community-based clinical survey. J Eur Acad Dermatol Venereol 2007; 21:643-9. [PMID: 17447978 DOI: 10.1111/j.1468-3083.2006.02036.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological study on childhood dermatoses performed by direct inspection of dermatologists is limited. OBJECTIVE To investigate the prevalence of selective childhood dermatoses in Taiwan. METHODS In a cross-sectional study carried out in June 2004, 4067 of 7851 children aged between 6 and 11 years living in the Kaohsiung County in south Taiwan were clinically surveyed and examined by two board-certified dermatologists (response rate 52%), regarding the point prevalence of acne, ephelides, warts, atopic dermatitis (AD), psoriasis, alopecia areata (AA) and keloid. RESULTS Acne vulgaris was found in girls and boys from the age of 6 and 7, respectively, with comedones being the earliest presentation. Ephelides were not infrequently observed in our children (prevalence rate 8.4%, 95% confidence interval, CI 7.9-9.3%). The prevalence of warts on hands was 2.4% (95% CI 1.9-2.9%). The prevalence of AD was 1.7% (95% CI 1.3-2.1%), without gender difference. There were only four cases of AA but no psoriasis was found. Keloid was identified in 13 boys and 10 girls, accounting for 0.6% (95% CI 0.598-0.602%) of the children. CONCLUSION Acne vulgaris is as common in Taiwan as in Western countries. Ephelides are not uncommon in our population with the main skin types III-IV. A clustered distribution of the wart infection was noted. The low prevalence of AD in Taiwan seems unaltered over the past decade. AA and psoriasis are rare in our series. Most keloids in our children are caused by BCG vaccination.
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Affiliation(s)
- Y-C Yang
- Department of Dermatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, College of Medicine, Taiwan
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Kyriakis K, Pagana G, Michailides C, Emmanuelides S, Palamaras I, Terzoudi S. Lifetime prevalence fluctuations of common and plane viral warts. J Eur Acad Dermatol Venereol 2007; 21:260-2. [PMID: 17243971 DOI: 10.1111/j.1468-3083.2006.01833.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brandsma JL, Shlyankevich M, Buonocore L, Roberts A, Becker SM, Rose JK. Therapeutic efficacy of vesicular stomatitis virus-based E6 vaccination in rabbits. Vaccine 2006; 25:751-62. [PMID: 16962690 DOI: 10.1016/j.vaccine.2006.08.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2006] [Revised: 08/04/2006] [Accepted: 08/09/2006] [Indexed: 10/24/2022]
Abstract
Millions of people worldwide are currently infected with human papillomaviruses (HPVs). A therapeutic HPV vaccine would have widespread applicability because HPV-associated lesions are difficult to treat and may progress to carcinoma. We developed three attenuated VSV recombinants expressing the cottontail rabbit papillomavirus (CRPV) early protein E6 for use as vaccines. In cultured cells, two vectors expressed different levels of the E6 protein, and one expressed a ubiquitin-E6 fusion protein. All three were tested for therapeutic efficacy in the cottontail rabbit papillomavirus (CRPV)-rabbit model. Mock vaccination had no effect on papilloma growth. In contrast, inoculation with any of the VSV-E6 vaccines reduced the rate of papilloma growth to as little as 24% the rate in the controls. In five experiments, these effects were achieved after a single immunization. Furthermore, complete papilloma regression occurred in some rabbits observed for 4 months. A VSV-based papillomavirus E6 vaccine could have significant advantages over other therapeutic HPV vaccine candidates described to date.
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Affiliation(s)
- Janet L Brandsma
- Section of Comparative Medicine, Yale University School of Medicine, New Haven, CT 06520-8016, USA.
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Abstract
BACKGROUND Viral warts are common and usually harmless but very troublesome. A very wide range of local treatments are used. OBJECTIVES To assess the effects of different local treatments for cutaneous, non-genital warts in healthy people. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to March 2005), EMBASE (1980 to March 2005) and a number of other biomedical databases. The references of all trials and selected review articles were also searched. In addition, we contacted pharmaceutical companies involved in local treatments for warts and experts in the field SELECTION CRITERIA Randomised controlled trials of local treatments for cutaneous non-genital viral warts in immunocompetent (healthy) people. DATA COLLECTION AND ANALYSIS Data was extracted and two authors independently selected the trials and assessed methodological quality. MAIN RESULTS Sixty trials were identified that fulfilled the criteria for inclusion. The evidence provided by these studies was generally weak due to poor methodology and reporting. In 21 trials with placebo groups that used participants as the unit of analysis, the average cure rate of placebo preparations was 27% (range 0 to 73%) after an average period of 15 weeks (range 4 to 24 weeks). The best available evidence was for simple topical treatments containing salicylic acid, which were clearly better than placebo. Data pooled from five placebo-controlled trials showed a cure rate of 117/160 (73%) compared with 78/162 (48%) in controls, which translates to a risk ratio of 1.60 (95% confidence interval 1.16 to 2.23), using a random effects model. Evidence for the absolute efficacy of cryotherapy was surprisingly lacking. Two trials comparing cryotherapy with salicylic acid and one comparing duct tape with cryotherapy showed no significant difference in efficacy. Evidence for the efficacy of the remaining treatments reviewed was limited. AUTHORS' CONCLUSIONS There is a considerable lack of evidence on which to base the rational use of topical treatments for common warts. The reviewed trials are highly variable in method and quality. Cure rates with placebo preparations are variable but nevertheless considerable. There is certainly evidence that simple topical treatments containing salicylic acid have a therapeutic effect. There is less evidence for the efficacy of cryotherapy, but reasonable evidence that it is only of equivalent efficacy to simpler and safer treatments. The benefits and risks of topical dinitrochlorobenzene and 5-fluorouracil, intralesional bleomycin and interferons, photodynamic therapy and other miscellaneous treatments remain to be determined.
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Affiliation(s)
- S Gibbs
- Ipswich Hospital NHS Trust, Department of Dermatology, Ipswich, UK IP4 5PD.
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Abstract
PURPOSE OF REVIEW The human papillomavirus is a ubiquitous 55-nm DNA virus that causes a variety of clinical disease states in children, commonly referred to as warts. The natural history of warts is spontaneous regression through the development of a complex blend of cell-mediated and humoral immunity. Although spontaneous immunity can develop, as many as one third of children will have persistent human papillomavirus infection beyond 2 years. Therapeutic modalities are manifold, primarily because no therapy is universally effective. The purpose of this review is to update the reader with the latest information on the human papillomavirus and its therapeutics in children. RECENT FINDINGS Recently, encouraging research has been conducted in human papillomavirus, including destructive and immunologic therapies. Vaccines tailored to genital human papillomavirus strains are just coming into clinical use. SUMMARY Manipulation of the immune system through medications or vaccination will likely help contain human papillomavirus in the future and prevent secondary human papillomavirus oncogenesis of the skin and cervix.
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Affiliation(s)
- Nanette B Silverberg
- Department of Pediatric Dermatology, St. Luke's-Roosevelt Hospital Center, New York, New York, USA.
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