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Xie K, Cheng M, He B, Li W, Zhong W. Photodynamic Therapy Combined with Liquid Nitrogen Cryotherapy and Curettage for the Treatment of Recalcitrant Periungual and Subungual Warts: Clinical Experience and Literature Review. Indian J Dermatol 2024; 69:57-62. [PMID: 38572045 PMCID: PMC10986876 DOI: 10.4103/ijd.ijd_524_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024] Open
Abstract
Warts are caused by human papillomavirus (HPV) infection and can involve multiple parts of skin and mucosa, of which periungual and subungual warts are the most difficult to treat. Periungual or subungual wart is verruca vulgaris growing around or under the fingernail, destroying and deforming the nail and nail bed. Currently, liquid nitrogen cryotherapy and CO2 laser are often used for the treatment. Clinically, few doctors routinely use photodynamic therapy (PDT) to treat viral warts. We used PDT combined with liquid nitrogen cryotherapy and curettage to successfully treat a case of intractable periungual and subungual warts.
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Affiliation(s)
- Kuixia Xie
- From the Department of Dermatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Meihong Cheng
- From the Department of Dermatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Bo He
- Department of Orthopedic Surgery, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, Jiangsu, 221009, China
| | - Wei Li
- From the Department of Dermatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Wenying Zhong
- From the Department of Dermatology, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China
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Lui BLJ, Tan CL. Outcomes of nurse-led cryotherapy treatment for viral warts. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:437-439. [PMID: 38920175 DOI: 10.47102/annals-acadmedsg.202372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Cryotherapy is a cost-effective treatment that can be performed by non-dermatologists for viral warts, which are very common.1,2 The National University Hospital, Singapore runs a nurse-led wart clinic where nurses are trained to administer cryotherapy. This study reviewed eradication rates and side effects in patients treated at the nurse-led wart clinic.
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Affiliation(s)
| | - Chris Lixian Tan
- Division of Dermatology, Department of Medicine, National University Healthcare System, Singapore
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Zheng K, Egawa N, Shiraz A, Katakuse M, Okamura M, Griffin HM, Doorbar J. The Reservoir of Persistent Human Papillomavirus Infection; Strategies for Elimination Using Anti-Viral Therapies. Viruses 2022; 14:214. [PMID: 35215808 PMCID: PMC8876702 DOI: 10.3390/v14020214] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Human Papillomaviruses have co-evolved with their human host, with each of the over 200 known HPV types infecting distinct epithelial niches to cause diverse disease pathologies. Despite the success of prophylactic vaccines in preventing high-risk HPV infection, the development of HPV anti-viral therapies has been hampered by the lack of enzymatic viral functions, and by difficulties in translating the results of in vitro experiments into clinically useful treatment regimes. In this review, we discuss recent advances in anti-HPV drug development, and highlight the importance of understanding persistent HPV infections for future anti-viral design. In the infected epithelial basal layer, HPV genomes are maintained at a very low copy number, with only limited viral gene expression; factors which allow them to hide from the host immune system. However, HPV gene expression confers an elevated proliferative potential, a delayed commitment to differentiation, and preferential persistence of the infected cell in the epithelial basal layer, when compared to their uninfected neighbours. To a large extent, this is driven by the viral E6 protein, which functions in the HPV life cycle as a modulator of epithelial homeostasis. By targeting HPV gene products involved in the maintenance of the viral reservoir, there appears to be new opportunities for the control or elimination of chronic HPV infections.
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Affiliation(s)
- Ke Zheng
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK; (K.Z.); (N.E.); (A.S.); (H.M.G.)
| | - Nagayasu Egawa
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK; (K.Z.); (N.E.); (A.S.); (H.M.G.)
| | - Aslam Shiraz
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK; (K.Z.); (N.E.); (A.S.); (H.M.G.)
| | - Mayako Katakuse
- Kyoto R&D Centre, Maruho Co., Ltd., Kyoto 600-8813, Japan; (M.K.); (M.O.)
| | - Maki Okamura
- Kyoto R&D Centre, Maruho Co., Ltd., Kyoto 600-8813, Japan; (M.K.); (M.O.)
| | - Heather M. Griffin
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK; (K.Z.); (N.E.); (A.S.); (H.M.G.)
| | - John Doorbar
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK; (K.Z.); (N.E.); (A.S.); (H.M.G.)
