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Giacaman A, Granger C, Aladren S, Bauzá A, Alomar Torrens B, Riutort Mercant M, Martin-Santiago A. Use of Topical Nitric-Zinc Complex Solution to Treat Palmoplantar and Periungual Warts in a Pediatric Population. Dermatol Ther (Heidelb) 2019; 9:755-760. [PMID: 31586309 PMCID: PMC6828862 DOI: 10.1007/s13555-019-00330-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Indexed: 02/07/2023] Open
Abstract
Introduction Nitric–zinc complex solution (NZCS) is a topically applied solution containing nitric acid, zinc, copper, and organic acids that induce a painless caustic effect on “difficult-to-treat” warts, including palmoplantar and periungual locations. The objective of the present prospective clinical study was to describe the efficacy and tolerability of NZCS in the treatment of palmoplantar and periungual warts in children. Methods Eligible patients were immunocompetent children and adolescents, with at least one palmoplantar or periungual wart. NZCS was topically applied every 2 weeks in clinic. Efficacy was recorded by clinical evaluation, and acceptability assessments were measured using a visual analogue scale (VAS). Results Pediatric patients (N = 12) were equally distributed by gender, and the mean age was 9.60 ± 3.34 years. The youngest patient was 4 years old. A total of 31 warts were identified: 24 periungual warts (77.4%), 2 palmar warts (6.45%), and 5 plantar warts (16.12%). We observed complete resolution in 83.9% of the warts treated with NZCS, achieving total cure considered as therapy success in 87.5% of periungual warts and 71% of palmoplantar warts, with a mean of 6.0 treatment sessions. The esthetic results evaluated by the investigator were considered excellent in 83.3% of cases and good in 16.7%. In 100% of the completely resolved cases, no scars, erythema, hyperpigmentation, hypopigmentation, or hypertrophy in the area surrounding the treated warts were observed by the investigator. The esthetic results evaluated by the patients or parents/guardians were excellent. Pain and burning sensation were minimal and well tolerated. No clinically relevant adverse events were reported. Conclusion NZCS was an effective treatment of warts in this pediatric population. The painlessness, simplicity, and twice-monthly dosing regimen of this treatment represents an advantage over standard approaches. Funding ISDIN. Trial Registration Retrospectively registered 6 September 2019, ISRCTN90862249.
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Affiliation(s)
- Aniza Giacaman
- Dermatology Department, Hospital Universitari Son Espases, Mallorca, Spain.
| | | | | | - Ana Bauzá
- Dermatology Department, Hospital Universitari Son Espases, Mallorca, Spain
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Moon DS, Choi WY, Yoon NR, Kim DM. Granulomatous hepatitis in a healthy adult after bacillus Calmette-Guérin injection into a plantar wart. JAAD Case Rep 2017; 3:566-569. [PMID: 29159252 PMCID: PMC5683750 DOI: 10.1016/j.jdcr.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Do Sik Moon
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Woo Young Choi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Na-Ra Yoon
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Dong-Min Kim
- Department of Internal Medicine, College of Medicine, Chosun University, Gwangju, Republic of Korea
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Kumar N, Warren CB. Photodynamic therapy for dermatologic conditions in the pediatric population: a literature review. PHOTODERMATOLOGY PHOTOIMMUNOLOGY & PHOTOMEDICINE 2017; 33:125-134. [DOI: 10.1111/phpp.12296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 01/22/2023]
Affiliation(s)
- Neha Kumar
- Case Western Reserve University School of Medicine; Cleveland OH USA
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Gerlero P, Hernández-Martín Á. Treatment of Warts in Children: An Update. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:551-8. [PMID: 27241712 DOI: 10.1016/j.ad.2016.04.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/01/2016] [Accepted: 04/03/2016] [Indexed: 10/21/2022] Open
Abstract
Warts are among the most common skin infections in children. Although numerous treatment options are available, none are completely effective in a single session. Treatment is particularly complicated in children, not only because certain treatments are poorly tolerated, but also because parents frequently have unrealistic expectations. In this article, we offer an update on the treatments available for warts, focusing specifically on pediatric patients. We do not discuss treatments for oral and anogenital warts.
