Human papillomavirus infections in children

Superficial radiotherapy (SRT-100) for refractory plantar warts: An alternative noninvasive treatment strategy

BACKGROUND

Verrucas that occur on the soles of the feet are called plantar warts, most of which can recur repeatedly and are difficult to eradicate. Hypertrophic and refractory plantar warts are often accompanied by pain and discomfort, which cause many inconveniences in patients' daily lives.

AIM

This study aimed to analyze the therapeutic effect of superficial radiotherapy (SRT-100) on refractory plantar warts and further create favorable conditions for the subsequent treatment of this disease with a high recurrence rate.

METHODS

A retrospective analysis was conducted for refractory plantar warts treated with superficial radiotherapy in our outpatient department from January to June 2023.

RESULTS

A total of 30 patients were included in our study (median age, 33 years). The female-to-male ratio was 1:3.29. Two to six months after radiotherapy, all of the warts subsided in 23 (76.67%) patients, most of the warts subsided in 4 (13.33%) patients, 3 (10%) patients did not respond to treatment, and 7 (23.33%) patients had recurrent or new warts after their warts subsided.

CONCLUSIONS

Most patients with refractory plantar warts improved after superficial radiotherapy. Our study presented that men are more susceptible to plantar warts than women, and young and middle-aged people are the main population affected by the disease. Superficial radiotherapy is an effective treatment for refractory plantar warts, which can quickly remove the warts in a short period. It is safe and noninvasive, with minimal adverse reactions. Some patients relapse after the lesion is clear, and superficial radiotherapy can create favorable conditions for the subsequent treatment of viral warts in clinical practice.

Verrulyse Methionine® as Monotherapy in Children and Adolescents With Common Warts

BACKGROUND

Common cutaneous non-genital viral warts are a common skin infection with significant morbidity in the pediatric population. Although various therapeutics are available, many of them necessitate recurrent patient visits and may be associated with significant irritation and pain. Verrulyse Methionine® (VM), a nutritional supplement, was previously suggested as a non-invasive treatment option for the disease.

OBJECTIVE

To assess the response to oral VM supplement as a monotherapy in a cohort of children and adolescents with multiple, non-genital viral warts after failing previous treatments.

METHODS

We reviewed medical records of pediatric patients (<18 y/o) with viral warts treated with VM between 2010 and 2021.

RESULTS

Among 25 patients with multiple verrucae vulgaris lesions who failed previous treatments, 14 (56%) had complete or almost-complete response to VM within 4 months, after an average of 18 months of active disease prior to VM treatment initiation. None of the 4 patients with verruca plana had response to VM treatment. Favourable cosmetic results were found in responders, and no adverse events were recorded.

CONCLUSION

Response rates in our cohort are comparable to those reported in the literature for destructive local therapeutics for viral warts. Thus, our data suggest that VM may be considered for children with multiple verrucae vulgaris, providing a painless and non-invasive therapeutic option for this common disease.

Successful Treatment with Topical Diphenylcyclopropenone for Three Cases of Anogenital Warts in Children

Anogenital warts are caused by human papillomavirus types 6 and 11. They are rare in children, and treatment is difficult since conventional treatments are generally painful and require the patient to be anesthetized. Topical diphenylcyclopropenone (DPCP) is a contact immunotherapy used for treatments of recalcitrant warts and alopecia areata. We herein report 3 cases of anogenital warts in children successfully treated with topical DPCP. Our results suggest that topical DPCP may be a valuable option for the treatment of anogenital warts in children who have difficulty with painful destructive therapy.

Cryotherapy versus CO2 laser in the treatment of plantar warts: a randomized controlled trial

Background

Warts are one of the most common infections in humans. Plantar warts are a subtype of non-genital warts, and several procedures and topical treatments have been used in its treatment. Cryotherapy is one of the most popular modalities, but it is time-consuming and remission rates vary in different studies. CO₂ laser was the first laser used for treating warts. To date, no clinical trial has been done to compare CO₂ laser with cryotherapy in the treatment of plantar warts.

Patients and Methods

This randomized controlled trial was performed in order to compare the efficacy and number of sessions needed to treat plantar warts in 60 patients who had received no previous treatment in the previous 3 months. They were randomly allocated to the cryotherapy or CO₂ laser group. The number of sessions needed for response and the recurrence rate after a 3-month follow-up was compared in the 2 groups.

