1
|
Le M, Conte S, Hsu JTS, Li MK. Energy-Based Devices for the Treatment of Cutaneous Verrucae: A Systematic Review. Dermatol Surg 2024; 50:345-353. [PMID: 38551277 DOI: 10.1097/dss.0000000000004069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Warts are one of the most common benign neoplasms caused by human papillomavirus infection and often pose a therapeutic challenge. OBJECTIVE To summarize the current evidence on the safety and efficacy of laser and energy-based devices for the treatment of cutaneous verrucae. METHODS A comprehensive systematic review of the literature on laser and energy-based devices for the treatment of cutaneous verrucae was performed. RESULTS A total of 904 unique studies were identified, of which 109 were included in this review. The most commonly used lasers as a single treatment modality for verrucae included the long-pulsed Nd:Yag (n = 20) and pulsed dye (n = 18) lasers. Other modalities included the CO2 ablative laser (n = 10), photodynamic therapy (n = 11), local hyperthermia (n = 11), microwave therapy (n = 2), and nanopulse stimulation (n = 1). Other studies combined energy-based modalities with additional treatments, such as retinoids, imiquimod, and intralesional bleomycin. Overall, such devices were generally well-tolerated, with only a mild side effect profile. CONCLUSION Overall, the use of laser and energy-based devices is a safe and well-tolerated option for cutaneous verrucae that is relatively less invasive than surgical interventions. Future studies using more consistent outcome assessment tools will be valuable to help clinicians develop device-specific protocols and treatment regimens to ensure replicable and effective outcomes.
Collapse
Affiliation(s)
- Michelle Le
- Division of Dermatology, McGill University, Québec, Canada
| | - Santina Conte
- Faculty of Medicine and Health Sciences, McGill University, Québec, Canada
| | - Jeffrey T S Hsu
- Oak Dermatology, Itasca, Illinois
- Department of Dermatology, University of Illinois, Chicago, Illinois
| | - Monica K Li
- Department of Dermatology & Skin Science, University of British Columbia, Vancouver, British Columbia
| |
Collapse
|
2
|
Jiryis B, Avitan-Hersh E, Mirmovich O, Judith Nevet M, Khamaysi Z. Evaluation of combined treatment with Er:YAG laser and long-pulsed Nd:YAG laser for the treatment of recalcitrant warts: A prospective randomized controlled trial. J Eur Acad Dermatol Venereol 2023; 37:2569-2574. [PMID: 37528476 DOI: 10.1111/jdv.19388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 07/11/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Viral warts are common infectious skin disease induced by human papillomavirus (HPV). Lasers have been used for warts treatment in recent years with variable success rates. OBJECTIVE This study aimed to prospectively evaluate combined treatment with Er:YAG laser and long-pulsed Nd:YAG laser compared to Er:YAG laser for the treatment of recalcitrant warts after one session. MATERIALS AND METHODS This study included 240 lesions from 24 patients. All the lesions were diagnosed clinically as recalcitrant warts after failure of topical treatment and cryotherapy. About 120 lesions underwent a combined therapy of Er:YAG and long-pulsed (LP) Nd:YAG lasers, and the remaining 120 lesions underwent Er:YAG laser therapy only. The clearance rate was evaluated 5 weeks after and classified by three-graded evaluation: complete response, partial response and poor response. RESULTS The clearance rate in the combined Er:YAG + LP Nd:YAG lasers group was, statistically significant, higher than that of the Er:YAG laser group (p = 0.008). The complete response rate was 48% (58 of 120 warts) for the Er:YAG +LP Nd:YAG lasers group and only 29% (35 of 120 warts) for the Er:YAG laser group. CONCLUSION The combination of Er:YAG and long-pulsed Nd:YAG lasers is more effective than Er:YAG laser alone in treating recalcitrant warts after single session.
Collapse
Affiliation(s)
- B Jiryis
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - E Avitan-Hersh
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - O Mirmovich
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
| | - M Judith Nevet
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| | - Z Khamaysi
- Department of Dermatology, Rambam Health Care Campus, Haifa, Israel
- Bruce Rappaport Faculty of Medicine, Technion Institute of Technology, Haifa, Israel
| |
Collapse
|
3
|
Park S, Kim H, Kim JY, Lee EJ, Bae YJ, Oh SH, Kim J. Dual-wavelength long-pulsed 755-nm alexandrite/1,064-nm Nd:YAG laser versus Nd:YAG alone for treatment of palmoplantar verruca. J COSMET LASER THER 2023; 25:86-91. [PMID: 37839083 DOI: 10.1080/14764172.2023.2268309] [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: 12/26/2022] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
We compared the effectiveness and safety of the long-pulsed neodymium-doped yttrium-aluminum-garnet (Nd:YAG) laser alone and combined with a 755-nm alexandrite laser for treating palmoplantar warts. We divided patients into two groups to receive up to four monthly treatments with Nd:YAG alone (single-wavelength) or combined with the alexandrite laser (dual-wavelength). We assessed treatment responses (according to clearance rate), vascular/hyperkeratosis grades, and patient satisfaction and pain ratings. The differences in treatment response (p = .348), patient satisfaction (p = .560), and pain ratings (p = .728) between the groups were not significant. The single- and dual-wavelength treatment options were equally effective in treating recalcitrant palmoplantar warts.
