1
|
Shady NH, Mokhtar FA, Abdullah HS, Abdel-Aziz SA, Mohamad SA, Imam MS, El Afify SR, Abdelmohsen UR. In Vitro and Randomized Controlled Clinical Study of Natural Constituents' Anti-HPV Potential for Treatment of Plantar Warts Supported with In Silico Studies and Network Analysis. Pharmaceuticals (Basel) 2024; 17:759. [PMID: 38931426 PMCID: PMC11206833 DOI: 10.3390/ph17060759] [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: 04/24/2024] [Revised: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/28/2024] Open
Abstract
The aim of this study is to evaluate the anti-HPV potential of a Moringa olifera Lam seed, Nigella sativa L. seed, and Musa Acuminata peel herbal mixture in the form of polymer film-forming systems. A clinical trial conducted in outpatient clinics showed that the most significant outcome was wart size and quantity. Compared to the placebo group, the intervention group's size and number of warts were considerably better according to the results. Chemical profiling assisted by LC-HRMS led to the dereplication of 49 metabolites. Furthermore, network pharmacology was established for the mixture of three plants; each plant was studied separately to find out the annotated target genes, and then, we combined all annotated genes of all plants and filtered the genes to specify the genes related to human papilloma virus. In a backward step, the 24 configured genes related to HPV were used to specify only 30 compounds involved in HPV infection based on target genes. CA2 and EGFR were the top identified genes with 16 and 12 edges followed by PTGS2, CA9, and MMP9 genes with 11 edges each. A molecular docking study for the top active identified compounds of each species was conducted in the top target HPV genes, CA2 and EGFR, to investigate the mode of interaction between these compounds and the targets' active sites.
Collapse
Affiliation(s)
- Nourhan Hisham Shady
- Department of Pharmacognosy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt;
- Center for Research and Sustainability, Deraya University, Universities Zone, New Minia 61111, Egypt
| | - Fatma Alzahraa Mokhtar
- Fujairah Research Centre, Sakamkam Road, Sakamkam, Fujairah 0000, United Arab Emirates;
- Department of Pharmacognosy, Faculty of Pharmacy, El Saleheya El Gadida University, El Saleheya El Gadida, Sharkia 44813, Egypt
| | - Hend Samy Abdullah
- Faculty of Pharmacy, Deraya University, Universities Zone, New Minia City 61111, Egypt;
| | - Salah A. Abdel-Aziz
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt;
- Department of Pharmaceutical Medicinal Chemistry, Faculty of Pharmacy, Al-Azhar University, Assiut 71524, Egypt
| | - Soad A. Mohamad
- Department of Clinical Pharmacy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt;
| | - Mohamed S. Imam
- Department of Clinical Pharmacy, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia
- Department of Clinical Pharmacy, National Cancer Institute, Cairo University, Fom El Khalig Square, Kasr Al-Aini Street, Cairo 11796, Egypt
| | - Sherin Refat El Afify
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Alsalam University, Kafr alzayat, Algharbia 31611, Egypt;
| | - Usama Ramadan Abdelmohsen
- Department of Pharmacognosy, Faculty of Pharmacy, Deraya University, Universities Zone, New Minia 61111, Egypt;
- Department of Pharmacognosy, Faculty of Pharmacy, Minia University, Minia 61519, Egypt
| |
Collapse
|
2
|
Chen Z, Liu X, Jiang Z, Wu H, Yang T, Peng L, Wu L, Luo Z, Zhang M, Su J, Tang Y, Li J, Xie Y, Shan H, Lin Q, Wang X, Chen X, Peng H, Zhao S, Chen Z. A piezoelectric-driven microneedle platform for skin disease therapy. Innovation (N Y) 2024; 5:100621. [PMID: 38680817 PMCID: PMC11053245 DOI: 10.1016/j.xinn.2024.100621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/29/2024] [Indexed: 05/01/2024] Open
Abstract
With over a million cases detected each year, skin disease is a global public health problem that diminishes the quality of life due to its difficulty to eradicate, propensity for recurrence, and potential for post-treatment scarring. Photodynamic therapy (PDT) is a treatment with minimal invasiveness or scarring and few side effects, making it well tolerated by patients. However, this treatment requires further research and development to improve its effective clinical use. Here, a piezoelectric-driven microneedle (PDMN) platform that achieves high efficiency, safety, and non-invasiveness for enhanced PDT is proposed. This platform induces deep tissue cavitation, increasing the level of protoporphyrin IX and significantly enhancing drug penetration. A clinical trial involving 25 patients with skin disease was conducted to investigate the timeliness and efficacy of PDMN-assisted PDT (PDMN-PDT). Our findings suggested that PDMN-PDT boosted treatment effectiveness and reduced the required incubation time and drug concentration by 25% and 50%, respectively, without any anesthesia compared to traditional PDT. These findings suggest that PDMN-PDT is a safe and minimally invasive approach for skin disease treatment, which may improve the therapeutic efficacy of topical medications and enable translation for future clinical applications.
