Factors contributing to the treatment duration of diphenylcyclopropenone immunotherapy for periungual warts

Use of Contact Immunotherapy in the Treatment of Skin Diseases Other than Alopecia Areata

For decades, contact immunotherapy with dinitrochlorobenzene, diphencyprone, and squaric acid dibutylester has played an important role in both clinical practice and scientific research. It is listed as the first-line treatment for extensive alopecia areata and was more recently approved for melanoma treatment as an orphan drug in the USA. Moreover, owing to the relative low cost and safety, topical immunotherapy has also been used in many infectious, neoplastic, and inflammatory dermatological diseases. It is especially valuable in vulnerable groups, for cosmetic/pain sensitive areas, or for multiple lesions. In this review, we summarize the current evidence supporting the use of contact immunotherapy for treatment of skin diseases, from articles collected from PubMed database. Owing to space limitation and already numerous studies focusing on alopecia areata, we include only skin diseases other than alopecia areata. In addition to diseases that have been reported to be treated by contact immunotherapy, the hypothesized mechanism, prognosis prediction, efficacy, and safety of these topical agents are discussed.

Silver duct tape occlusion in treatment of plantar warts in adults: Is it effective?

Duct tape occlusive therapy may represent a convenient alternative to the standard wart therapies. The objective of the current study is to assess the therapeutic effect of duct tape occlusion in comparison to cryotherapy in treatment of plantar warts in adults, in a prospective comparative randomized non-inferiority design. A total of 100 patients presenting with plantar warts were divided into two equal groups. First group was treated with silver duct tape occlusion for up to 8 weeks or disappearance of warts, whichever occurred first. Second group was treated with cryotherapy every 2 to 3 weeks for a maximum of four sessions or disappearance of warts. There was a statistically significant lower rate of complete resolution in duct tape than cryotherapy group (20% vs 58%, P = .0001, respectively). Degree of response to treatment in the duct tape and cryotherapy groups was not correlated to patients' age (P = .361 and .334, respectively) or disease duration (P = .266 and .285, respectively), while there was a statistically significant inverse relationship between the number (P = .0032 and .001, respectively) and diameter of warts (P = .013 and .003, respectively) and the degree of response in the two studied groups. Cryotherapy has higher efficacy than duct tape in the treatment of plantar warts in adults; however, duct tape may represent a practical and convenient alternative to cryotherapy in certain circumstances.

The efficacy of diphencyprone immunotherapy for the treatment of cutaneous warts: a systematic review and meta-analysis

BACKGROUND

Cutaneous warts, a common skin condition, may resolve spontaneously or become recalcitrant. Diphencyprone has been shown by many studies to have efficacy in treating warts, with varied results.

OBJECTIVES

We aimed to perform a meta-analysis of the cure rate following the use of diphencyprone immunotherapy as a cutaneous wart treatment.

MATERIALS AND METHODS

The databases of Medline, PubMed, Embase, ClinicalTrials.gov, and Cochrane Controlled Trials Register were searched for prospective and retrospective cohort studies and randomized controlled trials reporting a cure rate for diphencyprone immunotherapy between 1984 and 2018. The Comprehensive Meta-Analysis software (Biostat Inc) was used to perform a meta-analysis of the diphencyprone pool efficacy.

RESULTS

A total of 153 studies were obtained by searching the databases. After screening for eligibility, 14 studies were included (6 prospective studies, 4 retrospective studies, 3 randomized controlled trials, and 1 case report), representing a total of 851 patients. The random-effects pooled efficacy for diphencyprone was 75.5% (95% CI, 64.6%-83.9%; I² = 87%).

CONCLUSIONS

Diphencyprone immunotherapy has a high efficacy to cure warts. This method may be used as an adjunctive modality for the treatment of warts in cases of conventional treatment failure.

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.

Clinical Efficacy of Diphenylcyclopropenone Immunotherapy as Monotherapy for Multiple Viral Warts

Background:

Diphenylcyclopropenone (DPCP) immunotherapy for viral warts has been used for many years, but no studies have analyzed the treatment effects of DPCP alone, without the use of conventional therapy before immunotherapy.

Objectives:

We evaluated clinical efficacy of DPCP monotherapy compared to cryotherapy and pulsed dye laser (PDL) therapy. We also assessed the impact of initial sensitization on clinical response.

Methods:

We retrospectively analyzed the medical records of 250 patients with multiple viral warts between January 2008 and December 2015.

Results:

The DPCP-only group (n = 43) showed a lower clinical response (75.6%) than the cryotherapy-only group (n = 171, 89.8%, P < .01) and PDL-only group (n = 36, 90.3%, P < .01). The positive clinical response was 76.3% (119/156) in the successful sensitization group (n = 21) and 74.4% in the failed sensitization group ( P = .870).

Conclusions:

DPCP monotherapy has a lower clinical response than conventional therapy. Initial sensitization to DPCP does not predict a failed response with continued immunotherapy for viral warts.