Collapse
Affiliation(s)
- Sujin Park
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Kim
- Department of Dermatology, Yongin Severance Hospital, Yongin, Korea
| | - Ji Young Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yu Jeong Bae
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jihee Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Dermatology, Yongin Severance Hospital, Yongin, Korea
| |
Collapse
|
4
|
Al‐Sabak H, Jaafar AA. Treatment of plane warts with long pulse ND - YAG laser 532 nm. Skin Res Technol 2023; 29:e13462. [PMID: 37753672 PMCID: PMC10493339 DOI: 10.1111/srt.13462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 08/30/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Warts are one of the contagious viral diseases that may cause disturbing cosmetic problems. Plane warts represents a common self-limiting viral infection of the skin caused by the Human Papilloma Virus, however, those that do not disappear by themselves can be very difficult to treat with no uniformly effective treatment modality. OBJECTIVE To assess the efficacy of long pulsed 532 nm ND:YAG laser in the treatment of plane warts. PATIENTS AND METHODS In this therapeutic clinical trial study, 34 patients with plane warts were enrolled. Each patient was eligible for up to three treatment sessions administrated at 2 weeks intervals with long pulsed ND:YAG laser at a spot size 3 mm; wavelength 532 nm; pulsed duration 20 ms; and fluence 30 J/cm2 . The patients were assessed before each treatment session and at 3 months after the last treatment session. The response to treatment was graded using four points scale: Scale 1 = poor: <25%, Scale 2 = fair: 25%-50%, Scale 3 = good: 51%-75%, Scale 4 = excellent: >75%. RESULTS Twenty-two patients only with a total of 478 lesions, completed the study; their ages ranged from (6-45) years with a mean ± SD 19.95 ± 13.142 years. Thirteen patients (59.09%) were female and nine (40.90%) were male. The results from this study showing that long pulsed ND:YAG laser 532 nm led to an excellent response in 19 patients (86.36%) in which 15 of 19 patients showed a complete response (78.94%); one patient showed a good response (4.545%), one showed a fair response (4.545%) and one showed a poor response (4.545%) at the end of three-months follow up. The difference was statistically significant; the P value at the three months follow-up was 0.002. The cumulative clearance rate after the first, second, and third treatment sessions was 58.4%, 77.7%, and 89.9% respectively. Recurrence was seen in only one patient (4.545%). Side effects were generally mild and didn't prevent normal activity. CONCLUSION Long pulsed ND:YAG laser 532 nm appears to be an effective method for treatment of plane warts.
Collapse
Affiliation(s)
- Haider Al‐Sabak
- Head of Dermatology and Laser DepartmentCollege of MedicineUniversity of KufaNajafIraq
| | | |
Collapse
|
5
|
Liu JJ, Li HT, Ren YY, Yang F, Cheng ZH, Xia TB, Liu JL, Cao XJ, Lu SC. Long-pulsed neodymium-doped yttrium-aluminum-garnet laser versus cryotherapy for the treatment of cutaneous warts: A randomized controlled trial. J Am Acad Dermatol 2022; 87:1328-1335. [PMID: 33031838 DOI: 10.1016/j.jaad.2020.09.085] [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: 06/10/2020] [Revised: 09/13/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Observational studies have shown promising therapeutic effects of long-pulsed neodymium-doped yttrium-aluminum-garnet (LP-Nd:YAG) laser on warts. OBJECTIVE To evaluate whether LP-Nd:YAG laser was superior to cryotherapy for cutaneous warts. METHODS In this study, 150 adult patients with warts were randomized equally to receive laser or cryotherapy every 3 to 4 weeks, for a maximum of 4 sessions. The primary outcomes were the cure rates at 16 weeks and 6 months; secondary outcomes included time to clearance of warts and treatment-related adverse effects. RESULTS There was no difference in the cure rate for laser versus cryotherapy at 16 weeks (54.1% vs 46.7%, respectively) and 6 months (59.5% vs 57.3%, respectively). However, time to clearance of warts, up to 16 weeks and 6 months, tended to be shorter for laser versus cryotherapy (P = .04 and .08, respectively). Post hoc analyses showed a significantly higher cure rate for laser versus cryotherapy in 3 subgroups of human papillomavirus 2/27/57-induced recalcitrant warts but not in their counterpart subgroups. Laser had more mild adverse effects. LIMITATIONS Single center. CONCLUSIONS The overall therapeutic effects of LP-Nd:YAG laser were similar to cryotherapy, but laser may be more effective to relatively recalcitrant warts and may be associated with shorter time to clearance of warts.
Collapse
Affiliation(s)
- Jian-Jun Liu
- Department of Dermatology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Hong-Tian Li
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Ying-Yun Ren
- Department of Dermatology, Foresea Life Insurance Guangzhou General Hospital, Guangzhou, Guangdong, China
| | - Fan Yang
- Department of Dermatology, The Second People Hospital of Wuqing, Tianjin, China
| | - Zhi-Hao Cheng
- Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China
| | - Tian-Bao Xia
- Department of Dermatology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Jun-Lian Liu
- Department of Dermatology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Xiao-Jia Cao
- Department of Dermatology, 306 Hospital of People's Liberation Army, Beijing, China
| | - Shi-Chao Lu
- Department of Dermatology, 306 Hospital of People's Liberation Army, Beijing, China.