Collapse
Affiliation(s)
- Ziyan Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| | - Xin Liu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Dermatology, Xijing Hospital, The Fourth Military Medical University, Xi’an, Shaanxi 710000, China
| | - Zixi Jiang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Huayi Wu
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| | - Tao Yang
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics & Astronautics, Nanjing 210016, China
| | - Lanyuan Peng
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Lisha Wu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zhongling Luo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Mi Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yan Tang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Jinmao Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yang Xie
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| | - Han Shan
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| | - Qibo Lin
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| | - Xiuli Wang
- Institute of Photomedicine, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai 200443, China
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hanmin Peng
- State Key Laboratory of Mechanics and Control for Aerospace Structures, Nanjing University of Aeronautics & Astronautics, Nanjing 210016, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zeyu Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, China
- Furong Laboratory (Precision Medicine), Changsha 410008, China
- National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Central South University, Changsha 410008, China
- School of Mechanical and Electrical Engineering, Central South University, Changsha 410083, China
| |
Collapse
|
3
|
Zhang Y, Wu S, Zeng Y. Photodynamic therapy for recalcitrant plantar warts: Case reports and a literature review. Photodiagnosis Photodyn Ther 2024; 46:104087. [PMID: 38614271 DOI: 10.1016/j.pdpdt.2024.104087] [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: 02/16/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
Plantar wart is one of the most recalcitrant types of cutaneous warts with a high recurrence rate. Recalcitrant plantar warts are resistant to traditional treatments such as cryotherapy. Photodynamic therapy (PDT) is a modern, non-invasive method utilized to treat benign and malignant skin disorders. Several previous studies have reported the effective application of PDT treatment for plantar warts. We reported three cases of recalcitrant plantar warts successfully treated with PDT.
Collapse
Affiliation(s)
- Yao Zhang
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, China
| | - Siyuan Wu
- Department of Dermatology, Gongli Hospital of Shanghai Pudong New Area, Shanghai, China
| | - Yibin Zeng
- Department of Dermatology, Minhang Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
4
|
Gustafsson L, Wilson A, Bergvall K. Efficient Topical Treatment of Canine Nodular Sebaceous Hyperplasia with a Nitric Acid and Zinc Complex Solution. Animals (Basel) 2024; 14:570. [PMID: 38396537 PMCID: PMC10885944 DOI: 10.3390/ani14040570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Nodular sebaceous gland hyperplasia in the often middle-aged to old dog is a common, benign proliferation that results in exophytic, pink to yellow, alopecic, and often multilobulated nodules. Removal is usually carried out by surgical excision. As many old dogs have comorbidities that increase the risk of anesthesia, a topical treatment is warranted. We hypothesized that the application of a solution containing nitric acid, zinc, copper, and organic acids (Verrutop®), would be a safe and efficient way to treat these nodules. Eleven dogs with a total of 29 nodules, grossly compatible with nodular sebaceous gland hyperplasia, were included in the study. Eighteen of the nodules were treated; 11 were left untreated. No anesthesia or sedation was needed. Four weeks after one application, 17/18 treated nodules had decreased by 100% in volume. There was a statistically significant difference in percentual volume change between the treated and untreated nodules from day 0 to day 28 (p < 0.0001). No serious side effects were noted. Sebaceous hyperplasia cannot always be distinguished grossly from sebaceous tumors. Cytological evaluation can be helpful, and in cases of deviant macroscopic features, local recurrence, or more aggressive behavior, the appropriate intervention would be to biopsy or excise the nodule for histopathology. Topical application of Verrutop® is an easy, low-cost, and efficient way to remove canine sebaceous gland hyperplasia with minimal side effects in cases where surgery and anesthesia are not desired.