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Affiliation(s)
- P Gerlero
- Servicio de Dermatología, Hospital Nacional de Clínicas, Córdoba, Argentina
| | - Á Hernández-Martín
- Servicio de Dermatología, Hospital Infantil del Niño Jesús, Madrid, España.
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Stefanaki C, Lagogiani I, Kouris A, Kontochristopoulos G, Antoniou C, Katsarou A. Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: A randomized study. J DERMATOL TREAT 2015; 27:80-2. [DOI: 10.3109/09546634.2015.1034079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Suh DW, Lew BL, Sim WY. Investigations of the efficacy of diphenylcyclopropenone immunotherapy for the treatment of warts. Int J Dermatol 2014; 53:e567-71. [DOI: 10.1111/ijd.12688] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Dong-Woo Suh
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
| | - Bark-Lynn Lew
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
| | - Woo-Young Sim
- Department of Dermatology; College of Medicine; Kyunghee University; Seoul Korea
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Salem A, Nofal A, Hosny D. Treatment of common and plane warts in children with topical viable Bacillus Calmette-Guerin. Pediatr Dermatol 2013; 30:60-3. [PMID: 22958215 DOI: 10.1111/j.1525-1470.2012.01848.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Treatment of verrucae in children is difficult and may be painful using traditional methods, especially if they are multiple or on the face. The objective of the current study was to evaluate the efficacy and safety of topical application of viable Bacillus Calmette-Guérin (BCG) in a paste formula as a new immunotherapeutic modality in the treatment of common and plane warts in children. The present study included 80 children with common and plane warts at different sites on the body. They were divided into two groups. Group A (40 patients) received topical viable BCG and group B (40 patients) received topical saline as control. All patients and controls had received a previous vaccination of BCG. BCG was applied once weekly for six consecutive weeks. Patients who had partial or no response received another course of treatment for another 6 weeks. Follow-up was at 6 months to detect any recurrences. A highly significant difference was found between the therapeutic response of common and plane warts to BCG and saline (placebo) (p < 0.001). Complete response was achieved in 65% of children with common warts and 45% of patients with plane warts. No response was detected in the control group. No recurrences or side effects were observed in the BCG group. Topical immunotherapeutic BCG is a new, effective, safe treatment option for children with common and plane warts.
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Affiliation(s)
- Ahmed Salem
- Department of Dermatology and Venereology, Zagazig University, Zagazig, Egypt.
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Nasser N. Treatment of common warts with the immune stimulant Propionium bacterium parvum. An Bras Dermatol 2012; 87:585-9. [DOI: 10.1590/s0365-05962012000400011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 06/08/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: Warts are epithelial proliferations in the skin and mucous membrane caused by various types of HPV. They can decrease spontaneously or increase in size and number according to the patient's immune status. The Propionium bacterium parvum is a strong immune stimulant and immune modulator and has important effects in the immune system and it is able to produce antibodies in the skin. OBJECTIVE: To show the efficacy of the Propionium bacterium parvum in saline solution in the treatment of skin warts. METHODS: A randomized double-blind study. Twenty patients with multiple warts were divided into two groups: one received 0,1ml intradermal injection of placebo solution in just one of the warts and the other received 0,1 ml of saline solution of Propionium bacterium parvum, one dose a month, for 3 to 5 months. RESULTS: Among the 20 patients who participated in the study, ten received the placebo and ten received the saline solution with Propionium bacterium parvum. In 9 patients treated with the Propionium bacterium parvum solution the warts disappeared without scars and in 1 patient it decreased in size. In 9 patients who received the placebo no change to the warts was observed and in 1 it decreased in size. CONCLUSIONS: The immune modulator and immune stimulant Propionium bacterium parvum produced antibodies in the skin which destroyed the warts without scars, with statistically significant results (P<0,001), and cured 90 % of the patients. We suggest the use of the immune stimulant in the treatment of warts.