| |
Collapse
|
6
|
Le HTT, Truong Van C, Nguyen Thi M, Al-Niaimi F. Our experience using 1064 nm Nd:YAG in palmoplantar warts. J COSMET LASER THER 2022; 24:28-32. [PMID: 35833729 DOI: 10.1080/14764172.2022.2050761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Common warts (verruca vulgaris) are the most commonly seen benign cutaneous tumors occurring in both males and females of various ages. However, warts on the hands and feet (plantar warts and palmar warts) often respond poorly to traditional treatments such as topical salicylic acid, cryotherapy, surgical excision, electrocautery, and bleomycin injection. Recently, the long-pulsed 1064 nm Nd:YAG laser (LPNYL) has attracted attention in the treatment of palmoplantar warts. This study aims to evaluate the effectiveness of the LPNYL in the treatment of palmoplantar warts. We conducted a comparative cross-sectional descriptive study in 88 patients (49 males and 39 females) with palmoplantar warts. During the period from 2018 to 2020, the patients underwent up to three treatment sessions at intervals of 2-4 weeks between sessions. The LPNYL parameters comprised a spot size of 5 mm, 30 ms pulse width, 1 Hz repetition rate, and a fluence range of 140-180 J/cm2. The patient mean age was 29.0 ± 14.5 years (range, 4-66 years). Good results were seen in 72.9% (64/88) of patients. The remaining 27.1% (24/88) felt their treatment was unsuccessful. As for adverse events, 5 (5.6%) patients reported hemorrhagic blistering after treatment. At the 3- and 6-month follow-up assessments, no recurrence was seen (Figures 2-4). Our study showed that the LPNYL treatment was safe and effective in the majority of palmoplantar warts. The duration of treatment was shorter than most traditional methods; however, the limitations of this method are that the treatment required several sessions, the procedure was painful, and adverse events occurred in just over 5% of the patients.
Collapse
Affiliation(s)
- Hai Thi Thu Le
- Aesthetic surrgery and Laser Department, 108 Military Central Hospital, Hanoi, Vietnam
| | - Cuong Truong Van
- Aesthetic surrgery and Laser Department, 108 Military Central Hospital, Hanoi, Vietnam
| | - Minh Nguyen Thi
- Laser Department, National Hospital of Odonto - Stomatology, Hanoi, Vietnam
| | - Firas Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| |
Collapse
|
7
|
García-Oreja S, Álvaro-Afonso FJ, Tardáguila-García A, López-Moral M, García-Madrid M, Lázaro-Martínez JL. Efficacy of cryotherapy for plantar warts: a systematic review and meta-analysis. Dermatol Ther 2022; 35:e15480. [PMID: 35365922 PMCID: PMC9285476 DOI: 10.1111/dth.15480] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/22/2022] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
Recent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than alternative treatments. A systematic review using meta‐analyses of the efficacy of cryotherapy in plantar warts treatment was performed. Systematic electronic searches were conducted. The primary endpoint was complete clearance of plantar warts. Risk‐of‐bias assessment was based on Cochrane Handbook recommendations. Meta‐analyses used Review Manager v5.4.1 software. Cryotherapy appears to have lower cure rates than other treatments (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12–0.78) with substantial heterogeneity (I2 = 80%). A second subgroup analysis had low heterogeneity (I2 = 28.2%). Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to the physical treatment group (OR 0.05, 95% CI 0.01–0.49) with substantial heterogeneity (I2 = 79%), and antiviral, chemotherapy, and retinoid group (OR 0.30, 95% CI 0.14–0.66) without heterogeneity (I2 = 0%). Intralesional versus spray‐on cryotherapy appears to be more effective (OR 0.21, 95% CI 0.09–0.48). No difference in efficacy between two rounds of 10‐s and four rounds of 5‐s freeze–thaw cycles in cryotherapy was found. Evidence of the superiority of antivirals and chemotherapy over cryotherapy in the treatment of plantar warts was found. However, no evidence supports the superiority or inferiority of cryotherapy compared to other treatments.
Collapse
Affiliation(s)
- Sara García-Oreja
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Aroa Tardáguila-García
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Mateo López-Moral
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Marta García-Madrid
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Lázaro-Martínez
- Complutense University of Madrid, University Podiatric Clinic, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| |
Collapse
|
8
|
Bennardo L, Fasano G, Tamburi F, Zappia E, Rizzuto F, Nisticò SP, Cannarozzo G. Sequential Use of CO 2 Laser Prior to Nd:YAG and Dye Laser in the Management of Non-Facial Warts: A Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:115. [PMID: 35056422 PMCID: PMC8780825 DOI: 10.3390/medicina58010115] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/06/2022] [Accepted: 01/11/2022] [Indexed: 12/26/2022]
Abstract
Background and Objectives: Warts are benign lesions of viral etiology characterized by a hyperkeratotic appearance tending to spread across the skin surface. Various treatments have been proposed to manage this condition, such as acids, imiquimod, photodynamic therapy, cryotherapy, and various lasers. Materials and Methods: In this paper, we describe a combination protocol using CO2 laser prior to Nd:YAG laser for lesions interesting the palmoplantar areas or dye laser for lesions on other skin surfaces in the management of non-facial warts resistant to traditional therapies. In total, 34 patients with 103 warts suffering from wart infection resistant to traditional therapies treated from 1 January 2019 to 1 June 2020 were retrospectively enrolled at the Dermatological Unit of Magna Graecia University (Catanzaro, Italy). Two dermatologists measured clinical results, classifying lesions with complete resolution, partial resolution, or non-responding. Patients at four months follow-up were asked to evaluate their degree of satisfaction with a visual analog scale (VAS). Results: Almost all patients reported the complete resolution of lesions, with no patient reporting scarring. Five patients reported hypopigmentation in the treated areas. The mean satisfaction level was high. Only three patients experienced a relapse of the condition. Conclusions: Using a vascular laser following a CO2 superficial ablation of warts may help reduce the risk of scarring and decrease the incidence of relapses for lesions resistant to traditional therapies. Therefore, more extensive studies will be necessary to confirm the obtained results.