Results

Sixty patients with plantar warts were randomly allocated to either the CO₂ laser or cryotherapy groups. Median age was 25 (range=18–53) and 27 (range= 18–75) years in the cryotherapy group and CO₂ laser groups, respectively. Both groups were matched for age and sex (56% male and 44% female in the cryotherapy group and 34% male and 66% female in the CO₂ laser group). The median number of sessions needed for complete resolution of the warts in the CO₂ laser and cryotherapy groups were 1 (range=1–2) and 3 (range=1–12), respectively. The difference in the number of sessions was statistically significant between the 2 groups (P-value≤0.001). Recurrence rates after a 3-month follow-up was not statistically significant (P-value= 0.069).

Conclusion

The number of sessions needed to treat plantar warts was less using CO₂ laser than cryotherapy; therefore, this modality can be a good addition to the already existing anti-wart armamentarium.

T* reatment of vulgar and plantar warts

The article presents data on clinical forms of warts associated with different types of human papillomavirus. The authors analyze the following wart treatment methods: excision, chemical and immune. Based on literature sources, the authors assess the efficacy, advantages and disadvantages of well-known treatment methods. The authors describe their own experience of treating primary and recurrent vulgar and plantar warts with an up-to-date chemical destruction drug - Mardil Zinc Max, a solution containing a complex compound of 1.5% zinc 2-chloropropionate in 2-chloropropionic acid. The efficacy of treatment of vulgar warts was 100%, and that of plantar ones - 62.5%. Clinical recovery was observed both in case of primary and recurrent processes. The treatment had no adverse effects or complications and was characterized by a low injury rate, good tolerance and full tissue recovery without any cosmetic defects.

A practical approach to warts in the emergency department

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.

Comparative study of fig tree efficacy in the treatment of common warts (Verruca vulgaris) vs. cryotherapy

BACKGROUND

A traditional method for the treatment of warts in some rural areas of Iran comprises the use of fig tree (ficus carica) latex as a local treatment; however, there is no scientific evaluation of its efficacy.

METHODS

A prospective, open right/left comparative trial of fig tree latex therapy vs. local standard of cryotherapy was carried out. Twenty-five patients with common warts were recruited into the study from an outpatient clinic. The patients were instructed in self-application of fig tree latex to warts on one side of the body. The wart on the opposite side was treated using standard cryotherapy. A 6-month follow-up study was planned.

RESULTS

In 11 (44%) of the 25 patients complete resolution of fig tree latex-treated warts was observed. The remaining 14 patients (56%) had a complete cure following cryotherapy. Two patients had complete remission on both sides. Two patients failed to respond to either cryotherapy or fig tree latex. It was found that fig tree latex therapy was marginally less effective than cryotherapy. Adverse effects were observed only in cryo-treated warts. At the 6-month follow-up study there was an 18% recurrence rate.

CONCLUSION

Fig tree latex therapy of warts offers several beneficial effects including short-duration therapy, no reports of any side-effects, ease-of-use, patient compliance, and a low recurrence rate. The exact mechanism of the antiwart activity of fig tree latex is unclear but is likely to be the result of the proteolytic activity of the latex enzymes.

Effectiveness of imiquimod 5% cream for treatment of extensive anogenital warts in a seven-year-old child

Conventional treatment options for anogenital warts in prepubertal children rely on chemical and physical destruction methods that can be difficult and painful and frequently require the use of general anesthesia. Other approaches include the use of immunotherapies, as topical imiquimod and intralesional or systemic interferon. We report a 7-year-old girl with extensive anogenital warts who was successfully treated with topical 5% imiquimod cream.

Pulsed dye laser therapy for pediatric warts

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.

Therapeutic efficacy of vesicular stomatitis virus-based E6 vaccination in rabbits

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.

Human Papillomavirus Infections of the Genital and Respiratory Tracts in Young Children

Human papillomavirus (HPV) causes papillomas (warts) on the skin and respiratory mucosal surfaces (laryngeal and oral papillomas) in addition to condyloma acuminata (anogenital warts). HPV has become one of the most common sexually transmitted diseases in adults. Vertical transmission from mother to infant during birth is well recognized. Laryngeal papillomas are the most common tumors of the larynx in children worldwide, and recurrent lesions are common occurrences. Anogenital warts in children are problematic in that child sexual abuse is a potential means of acquisition, but many cases are acquired perinatally. Postnatal acquisition by nonsexual means also can occur. The likelihood of sexual abuse as the mode of acquisition increases with increasing age in childhood. The virus infects primarily epithelial cells, where it can exist as a long-term latent infection that can reactivate or persist actively (even subclinically), with resultant accumulation of host chromosomal mutations. The latter accounts for the oncogenic potential of a number of HPV types, and childhood infections may lead to neoplasia later in life. Regression of papillomas over the course of months to years is the usual natural course. Numerous treatments are available, but most do not prevent persistent infection or problematic recurrences. Multivalent HPV vaccines have been developed, and early results of clinical trials appear to be very promising.