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Yu YE, Kuohung V, Penrose C, Shim H, Gilchrest BA. Letter: Photodynamic Therapy for Treatment of Hand Warts. Dermatol Surg 2012; 38:818-20. [DOI: 10.1111/j.1524-4725.2012.02385.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Warts remain one of the most common reasons for dermatology and primary care visits, yet no definitive therapy is available. Treatment of pediatric patients adds additional challenges, as the adept provider must effectively manage parents' expectations and patients' fears. This article provides an update on research in the field of viral cutaneous wart therapies with a focus on pediatric patients. Safety issues and potential complications of therapy are also addressed.
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Affiliation(s)
- Christina Boull
- Department of Medicine-Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
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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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Rahimi AR, Emad M, Rezaian GR. Smoke from leaves of Populus euphratica Olivier vs. conventional cryotherapy for the treatment of cutaneous warts: a pilot, randomized, single-blind, prospective study. Int J Dermatol 2008; 47:393-7. [DOI: 10.1111/j.1365-4632.2008.03571.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Although cutaneous warts are one of the most common skin conditions affecting children, their management can be challenging, especially in complex cases and even more so during a single emergency department encounter. Anogenital warts require particular attention because of their possible but nonspecific association with sexual abuse. This review will focus on cutaneous warts and anogenital warts, with a discussion of their recognition and treatment, especially in the emergency department. The medicolegal implications of anogenital warts in children are also reviewed.
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Abstract
Viral wart infections constitute one of the most common pediatric skin diseases, and various modalities have been used to manage them. Although pulsed dye laser therapy is known to be a safe and efficacious modality, the reported cure rates for this method have varied, and no studies have reported treatment of pediatric patients alone. This prospective, nonblinded, nonrandomized study was performed to evaluate the efficacy and safety of pulsed dye laser therapy for pediatric warts. We found that this method is safe, relatively effective, and worth considering as an additional therapeutic option for viral warts in children, although not as a first-line therapy.
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Affiliation(s)
- Hyun Su Park
- Department of Dermatology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
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Passeron T, Sebban K, Mantoux F, Fontas E, Lacour JP, Ortonne JP. Traitement des verrues palmo-plantaires par le laser à colorant pulsé à 595 nm : étude randomisée en simple insu contre placebo. Ann Dermatol Venereol 2007; 134:135-9. [PMID: 17375008 DOI: 10.1016/s0151-9638(07)91604-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulse dye laser (PDL) appears an attractive method to treat warts. However, data concerning the efficacy of this approach are based chiefly upon open clinical studies or case reports and results vary widely from one study to another. The purpose of this study was to compare the efficacy and safety of PDL with a placebo in the treatment of a homogeneous group of patients presenting palmoplantar warts. METHODS This was a randomized, prospective, placebo-controlled, single-blind study conducted between December 2004 and July 2005 in patients consulting for palmoplantar warts at the Dermatology Department of the University Teaching Hospital of Nice. The treatment settings used for the 595-nm PDL were as follows: spot diameter 5 mm, pulse duration 0.45 ms, fluence 9 J/cm2 with 5 passes at a frequency of 1 Hz. Cryogen spray cooling (system incorporated in the machine) was given at a rate of 50 spurts of 40 ms prior to each laser pulse. In patients in the placebo group, cooling pulses alone were given. For the plantar warts (in both groups), hyperkeratosis was removed manually with a scalpel before each session. A maximum of three sessions was administered at 3-week intervals. The type and number of warts was counted and recorded in a treatment schedule before the start of therapy, at each session and 5 weeks after the final session. The global safety of the treatment was evaluated using a visual analog scale between 0 (intolerable) and 10 (completely safe). RESULTS Nineteen patients were included in the laser group and 16 were included in the placebo group. Sixty-four per cent (48/75) of warts in the laser group resolved completely compared with 13% (4/30) in the placebo group (p<0.001). In the PDL group, 6 of 19 patients (31.5%) no longer had warts by the end of the study compared with 3 of 16 patients (18.75%) in the placebo group (p=0.46). The global safety score of the treatment as assessed by the patients themselves was 8.31 in the laser group and 9.81 in the placebo group. DISCUSSION Pulse dye laser appears to be an effective treatment in palmoplantar warts but the efficacy of this method seems to be only equivalent to that of standard treatments (cryotherapy or salicylic acid preparations). Safety is excellent and constitutes one of the major advantages of this technique. The absence of any proven superiority over the standard treatments in terms of efficacy, coupled with the high costs involved, means that PDL should only be used second-line therapy in patients wishing to avoid constraints affecting their professional activity.