Collapse
Affiliation(s)
- Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Gaia Fasano
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Federica Tamburi
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Elena Zappia
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Francesco Rizzuto
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (L.B.); (G.F.); (F.T.); (E.Z.); (F.R.)
| | | |
Collapse
|
9
|
García-Oreja S, Álvaro-Afonso FJ, García-Álvarez Y, García-Morales E, Sanz-Corbalán I, Lázaro Martínez JL. Topical treatment for plantar warts: A systematic review. Dermatol Ther 2020; 34:e14621. [PMID: 33263934 DOI: 10.1111/dth.14621] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 01/08/2023]
Abstract
There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the efficacy of different topical treatments on plantar warts. Systematic electronic searches (Pubmed, Cochrane Library, Embase, and Web of Science) were conducted in April 2020. Meta-analyses, systematic reviews, and retrospective or prospective clinical trials of the effects of topical and nonsurgical treatments of plantar warts were included. Two authors performed the study selection and data extraction. Any discrepancies between the two reviewers were discussed with a third reviewer. Forty-four studies were included. The average cure rates of the most frequent treatments were variable across the studies: cryotherapy (45.61%), salicylic acid (13.6%), cantharidin-podophyllin-salicylic acid formulation (97.82%), laser (79.36%), topical antivirals (72.45%), intralesional bleomycin (83.37%), and intralesional immunotherapy (68.14%). Twenty-two studies (50%) had a level of evidence 1b and grade of recommendation A, five studies (11.4%) had a level of evidence 2b and grade of recommendation B, two studies (4.5%) had a level of evidence 3b and grade of recommendation B, and 15 studies (34,1%) with a level of evidence 4 and grade of recommendation C. First-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts. Other treatments, such as CPA formulation, immunotherapy, and intralesional bleomycin, which have compassionate use, have higher cure rates. This review should stimulate future high-quality research to evaluate these specialized treatments.
Collapse
Affiliation(s)
- Sara García-Oreja
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Esther García-Morales
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Irene Sanz-Corbalán
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| | - Jose Luis Lázaro Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Complutense University of Madrid, University Podiatric Clinic, Madrid, Spain
| |
Collapse
|
10
|
Zorman A, Koron N. Wart removal without anesthesia using long-pulse 1064-nm Nd:YAG laser. J Cosmet Dermatol 2020; 20:506-512. [PMID: 32640061 PMCID: PMC7891349 DOI: 10.1111/jocd.13593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/11/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Warts are benign epithelial proliferations that result from human papillomavirus (HPV) infection occurring on the skin and mucosa. Patients express a significant reduction in quality of life due to this cosmetic nuisance, as well as functional problems and physical discomfort. Newer methods of wart removal include different energy-based devices, mostly lasers. Nonablative lasers such as Nd:YAG have a higher success rate and are usually used with topical or infiltrative anesthesia. The procedure may be safer without anesthesia but still tolerable with an appropriate cooling and technique. AIMS The purpose of this study is to report on our experience over 3 years since the approach without anesthesia has been utilized. PATIENTS/METHODS A retrospective chart review analysis of all 85 patients who underwent 1064 nm Nd:YAG wart removal without anesthesia between November 2016 and August 2019 was conducted. One of the main outcome measures was determining the number of sessions required in order to get full clearance. RESULTS The mean number of sessions was 2.2 (range 1-7). The mean VAS pain score during the procedure was 6 (range: 2-10), and side effects were negligible. CONCLUSION Long-pulse 1064-nm Nd:YAG laser without any chemical anesthesia is safe and effective for the treatment of warts.
Collapse
|
11
|
Khattab FM, Khashaba SA. Evaluation of combined treatment with long-pulsed neodymium-doped yttrium aluminum garnet laser and potassium hydroxide for the treatment of recalcitrant wart: a prospective comparative study. J DERMATOL TREAT 2019; 31:56-60. [DOI: 10.1080/09546634.2019.1618436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Fathia M. Khattab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Shrook A. Khashaba
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
12
|
Comparison of long-pulsed Nd: YAG laser with cryotherapy in treatment of acral warts. Lasers Med Sci 2018; 34:397-403. [DOI: 10.1007/s10103-018-2613-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/07/2018] [Indexed: 10/28/2022]
|
13
|
Izadi Firouzabadi L, Khamesipour A, Ghandi N, Hosseini H, Teymourpour A, Firooz A. Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: A randomized controlled trial. Dermatol Ther 2017; 31. [PMID: 29082602 DOI: 10.1111/dth.12564] [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: 05/25/2017] [Revised: 09/20/2017] [Accepted: 09/26/2017] [Indexed: 11/29/2022]
Abstract
The effect of thermotherapy in the treatment of skin warts in comparison to cryotherapy, as the standard conventional method, has remained uncertain. This study aimed to assess the clinical efficacy and safety of thermotherapy and cryotherapy in removing skin warts. This randomized controlled trial was conducted on 52 patients aged 18 years and over with ≤ 10 skin warts. The participants were randomly assigned into two groups to receive cryotherapy (every 2 to 3 weeks up to six sessions if required) or thermotherapy (one session). The patients in both groups were followed every 2 to 3 weeks for the first three months, and then three months after the last treatment session. The clearance rate was 79.2% in the thermotherapy group and 58.3% in the cryotherapy group with no significant difference (p = 0.212). The rate of scarring in the thermotherapy group was 20% (p = .018). A higher clearance rate was achieved in the thermotherapy group. However, this result was not statistically significant. There were some minimal post-treatment complications. Patients needed only one session of thermotherapy. Due to the risk of scarring, we suggest thermotherapy only as a suitable treatment method for palmoplantar warts.
