The diverse methods of bleomycin delivery in cutaneous warts: A literature review

Topical antimitotic treatments for plantar warts are more beneficial: A Bayesian network meta-analysis of randomized controlled trials

BACKGROUND

Plantar warts are common infectious cutaneous growths causing severe physiological and psychological discomforts in patients and heaving global financial burdens. However, paucity of clear-cut guidelines for plantar warts, selecting appropriate treatments for plantar warts remains challenging. The objective of the study is to evaluate the efficacy and safety of common treatments for plantar warts.

METHODS

PubMed, EMbase, and The Cochrane Library were searched from inception to March 1, 2023 for randomized controlled trials (RCTs) of plantar warts. The primary outcome (complete response) and secondary outcome (recurrence and pain) were extracted and combined using Bayesian network meta-analysis (NMA) with random-effect and fixed-effect models.

RESULTS

Totally, 33 RCTs were included in the systematic review and quantitative NMA. In NMA of complete response, topical application of 1% cantharidin, 20% podophylotoxin, 30% salicylic acid (CPS), microneedles plus bleomycin (MNB), and intralesional bleomycin injection (INB) were the only three treatments significantly superior to no treatment (NT) and CPS was of the highest possibility to be the top-ranked treatment (SUCRA = 0.9363). However, traditional warts treatments, salicylic acid (SA) and cryotherapy were not superior to NT.

CONCLUSIONS

The NMA has produced evidence for using CPS, MNB, and INB, which are all topical antimitotic treatments, to improve the management of plantar warts. The classic treatment modalities for plantar warts, including SA and cryotherapy, may play a less important role in the clinical practice of plantar warts.

Treatment efficacy of 0.9% saline and mepivacaine infiltration with Dermojet® in eliminating plantar warts

BACKGROUND

Plantar warts are benign, epidermal neoformations, viral, and easily transmitted. Although 30% of these warts disappear spontaneously, the American Association of Dermatology recommends treatment if they cause pain or bleeding.

OBJECTIVES

The aim of this study was to determine the efficacy of Dermojet® infiltration using a solution composed of equal parts of 0.9% saline and 2% mepivacaine in the treatment of plantar warts, and to identify the type of necrosis achieved at 7-10 days after the infiltration (M1 sample) and at 15-17 days (M2 sample).

METHOD

In this analytical prospective observational study, 102 histories were reviewed by the same researcher. The patients were treated with this technique at four private podiatry clinics.

RESULTS

A total of 61.8% of the patients were male. The patients' mean age was 26.6 ± 14.10 years. A total percentage of 78.4% of the patients achieved complete elimination of the lesion by the second evaluation and after a single infiltration. Bivariate analysis revealed a significant inverse relationship between treatment efficacy and a history of previous disease (p < 0.001) and the period of evolution of the lesion (p < 0.001; 95% CI [0.78-7.91]). Multivariate linear regression analysis revealed an association with the number of evaluation sessions (p < 0.001) and with previous illnesses (p = 0.014). A total percentage of 82.35% presented partial necrosis in the M1 sample and 76.92% had complete necrosis in the M2 sample.

CONCLUSIONS

In 78.4% of the patients considered, the plantar warts treated disappeared after a single infiltration. The variables associated with treatment efficacy were the number of follow-up visits and the existence of associated diseases.

Intralesional cidofovir for the management of refractory cutaneous verrucae: a review of applications and opportunities

Viral warts - manifestations of cutaneous infection by human papilloma virus - can be a significant physical and emotional burden for patients when common treatments fail, particularly for individuals who are immunocompromised or with multiple lesions. Cidofovir, an antiviral agent typically used for the treatment of cytomegalovirus infection, has emerged as an alternative treatment option for viral warts when administered topically or intralesionally. In this review, we highlight the scientific rationale, published evidence, and practical clinical uses of intralesional cidofovir for the management of cutaneous warts as well as ongoing questions requiring further research and exploration of this emerging therapy for refractory verrucae.

Comparative efficacy of 595-nm Pulsed Dye Laser, Microwave Tissue Coagulation and Liquid Nitrogen Cryotherapy in the Treatment of Verruca Vulgaris in Children

OBJECTIVE

To evaluate the clinical efficacy and safety of 595-nm pulsed dye laser in the treatment of verruca vulgaris in children and to compare the efficacy of this method against two other methods, microwave tissue coagulation and liquid nitrogen cryotherapy.

METHODS

A total of 90 children being treated in the dermatology outpatient department of our hospital from 2019 to 2021 were selected and divided into three groups: the treatment group A (n = 30, treated with a 595-nm pulsed dye laser), treatment group B (n = 30, treated with microwave tissue coagulation), and treatment group C (n = 30, treated with liquid nitrogen cryotherapy). All the patients in the treatment group A, treatment group B, and treatment group C were treated once every two weeks, with a maximum of six treatments.

RESULTS

The response rate of the treatment group A was 93.3%, which was higher than the 83.3% rate of treatment group B and the 66.7% rate of treatment group C. The average treatment times of the treatment group A (2.45 ± 1.10) were lower than group B (3.51 ± 0.98) and group C(4.63 ± 0.96). The adverse reaction rate in the treatment group A (16.7%) was significantly lower than that in treatment group B (56.7%) and treatment group C (63.3%). The differences were statistically significant (all P < 0.05).

CONCLUSIONS

The 595-nm pulsed dye laser is safe and seems to be the most effective treatment for verruca vulgaris in children. Further high-level clinical trial is warranted to verify our results.

Skin needling with 100% trichloroacetic acid vs. needling with bleomycin in the treatment of recalcitrant cutaneous warts

The treatment of warts has always been a challenging prospect for dermatologists. In some cases, these warts can become resistant or recalcitrant to treatment. Although a plethora of therapeutic and destructive options is available for wart management, to date no treatment has been found to be completely effective because none of the agents induce specific antiviral immunity. We conducted a study to evaluate the efficacy and safety of skin needling with topical 100% trichloroacetic acid (TCA) against the same type of skin needling with bleomycin in patients with recalcitrant cutaneous warts. In total, 33 (63.5%) patients in the TCA group and 35 (81.4%) in the bleomycin group had complete clearance of all the warts, which was not statistically significant (P = 0.13). There was also no statistically significant difference between the treated and untreated warts in the bleomycin group, whereas in the TCA group there was a significantly higher response rate in the treated warts. The most common adverse event (AE) in both groups was transient procedure site pain. We found that the use of needling plus TCA leads to a faster resolution of warts compared with needling plus bleomycin, with a comparable safety profile. Additionally, we found that TCA is superior to bleomycin for management of multiple warts. However, needling with either TCA or bleomycin has excellent and fairly comparable efficacy, and these methods should be used for the management of multiple or recalcitrant warts, as they have minimal AEs and recurrence rates.