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Armour K, Orchard D. Treatment of palmoplantar warts with a diphencyprone and salicylic acid ointment. Australas J Dermatol 2006; 47:182-5. [PMID: 16866999 DOI: 10.1111/j.1440-0960.2006.00268.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report on 50 consecutive suitable patients with one or more palmoplantar warts who were treated with a patient-applied ointment comprising 0.1% diphencyprone and 15% salicylic acid in white soft paraffin. All patients sensitized to diphencyprone were followed up clinically and assessed by patient questionnaire. The intention to treat success rate in this series was 88%. The time to wart clearance ranged from less than 4 weeks to 4 months. In our patient group, 90% rated their treatment as 'excellent' or 'good', whereas 10% stated that the reaction induced by diphencyprone was 'too severe'. Our results are compared with those previously published using diphencyprone in the treatment of palmoplantar warts.
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Affiliation(s)
- Katherine Armour
- Department of Dermatology, Royal Children's Hospital, Parkville, Victoria, Australia
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Akarsu S, Ilknur T, Demirtaşoglu M, Ozkan S. Verruca vulgaris: pulsed dye laser therapy compared with salicylic acid + pulsed dye laser therapy. J Eur Acad Dermatol Venereol 2006; 20:936-40. [PMID: 16922941 DOI: 10.1111/j.1468-3083.2006.01679.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent years, lasers have been used in verruca therapy and some successful results have been obtained in some types of verruca. In some of these laser studies, peeling processes have been used to increase penetration. OBJECTIVE This study aimed to compare the effects of pulsed dye laser (PDL) therapy with the effects of PDL therapy following salicylic acid (SA) application. The purpose of the SA application is to increase the laser penetration by decreasing the hyperkeratosis of verruca vulgaris. METHODS This controlled study included 66 lesions from 19 patients enrolled in the study. PDL was applied to 33 lesions following 30% SA application twice a day for 5 days, and the remaining 33 lesions underwent PDL therapy. PDL was administered in both groups at 4-week intervals varying from one to five sessions. In the comparison of these two groups, the changes in verruca dimensions were recorded in width x length x height (mm3), and the results of the therapy were evaluated statistically. RESULTS In both PDL and SA + PDL groups, the regressions observed in the size of the lesions were statistically significant at the end of the fifth session compared with those observed at the onset of the therapy (P < 0.05). At the end of the fifth session, the difference between the two groups was not statistically significant (P = 0.451); however, the clearance rate in the SA + PDL group was more statistically significant than that in the PDL group after the second session (P = 0.049). The complete clearance rate in the SA + PDL group was 54.6% after the second session, but 66.4% in the PDL group only after the fifth session. Complete clearance in the SA + PDL group was observed after 2.2 sessions, and in the PDL group after 3.1 sessions (P < 0.05). CONCLUSIONS Although there was no difference between the clearance rate of the SA + PDL group and that of the PDL group after the fifth session, adding SA to PDL decreased the number of sessions to a large extent.
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Affiliation(s)
- S Akarsu
- Department of Dermatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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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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