Collapse
Affiliation(s)
| | - Ali Khamesipour
- Center for Research & Training in Skin Disease & Leprosy, Tehran University of Medical Science, Tehran, Iran
| | - Narges Ghandi
- Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Hamed Hosseini
- Clinical Trial Center, Tehran University of Medical Science, Tehran, Iran
| | - Amir Teymourpour
- Razi Hospital, Tehran University of Medical Science, Tehran, Iran
| | - Alireza Firooz
- Center for Research & Training in Skin Disease & Leprosy, Tehran University of Medical Science, Tehran, Iran.,Clinical Trial Center, Tehran University of Medical Science, Tehran, Iran
| |
Collapse
|
14
|
Ghonemy S. Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin–podophylline resin–salicylic acid. J COSMET LASER THER 2017; 19:347-352. [DOI: 10.1080/14764172.2017.1326608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Soheir Ghonemy
- Dermatology, Venereology, and Andrology Department, Faculty of Human Medicine, Zagazig University, Zagazig, Egypt
| |
Collapse
|
15
|
Hsu VM, Aldahan AS, Tsatalis JP, Perper M, Nouri K. Efficacy of Nd:YAG laser therapy for the treatment of verrucae: a literature review. Lasers Med Sci 2017; 32:1207-1211. [DOI: 10.1007/s10103-017-2219-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
|
16
|
Alshami MA, Mohana MJ. Novel Treatment Approach for Deep Palmoplantar Warts Using Long-Pulsed 1064-nm Nd:YAG Laser and a Moisturizing Cream Without Prior Paring of the Wart Surface. Photomed Laser Surg 2016; 34:448-455. [PMID: 27598414 DOI: 10.1089/pho.2015.4057] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the safety and efficacy of palmoplantar wart removal using long-pulsed 1064-nm Nd:YAG laser after application of a moisturizing cream. BACKGROUND Previously described laser treatments for wart removal are associated with negative side effects and need to pare the warts before laser treatment. PATIENTS/METHODS Two hundred forty patients (142 males, 98 females) were treated for 1-40 palmoplantar warts by long-pulsed 1064-nm Nd:YAG laser (spot size 4-6 mm, pulse duration 20 msec, fluence 200 J/cm2) after covering the wart surface with a thin film of a moisturizing cream. The endpoint was lesion graying or whitening with or without development of a hemorrhagic bulla beneath the treated wart. Color photographs were taken before and immediately after each laser session and at 1, 4, and 16 weeks after the last session. RESULTS The overall clearance rate was 97%, with 90% of treated patients cured after one session, 4% after two, and 3% after three. Clearance rate after three laser sessions decreased linearly with the number of warts from 100% to 95%. Less accessible wart location in interdigital spaces also decreased the cure rate after three sessions from 100% to 95%. Additionally, warts became more difficult to eradicate as they aged. Remission lasted up to 6 years, and complications were mild and infrequent (17.5%). CONCLUSIONS This novel method is effective in removing palmoplantar warts. It is easier, time-saving, and safer than other methods described in previous studies conducted with ablative or nonablative lasers.
Collapse
Affiliation(s)
- Mohammad Ali Alshami
- Department of Dermatology, University Hospital, Sana'a University , Sana'a, Yemen
| | - Mona Jameel Mohana
- Department of Dermatology, University Hospital, Sana'a University , Sana'a, Yemen
| |
Collapse
|
17
|
Smith EA, Patel SB, Whiteley MS. Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot. J Eur Acad Dermatol Venereol 2014; 29:463-7. [PMID: 24910163 DOI: 10.1111/jdv.12579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/05/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment. OBJECTIVE This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases. METHODS We performed a retrospective audit by sending a questionnaire to all patients with recalcitrant verrucas who had been treated with Nd:YAG laser ablation over the previous 12 months. The questionnaire asked whether treatment had been successful, successful but new lesions had emerged, partially successful with improvement or unsuccessful. A Fontana Nd:YAG laser was used at the following specifications; long pulsed mode with pulse width 25 ms, frequency 1.0 Hz; fluence 240 J/cm(2) and spot size 2 mm. Some patients requested local anaesthesia and had direct infiltration with 0.5% plain lidocaine. RESULTS Fifty-three of the original 87 patients responded (60.9% response rate) with a male to female ratio of 24:29, mean age of 47 years and an age range between 22-72. Thirty-seven patients reported complete success post treatment (69.8%) and a further five reported improvement. The remaining 11 felt their treatment was unsuccessful. The cure rate was 81.8% in unilateral single cases, 68.1% in unilateral multiple cases and 65% in bilateral cases. Ten patients requested sublesional lidocaine injections of which 4 had skin breakdown after Nd: YAG ablation. CONCLUSION Nd:YAG laser ablation is effective in the treatment of recalcitrant verruca plantaris. However, we caution against the use of direct local anaesthesia infiltration before laser treatment.
Collapse
Affiliation(s)
- E A Smith
- Chiropodist and Podiatrist at the Whiteley Clinic, Guildford, UK
| | | | | |
Collapse
|
18
|
Kimura U, Takeuchi K, Kinoshita A, Takamori K, Suga Y. Long-pulsed 1064-nm neodymium:yttrium-aluminum-garnet laser treatment for refractory warts on hands and feet. J Dermatol 2014; 41:252-7. [DOI: 10.1111/1346-8138.12411] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/29/2013] [Accepted: 12/20/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Utako Kimura
- Department of Dermatology; Juntendo University Urayasu Hospital; Chiba Japan
| | - Kaori Takeuchi
- Department of Dermatology; Juntendo University Urayasu Hospital; Chiba Japan
| | - Ayako Kinoshita
- Department of Dermatology; Juntendo University Urayasu Hospital; Chiba Japan
| | - Kenji Takamori
- Department of Dermatology; Juntendo University Urayasu Hospital; Chiba Japan
| | - Yasushi Suga
- Department of Dermatology; Juntendo University Urayasu Hospital; Chiba Japan
| |
Collapse
|
19
|
Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study. Lasers Med Sci 2013; 29:1111-6. [DOI: 10.1007/s10103-013-1479-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
|
20
|
Huo W, Di ZH, Xiao BH, Qi RQ, Weiland M, Gao XH. Clearance of genital warts in pregnant women by mild local hyperthermia: a pilot report. Dermatol Ther 2013; 27:109-12. [PMID: 24703269 DOI: 10.1111/dth.12066] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Wei Huo
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang China
| | - Zheng-Hong Di
- Department of Dermatology; Shengjing Hospital of China Medical University; Shenyang China
| | - Bi-Huan Xiao
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang China
| | - Rui-Qun Qi
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang China
| | - Matthew Weiland
- Department of Dermatology; Henry Ford Health System; Detroit Michigan
| | - Xing-Hua Gao
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang China
| |
Collapse
|
21
|
Abstract
Warts are the most common nail tumor generally caused by human papilloma virus (HPV) 1, 2, 4, 27, and 57. HPV 16 and 18 are associated with malignant transformation to squamous cell carcinoma, while HPV 2 and 7 are associated with "butcher's warts." Current treatments range from topical and intralesional therapies to systemic agents and surgical procedures. Despite the numerous available possibilities for treatment, intralesional bleomycin appears to be the most effective treatment for periungual warts.