Collapse
Affiliation(s)
- Lina Gustafsson
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
| | - Alison Wilson
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
| | - Kerstin Bergvall
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
- Swedish University of Agricultural Sciences, Faculty of Veterinary Medicine and Animal Science, P.O. Box 7084, 750 07 Uppsala, Sweden
| |
Collapse
|
5
|
García-Oreja S, Álvaro-Afonso FJ, García-Madrid M, López-Moral M, García-Álvarez Y, Lázaro-Martínez JL. Cryotherapy versus topical nitric-zinc complex solution for the treatment of plantar warts: A randomized controlled trial. J Med Virol 2023; 95:e29212. [PMID: 37930111 DOI: 10.1002/jmv.29212] [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: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
Cryotherapy is commonly regarded as the primary treatment method for plantar warts. A new medical device called nitric-zinc complex solution (NZCS) has also emerged as a potential alternative for wart treatment. The main aim of this study was to analyze and compare the effectiveness of cryotherapy using liquid nitrogen and NZCS in treating plantar warts. We conducted a randomized and controlled clinical trial involving patients with plantar warts. A total of 62 patients were enrolled in the study and monitored for 12 weeks or until their warts were completely resolved. The patients received either cryotherapy or NZCS, with a maximum of six treatment applications. The cure rate was 65.5% in the group treated with cryotherapy and 56.6% in the group treated with NZCS. The average number of treatment applications required for curing warts was significantly lower in the cured group (3.28 ± 1.63) than in the group with unresolved warts (5.5 ± 1.27) (p < 0.01). Moreover, the average number of applications was lower in the cryotherapy group (3.6 ± 1.8) than in the NZCS group (4.8 ± 1.8) (p < 0.01). Based on the findings, NZCS could be considered a favorable first-line treatment option for plantar warts.
Collapse
Affiliation(s)
- Sara García-Oreja
- Facultad de Enfermería, Fisioterapia y Podología, University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Marta García-Madrid
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Mateo López-Moral
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - José Luís Lázaro-Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| |
Collapse
|
6
|
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
|
7
|
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
|
8
|
Pontini P, Mastorino L, Gaspari V, Granger C, Ramoni S, Delmonte S, Evangelista V, Cusini M. A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc ® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts. Dermatol Ther (Heidelb) 2020; 10:1063-1073. [PMID: 32734366 PMCID: PMC7477018 DOI: 10.1007/s13555-020-00430-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Anogenital warts (AGW) are a relevant clinical issue in the field of sexually transmitted disease, and to date no treatment provides a satisfactory clearance rate. Treatment can be both medical and surgical, and be provided by a healthcare provider or by the patient. Cryotherapy (CRYO) is among the most common treatments for AGW. Nitrizinc® Complex solution (NZCS) is a solution containing organic acids, nitric acid and zinc and copper salts that is applied topically to warts, producing mummification of the damaged tissue. It is considered to be an effective and well-tolerated treatment for genital and common warts. The aim of our study was to compare NZCS to CRYO in the treatment of AGW. METHODS We performed a prospective, multicentre, single-blind, randomised, superiority clinical study involving 120 patients, aged 18-55 years, diagnosed with a first episode of AGW, with each patient having from three to ten AGW. The patients were treated either with NZCS or CRYO for a maximum of four treatments. Primary endpoints were: (1) comparison of the clinical efficacy of CRYO and NZCS, based on response to treatment (clearance of AGW) within four treatment sessions; and (2) tolerability, assessed via a short questionnaire at the end of each treatment session. Secondary endpoints were: (1) number of treatments needed for clearance; and (2) recurrence at 1 and 3e months after confirmed clearance. The results were analysed on an intention-to-treat basis. RESULTS A complete response was achieved in 89.7% of the NZCS group and in 75.4% of the CRYO group (p = 0.0443). NZCS was found to be better tolerated. There was no difference between the NZCS and CRYO treatment arms in the number of sessions needed to clear the lesions. Recurrence occurred after 1 month in 18.4% of the NZCS group and 38.1% of the CRYO group (p = 0.0356), and after 3 months in 25 and 40.6% of these groups, respectively (p = 0.1479). CONCLUSIONS Nitrizinc® Complex solution can be considered to be as effective as CRYO for the treatment of small (< 5 mm) external AGW, with a better tolerability profile and lower rate of recurrence. TRIAL REGISTRATION ISRCTN identifier, ISRCTN36102369.