Collapse
Affiliation(s)
- Jordana Herschthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | | |
Collapse
|
22
|
Huo W, Li GH, Qi RQ, Zhang L, Yan XX, Chen HD, Gao XH. Clinical and immunologic results of local hyperthermia at 44 °C for extensive genital warts in patients with diabetes mellitus. Int J Hyperthermia 2013; 29:17-20. [DOI: 10.3109/02656736.2012.758874] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
23
|
Khandelwal K, Bumb RA, Mehta RD, Ghiya BC, Satoskar AR. Long-term efficacy of radiofrequency ablation in treatment of common and palmo-plantar warts. Australas J Dermatol 2012; 54:307-9. [DOI: 10.1111/j.1440-0960.2012.00966.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/27/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Kanika Khandelwal
- Department of Skin, STD and Leprosy; SP Medical College; Bikaner Rajasthan India
| | - Ram A Bumb
- Department of Skin, STD and Leprosy; SP Medical College; Bikaner Rajasthan India
| | - Rajesh D Mehta
- Department of Skin, STD and Leprosy; SP Medical College; Bikaner Rajasthan India
| | - Bhikam C Ghiya
- Department of Skin, STD and Leprosy; SP Medical College; Bikaner Rajasthan India
| | - Abhay R Satoskar
- Departments of Pathology and Microbiology; Ohio State University; Columbus Ohio USA
| |
Collapse
|
24
|
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.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | | | | |
Collapse
|
25
|
Ma Y, Huo W, Hong YX, Chen HD, Gao XH. Successful clearance of facial common warts by local hyperthermia: report of two cases. Dermatol Ther 2012; 25:386-8. [PMID: 22950567 DOI: 10.1111/j.1529-8019.2012.01470.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yan Ma
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang; China
| | - Wei Huo
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang; China
| | - Yu-Xiao Hong
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang; China
| | - Hong-Duo Chen
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang; China
| | - Xing-Hua Gao
- Department of Dermatology; No.1 Hospital of China Medical University; Shenyang; China
| |
Collapse
|
26
|
Li X, Zhang C, Hong Y, Zhang D, Wei H, Chen HD, Gao XH. Local hyperthermia treatment of extensive viral warts in Darier disease: A case report and literature review. Int J Hyperthermia 2012; 28:451-5. [DOI: 10.3109/02656736.2012.677929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
27
|
Abstract
Heat has been used as a medicinal and healing modality throughout human history. Today, thermotherapy is being studied in the treatment of many diseases. Although the exact anti-infective mechanism of thermotherapy is yet to be solved, this historically important healing method has shown significant results in the treatments of a variety of dermatological infectious diseases ranging from simple acne to bacterial, parasitic and viral infections, in modern medicine. Induction of cellular apoptosis in medium doses and necrosis in high doses has made thermotherapy an important modality in the treatment of malignant tumors. Especially in dermatology, significant results have been achieved in the treatment of Bowen's disease, melanoma and simple warts. Thermotherapy, which today has also shown advancements in cosmetology, can be delivered by liquid nitrogen in the form of hypothermia and a variety of ways ranging from hot water pads to ultrasound and even to lasers, in the form of hyperthermia. In this article, the place of this historically important treatment method in modern medicine, especially in dermatology, has been reviewed by an extensive search of the literature.
Collapse
Affiliation(s)
- Sedef Bayata
- Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | | |
Collapse
|
28
|
Wang X, Gao XH, Hong Y, Li X, Chen HD. Local hyperthermia decreases the expression of CCL-20 in condyloma acuminatum. Virol J 2010; 7:301. [PMID: 21050487 PMCID: PMC2991315 DOI: 10.1186/1743-422x-7-301] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 11/04/2010] [Indexed: 12/02/2022] Open
Abstract
Background Local hyperthermia has been successfully used in the treatment of viral warts. However, the mechanism of action has largely remained unclear. CCL-20 (also known as MIP-3α) is the most potent chemokine for recruitment of Langerhans cell (LC) precursors into the skin. CCL-20 expression can be increased by TNF-α and IL-1α. The effects of local hyperthermia on the mRNA expressions of CCL-20, TNF-α, IL-1α have been investigated in both condyloma acuminata (CA) and normal skin. Under an organotypic culture condition, fresh CA and normal skin were subjected to surface heating at 37°C, 42°C and 45°C for 30 mins, respectively. Results The mRNA expressions of CCL-20 and IL-1α in CA specimen were significantly higher than those in normal skin. Local hyperthermia at 42°C and 45°C significantly decreased the mRNA levels of CCL-20 and IL-1α, as compared with the control groups (p < 0.01). The decrease of CCL-20 was well correlated with that of IL-1α. The expression of TNF-α in CA remained unchanged in spite of the temperature variation. Local hyperthermia at 45°C concomitantly increased the mRNA expression of CCL-20 and IL-1α in normal skin. Conclusions Our study suggests that hyperthermia decreases the expression of CCL-20 with concomitant decrease in IL-1α, and reduce the number of Langerhans cells in HPV infected skin.