Collapse
Affiliation(s)
- Paolo Pontini
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza-University of Turin, Turin, Italy
| | - Valeria Gaspari
- Unit of Dermatology, Head and Neck Department, Sant'Orsola Malpighi University Hospital, Bologna, Italy
| | | | - Stefano Ramoni
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Sergio Delmonte
- Dermatology Clinic, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza-University of Turin, Turin, Italy
| | - Valeria Evangelista
- Unit of Dermatology, Head and Neck Department, Sant'Orsola Malpighi University Hospital, Bologna, Italy
| | - Marco Cusini
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| |
Collapse
|
9
|
Ciccarese G, Drago F, Granger C, Parodi A. Efficacy Assessment of a Topically Applied Nitric-Zinc Complex Solution for the Treatment of External Ano-genital Warts in 100 Patients. Dermatol Ther (Heidelb) 2019; 9:327-335. [PMID: 31041663 PMCID: PMC6522592 DOI: 10.1007/s13555-019-0300-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION External ano-genital warts (AGWs) due to human papilloma virus infection are the most common sexually transmitted ano-genital lesions of viral origin worldwide. Treatments include topical chemicals/drugs, excisional surgery, cryosurgery, electrosurgery and laser surgery. Nitric-zinc complex (NZC) is a new topically applied solution containing nitric acid, zinc, copper and organic acids that induces a caustic effect on condyloma. The objective of this study was to investigate the efficacy and tolerability of NZC in the treatment of AGWs. METHODS Patients attending for AGWs between September 2016 and February 2018 were retrospectively studied. They received at least one NZC application for a maximum of four treatments (V0, V1, V2, V3) with average intervals of 25 days between sessions. Recurrences were evaluated at 3 and 6 months after clearance. RESULTS One hundred patients (70 males, 30 females) with a mean age of 36.39 years were studied. The total number of AGWs diagnosed at the baseline visit (V0) in all patients was 418 with a mean of 4.18 AGWs per patient. A wart cure rate of 92% was observed in ≤ 4 treatment sessions (383 lesions cured at visit 4, V4, out of 418 lesions at baseline), with a cure rate of 49% with only one NZC application. Complete clearance was observed in 25, 52, 72 and 84% of patients at V1, V2, V3 and V4, respectively. Relapses were observed in 29% of patients at 3 months and in 5% at 6 months. Of note, patients with ≤ 5 AGWs at V0 showed better clearance results than patients with > 5 lesions (p < 0.05). The treatment was well tolerated by most patients. CONCLUSION NZC has been demonstrated to be effective for AGWs after 1-4 treatment sessions, obtaining a good response from the first application. The better response in patients with fewer warts suggests that the earlier diagnosis is made and treatment started, the better the expected results. FUNDING ISDIN.
Collapse
Affiliation(s)
| | - Francesco Drago
- University of Genoa, Genoa, Italy
- Dermatologic Clinic, San Martino Policlinic Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| | | | - Aurora Parodi
- University of Genoa, Genoa, Italy
- Dermatologic Clinic, San Martino Policlinic Hospital, Largo Rosanna Benzi, 10, 16132, Genoa, Italy
| |
Collapse
|
10
|
Puviani M, Manfredini M, Eisendle K. The SILVER study. Efficacy of topical nitric-zinc complex solution in the treatment of resistant warts: A postmarketing evaluation. Dermatol Ther 2019; 32:e12940. [PMID: 30990239 DOI: 10.1111/dth.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/06/2019] [Accepted: 04/13/2019] [Indexed: 11/29/2022]
Abstract
The treatment of cutaneous viral warts caused by human papillomavirus (HPV) infection is often subject to local recurrence and a long clinical and treatment course. Our aim was to analyze real-life data on the treatment of difficult-to-treat warts from a multicenter postmarketing surveillance assessment on the efficacy, tolerability, and safety of a commercially available nitric-zinc complex solution (NZCS). Dermatologists from 14 Italian centers completed a questionnaire about their clinical experience on treatment of "difficult-to-treat" warts, which included warts in the plantar, periungual, anogenital and aesthetically sensitive areas. The questionnaire was designed to obtain detailed information on wart treatment and compare NZCS efficacy with previous treatments. Of 106 questionnaires returned, 83 reported NZCS use; 67 had previous treatments (23 cryotherapy, 2 electrocoagulation, 12 other topical application, and 30 combined treatment, such as laser, cryotherapy, and/or electrocoagulation). NZCS had superior efficacy to that of previous treatments (p < .0001), resulting in 84.1% with a full or partial clearance (vs. 44.8% for previous treatments), and had better local tolerability (p < .0001). NZCS showed better efficacy and tolerability than other previous wart treatments.
Collapse
Affiliation(s)
- Mario Puviani
- Department of Dermatology, Dermatologic Surgery Unit, Nuovo Ospedale Civile, Modena, Italy
| | - Marco Manfredini
- Department of Dermatology, Dermatologic Surgery Unit, Nuovo Ospedale Civile, Modena, Italy
| | - Klaus Eisendle
- Department of Dermatology, Venereology and Allergology, Academic Teaching Department of Medical University Innsbruck, Central Hospital Bolzano/Bozen, Bolzano, Italy.,IMREST Interdisciplinary Medical Research Center South Tyrol, Claudiana, College of Health-Care Professions, Bolzano, Italy
| |
Collapse
|
11
|
Rozas-Muñoz E, Mir-Bonafé J, Piquero-Casals J. Refractory warts successfully treated with a nitric-zinc complex solution. J Dermatol 2019; 46:e250-e251. [PMID: 30758872 DOI: 10.1111/1346-8138.14795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Eduardo Rozas-Muñoz
- Department of Dermatology, Hospital of Santa Creu in Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Mir-Bonafé
- Department of Dermatology, Hospital of Santa Creu in Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Jaime Piquero-Casals
- Derpartment of Dermatology, Dermik Multidisciplinary Dermatology Clinic, Barcelona, Spain
| |
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
|
de Planell-Mas E, Martínez-Garriga B, Zalacain AJ, Vinuesa T, Viñas M. Human papillomaviruses genotyping in plantar warts. J Med Virol 2016; 89:902-907. [PMID: 27736001 DOI: 10.1002/jmv.24713] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 11/08/2022]
Abstract
Plantar warts are caused by human papillomaviruses (HPVs) and have been associated with several HPV genotypes. However, there are few studies focused exclusively on plantar warts. In this work, we aim to identify the HPV genotypes of plantar warts and explore their relation to demographic and clinical characteristics of patients. A total of 72 patients diagnosed with plantar warts were recruited at the Laser unit at Podiatric Hospital, University of Barcelona, Spain. Inner hyperkeratosis laminar sections of warts were collected and DNA of samples were extracted. Amplification of a conserved region of the HPV L1 gene was performed with the SK-Polymerase chain reaction method. DNA amplicons were sequenced and HPV types identified. The most prevalent genotypes detected among the 105 analyzed plantar warts were HPV-57 (37.1%), HPV-27 (23.8%), HPV-1a (20.9%), HPV-2 (15.2%), and HPV-65 (2.8%). The majority of patients (78%) presented one single plantar wart, whereas multiple warts were detected in 22.2% of patients. One patient with multiple warts presented HPV types from two different genera, suggesting the spread of warts by self-inoculation as well as by de novo infection. No significant differences between the number of warts in toes, midfoot and heel were found. The most prevalent HPV types detected in all areas belonged to the alpha genus. This work provides new insight on plantar warts and their associated HPV genotypes, and evidences the usefulness and reliability of both the sample collection procedure and the PCR method used for HPV detection and typing. J. Med. Virol. 