Collapse
Affiliation(s)
- Xiaoqin Wang
- Department of Dermatology, No,1 Hospital of China Medical University, Shenyang 110001, PR China
| | | | | | | | | |
Collapse
|
29
|
Zhu LL, Gao XH, Qi R, Hong Y, Li X, Wang X, McHepange UO, Zhang L, Wei H, Chen HD. Local hyperthermia could induce antiviral activity by endogenous interferon-dependent pathway in condyloma acuminata. Antiviral Res 2010; 88:187-92. [PMID: 20797409 DOI: 10.1016/j.antiviral.2010.08.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 08/11/2010] [Accepted: 08/18/2010] [Indexed: 12/13/2022]
Abstract
Local hyperthermia has been successfully used in the treatment of viral warts by mechanisms that have largely remained unclear. Using an organotypic culture system, we found that hyperthermia at 42 °C and 45 °C could induce a significant increase in the transcriptional expression of interferon (IFN)-α, IFN-β and IFN-γ, in a temperature-dependent manner in condyloma acuminata (CA), but not in normal skin. Accordingly, local hyperthermia could enhance the expression of 2'-5' oligoadenylate synthase and double-stranded RNA (dsRNA)-dependent protein kinase, two antiviral enzymes downstream of the IFN-dependant pathway. Hyperthermia led to an increase in IFN-α/β receptor transcripts, and an increase in the levels in phospho-Stat1 and phospho-Stat2 in CA, though it had no influence on the levels of Jak1, Tyk2, Stat1 and Stat2 transcriptional expression. Local hyperthermia was proved effective in treating human papillomavirus-infected skin. These results suggested that hyperthermia took effect partly by inducing the expression of local endogenous IFN and partly by subsequent IFN-induced antiviral activity via Jak-STATs signalling pathway in CA.
Collapse
Affiliation(s)
- Li-li Zhu
- State Key Department of Dermatology, No. 1 Hospital of China Medical University, Shenyang 110001, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Local hyperthermia induces apoptosis of keratinocytes in both normal skin and condyloma acuminata via different pathways. Apoptosis 2010; 14:721-8. [PMID: 19363704 DOI: 10.1007/s10495-009-0344-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Local hyperthermia has been successfully used in the treatment of viral warts. However, the mechanism of action of hyperthermia has largely remained unclear. In this study we evaluated the effect of local hyperthermia on the induction of apoptosis in human keratinocytes, and expression of apoptosis-related genes in both condyloma acuminata (CA) and normal skin. The study showed that higher hyperthermia increased the number of apoptotic keratinocytes in CA and normal skin. The temperature-dependent increased expression of Fas and Bax were observed in both CA and normal skin. In contrast, the expression of Bcl-2 in CA was decreased at both transcriptional and translational levels. Furthermore, the transcriptional expression of DR4 and DR5 were increased in a temperature-dependent manner in CA, but not in normal skin. These results suggest that different mechanisms of action might be involved in hyperthermia induced apoptosis in CA and normal skin.
Collapse
|
31
|
Badgwell Doherty C, Doherty SD, Rosen T. Thermotherapy in dermatologic infections. J Am Acad Dermatol 2010; 62:909-27; quiz 928. [PMID: 20466169 DOI: 10.1016/j.jaad.2009.09.055] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 08/30/2009] [Accepted: 09/20/2009] [Indexed: 10/19/2022]
Abstract
The use of local induced hyperthermia or thermotherapy for dermatologic infections has not been fully explored in the more recent medical literature. Herein, we discuss the rationale behind the use of thermotherapy and review reported clinical experience with its use in the management of cutaneous infections.
Collapse
|
32
|
Li X, Gao XH, Jin L, Wang Y, Hong Y, McHepange UO, Wang X, Jiang Y, Wei H, Chen HD. Local hyperthermia could induce migrational maturation of Langerhans cells in condyloma acuminatum. J Dermatol Sci 2009; 54:121-3. [PMID: 19155157 DOI: 10.1016/j.jdermsci.2008.12.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/28/2008] [Accepted: 12/03/2008] [Indexed: 02/06/2023]
|
33
|
Abstract
Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts.
Collapse
Affiliation(s)
- Michelle M Lipke
- MPAS, PA-C, Department of Dermatology, Marshfield Clinic-Wausau Center, Wausau, WI 54401, USA.
| |
Collapse
|
34
|
|
35
|
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.
Collapse
Affiliation(s)
- S Gibbs
- Ipswich Hospital NHS Trust, Department of Dermatology, Ipswich, UK IP4 5PD.