89:902-907, 2017. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Elena de Planell-Mas
- Laboratory of Molecular Microbiology and Antimicrobials, Faculty of Medicine, Department of Pathology and Experimental Therapeutics, Podiatric Hospital, University of Barcelona, Barcelona, Spain.,Podiatric Hospital, University of Barcelona, Barcelona, Spain
| | - Blanca Martínez-Garriga
- Laboratory of Molecular Microbiology and Antimicrobials, Faculty of Medicine, Department of Pathology and Experimental Therapeutics, Podiatric Hospital, University of Barcelona, Barcelona, Spain
| | - Antonio Jesús Zalacain
- Laboratory of Molecular Microbiology and Antimicrobials, Faculty of Medicine, Department of Pathology and Experimental Therapeutics, Podiatric Hospital, University of Barcelona, Barcelona, Spain.,Podiatric Hospital, University of Barcelona, Barcelona, Spain
| | - Teresa Vinuesa
- Laboratory of Molecular Microbiology and Antimicrobials, Faculty of Medicine, Department of Pathology and Experimental Therapeutics, Podiatric Hospital, University of Barcelona, Barcelona, Spain
| | - Miguel Viñas
- Laboratory of Molecular Microbiology and Antimicrobials, Faculty of Medicine, Department of Pathology and Experimental Therapeutics, Podiatric Hospital, University of Barcelona, Barcelona, Spain
| |
Collapse
|
14
|
Shahmoradi Z, Assaf F, Al Said H, Khosravani P, Hosseini SM. Topical pyruvic acid (70%) versus topical salicylic acid (16.7%) compound in treatment of plantar warts: A randomized controlled trial. Adv Biomed Res 2015; 4:113. [PMID: 26261815 PMCID: PMC4513322 DOI: 10.4103/2277-9175.157833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 12/28/2014] [Indexed: 11/24/2022] Open
Abstract
Background: Recurrence rate is considerable with current topical treatments of plantar warts. We compared the efficacy of topical pyruvic acid (70%) with salicylic acid (16.7%) compound in treating multiple plantar warts. Materials and Methods: In this randomized controlled trial, 60 patients with multiple plantar warts were equally randomized to receive either pyruvic acid 70% or compound salicylic acid solution (salicylic acid 16.7%, lactic acid 16.7%, and collodion 100%) that was topically applied twice a day for 4 weeks. Patients were visited every 2 weeks for 1 month after starting treatment and then every 1 month for another 2 months. The number and size of warts, treatment complications (pain, burning, scar, pigmentation, and crust), and recurrence were evaluated. Results: Warts’ number was decreased by −13.12 ± 25.6% with pyruvic acid and by −23.0 ± 28.0% with compound salicylic acid (P = 0.159) after treatment. Warts’ size was decreased by −43.47 ± 57.0% with pyruvic acid and by −37.40 ± 32.76% with compound salicylic acid (P = 0.615) after treatment. There was no difference between the two groups in cumulative incidence of treatment complications (P > 0.05). Also, there was no difference between the two groups in recurrence rate at 2 months (10 vs. 16.7%, P = 0.500) or at 3 months after treatment (3.3 vs. 6.7%, P = 0.335). Conclusion: Topical pyruvic acid and compound salicylic acid had the same efficacy and complications in treating plantar warts. Decision for choosing the treatment can be made based on the costs and individual factors as well as patients preferences.
Collapse
Affiliation(s)
- Zabihollah Shahmoradi
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatima Assaf
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hassan Al Said
- Department of Biochemistry, Faculty of Sciences, EDST-PRASE, Lebanese University, Hadath-Beirut, Lebanon
| | - Parastoo Khosravani
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayyed Mohsen Hosseini
- Department of Dermatology, Skin Diseases and Leishmaniasis Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|