| | | |
Collapse
|
36
|
Abstract
BACKGROUND Viral warts caused by the human papilloma virus represent one of the most common diseases of the skin. Any area of skin can be affected although the hands and feet are by far the commonest sites. A very wide range of local treatments are available. OBJECTIVES To assess the effects of different local treatments for cutaneous, non-genital warts in healthy people. SEARCH STRATEGY We searched the Cochrane Controlled Trials Register (January 2003), the Skin Group trials register (January 2003), MEDLINE (1966 to January 2003), EMBASE (1980 to January 2003) and a number of other key biomedical and health economics databases. In addition the cited references of all trials identified and key review articles were searched. Pharmaceutical companies involved in local treatments for warts and experts in the field were contacted. The most recent searches were carried SELECTION CRITERIA Randomised controlled trials of local treatments for cutaneous non-genital viral warts in immunocompetent human hosts were included. DATA COLLECTION AND ANALYSIS Study selection and assessment of methodological quality were carried out by two independent reviewers. MAIN RESULTS Fifty two trials were identified which fulfilled the criteria for inclusion in the review. The evidence provided by these studies was generally weak because of poor methodology and reporting. In 17 trials with placebo groups that used participants as the unit of analysis the average cure rate of placebo preparations was 30% (range 0 to 73%) after an average period of 10 weeks (range 4 to 24 weeks). The best available evidence was for simple topical treatments containing salicylic acid, which are clearly better than placebo. Data pooled from six placebo-controlled trials show a cure rate of 144/191 (75%) compared with 89/185 (48%) in controls, odds ratio 3.91 (95% confidence interval 2.40 to 6.36), random effects model. Most of the bigger trials of cryotherapy studied different regimens rather than comparing cryotherapy with other treatments or placebo. Pooled data from two small trials that included cryotherapy and placebo or no treatment, showed no significant difference in cure rates. In two trials comparing cryotherapy with salicylic acid and one comparing duct tape with cryotherapy no significant difference in efficacy was demonstrated. There was no consistent evidence for the effectiveness of intralesional bleomycin. Four studies, using warts rather than individuals as the unit of analysis, had widely varying results which could not be meaningfully pooled. There was some evidence for the efficacy of dinitrochlorobenzene, a potent contact sensitizer. Pooled data from two small studies comparing dinitrochlorobenzene with placebo showed cure rates of 32/40 (80%) and 15/40 (38%) respectively, odds ratio 6.67 (95% confidence interval 2.44 to 18.23), random effects model. Only limited evidence was found for the efficacy of topical 5-fluorouracil, intralesional interferons and photodynamic therapy.Bleomycin, dinitrochlorobenzene, 5-fluorouracil, interferons and photodynamic therapy are potentially hazardous or toxic treatments. REVIEWER'S CONCLUSIONS There is a considerable lack of evidence on which to base the rational use of the local 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 and some evidence that it is only of equivalent efficacy to simpler, safer treatments. Dinitrochlorobenzene appears to be effective but there were no statistically significant differences when compared with the safer, simpler and cheaper topical treatments containing salicylic acid. The benefits and risks of 5-fluorouracil, bleomycin, interferons and photodynamic therapy remain to be determined.
Collapse
Affiliation(s)
- S Gibbs
- Ipswich Hospital NHS Trust, Ipswich, UK, IP4 5PD
| | | | | | | |
Collapse
|
37
|
Affiliation(s)
- Andreas Katsambas
- Department of Dermatology, University of Athens, A Sygros Hospital, Athens, Greece.
| | | |
Collapse
|
38
|
Abstract
Human papillomavirus infection remains a great source of morbidity and mortality. Progress in understanding the structure of HPV and its pathogenesis has led to a wide variety of possible new treatment modalities to combat HPV-related disease. Most HPV infections (whether high risk or low risk) resolve without any medical intervention. Persistent or progressive disease, however, remains difficult to treat. Although currently available therapies have proved efficacious and tolerable in the treatment of nongenital and genital warts, no single therapy is uniformly effective in eradicating persistent HPV infection. Cytodestructive methods, such as cryotherapy, remain the primary treatment modality for nongenital warts. Immune response modifiers, such as imiquimod, currently show the greatest promise in treating HPV-induced anogenital lesions, both with respect to complete response and in preventing recurrence. Human papillomavirus infection is one of the most common sexually transmitted diseases in the world, and cervical cancer still causes significant morbidity and mortality. Pap smear tests have greatly reduced the incidence and mortality of cervical cancer in developed countries. Additional research will focus on primary and secondary prevention strategies. Vaccines against high-risk HPV types are promising modalities currently under investigation to prevent HPV infections and possibly to treat them.
Collapse
Affiliation(s)
- Mathijs H Brentjens
- Departments of Dermatology, Microbiology/Immunology, and Internal Medicine, University of Texas Medical Branch-Galveston, Galveston, TX, USA
| | | | | | | |
Collapse
|
39
|
Abstract
BACKGROUND The aim of this study was to verify the efficacy of the intralesional injection of 2% zinc sulphate as compared to an injection of 7% hypertonic sodium chloride solution in the treatment of viral warts. PATIENTS AND METHODS One hundred patients (53 females and 47 males) aged 4-45 years (mean+/-SD 19.93+/-7.92) and diagnosed with multiple verruca vulgaris (common warts) were the subject of the study. The duration of the viral warts ranged from 0.1-17 years (mean+/- SD 1.87+/-2.73). A total of 623 lesions were included in the study (mean+/- SD of lesions, 10.8+/-8.05). The treated number of lesions were 316 (mean+/- SD 4.78+/-5.09), with the untreated 307 lesions left as control. RESULTS In 53 patients (30 females, 23 males), 173 lesions were treated with 2% zinc sulphate intralesionally, while 176 lesion were left untreated as control. The total clearance rate of the treated lesions were 98.2% within 6 weeks of follow-up (80.92% of lesions needed a single injection and showed total clearance within 2 weeks), while none of the control lesions showed any spontaneous clearance within the same period. In 47 patients (27 females, 20 males), 143 lesions were treated with 7% hypertonic sodium chloride solution intralesinally, with the remaining 131 lesions left untreated as control. Only 8.3% of treated lesions showed total clearance within 10 weeks of follow-up. CONCLUSION Two percent zinc sulphate can be recommended as a new and effective local mode of therapy of viral warts, especially for the recalcitrant form.
Collapse
Affiliation(s)
- Khalifa A Sharquie
- Department of Dermatology and Venereology, University of Baghdad, Medical Collection Office, Baghdad, Iraq
| | | |
Collapse
|