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Efficacy and Safety of Fire Needle Therapy for Flat Warts: Evidence from 29 Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:9513762. [PMID: 33531926 PMCID: PMC7834788 DOI: 10.1155/2021/9513762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/06/2020] [Accepted: 12/16/2020] [Indexed: 11/17/2022]
Abstract
Flat warts are a common and recurrent skin disease that has no specific antiviral treatment. As an alternative or complementary therapy, fire needle therapy has been widely used in the treatment of flat warts. The objective of this study was to systematically evaluate the efficacy and safety of fire needle therapy for flat warts. Using the search terms "flat warts" and "fire needle," we searched the PubMed, Embase, Cochrane, China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Chinese biomedical (SinoMed) database, and the China Science and Technology Journal databases for studies until March 12, 2020. Randomized controlled trials comparing fire needle therapies with conventional therapies were also included. We calculated the risk ratios (RR) and mean differences with a 95% confidence interval (CI). We analyzed 29 trials involving 2,666 patients. Results showed that the use of fire needle therapy alone may have a higher efficacy rate compared with that of an immunomodulator (RR = 1.11, 95% CI: 1.03 to 1.20, I 2 = 0%, P = 0.006; RR = 1.19, 95% CI: 1.03 to 1.37, I 2 = 70%, P = 0.02, respectively) or tretinoin (RR = 1.39, 95% CI: 1.25 to 1.55, I 2 = 0%, P < 0.00001), with a lower risk of blisters (P = 0.03) or erythema (P = 0.04), but with a higher risk of pigmentation (P = 0.02). We also determined the efficacy rate of fire needle therapy in combination with traditional Chinese medicine (RR = 1.16, 95% CI: 1.10 to 1.23, I 2 = 21%, P < 0.00001), immunomodulators (RR = 1.17, 95% CI: 1.07 to 1.28, I 2 = 33%, P = 0.0005), imiquimod (RR = 1.21, 95% CI: 1.04 to 1.42, P = 0.02), or as multidrug therapies (RR = 1.15, 95% CI: 1.07 to 1.24, I 2 = 0%, P = 0.0001) and found that the combination treatments could reduce recurrence rates (P < 0.00001) and provided a lower risk of desquamation (P = 0.006). In conclusion, fire needle therapy seems to be effective for flat warts, with a reduced incidence of adverse events, such as blisters, erythema, and desquamation, but may increase incidence of pigmentation.
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Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: A review. Dermatol Ther 2020; 33:e14034. [PMID: 32683782 DOI: 10.1111/dth.14034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
Viral warts or verruca are very common skin infections in children. Although benign, lesions can be extensive, painful, bleed, or lead to cosmetic disfigurement. Although spontaneous resolution can occur, parents often bring their children for treatment, especially when they are symptomatic. Many publications have assessed the efficacy and safety of treatment of warts in adults. However, treatment in children can be challenging due to their immune responses and lower threshold for pain. We review the current literature on the methods, efficacy, and side effect profile of common treatment modalities for cutaneous viral warts in children. There is evidence that salicylic acid and cryotherapy are effective, and although cryotherapy is more effective, there is a higher risk of side effects such as pain and blistering. Combination treatment with salicylic acid and cryotherapy may reduce these side effects. Although there is limited data, other treatment options such as cantharidin, immunotherapy and other mechanical therapies, for example, carbon dioxide lasers, may also be considered, especially for recalcitrant lesions.
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Affiliation(s)
| | | | - Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seng Bin Ang
- Duke-NUS Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
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Comparison of the Efficacy and Safety of Two Cryotherapy Protocols in the Treatment of Common Viral Warts: A Prospective Observational Study. Dermatol Res Pract 2020; 2020:2309309. [PMID: 32765598 PMCID: PMC7374216 DOI: 10.1155/2020/2309309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cryotherapy (freezing by liquid nitrogen) is an effective and widely used method for treatment of common warts. Patients often need multiple sessions at variable intervals. Protocols used by different dermatologists vary in terms of freezing time, the number of cycles, and the intervals between sessions. Aim To compare the efficacy (cure rates) and safety (complications, early and late) of two cryotherapy treatment protocols for common viral warts. Method A prospective observational study was conducted; it involved 80 patients with common warts on the hands and feet who were treated with cryotherapy done by two dermatologists who use different protocols; group 1 (45 patients) were treated by a single cycle of 10 seconds of freezing at 2 weekly intervals, and group 2 (35 patients) received a single cycle of 20 seconds of freezing at 4-weeks intervals. The two protocols were compared in terms of cure rate and complications 1-2 months after the final treatment. Recurrence rate and late complications were assessed at 9-12 months after the final treatment. Results Group 1 patients achieved higher cure rate than group 2, 77.8% and 54.3%, respectively (P=0.001). Early (blistering) and late complications (dyspigmentation and scarring) were comparable in both groups. Pain score associated with protocol 1 (5.2/10) was less than protocol 2 (6.4/10) (P=0.004). Recurrence rate (17%) was comparable in both groups. Association between cure rate and duration of warts (P=0.022) and also association between cure rate and the mean number of warts (P=0.001) were demonstrated. Conclusions Cryotherapy is an effective and safe treatment for common viral warts of hands and feet. The impact of shorter intervals on cure rate was more significant than increasing freezing time with longer intervals between freezing sessions. The study was approved by the local IRB committee (285-2018).
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Agarwal P, Bodar P, Saikia S, Dalal T, Jagati A. Evaluating the efficacy of 100% trichloroacetic acid needling in the treatment of palmoplantar warts. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2020. [DOI: 10.4103/ijdd.ijdd_38_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ghiasi MM, Zendehboudi S. Decision tree-based methodology to select a proper approach for wart treatment. Comput Biol Med 2019; 108:400-409. [DOI: 10.1016/j.compbiomed.2019.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 01/04/2023]
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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
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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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Cengiz FP, Emiroglu N, Su O, Onsun N. Effectiveness and safety profile of 40% trichloroacetic acid and cryotherapy for plantar warts. J Dermatol 2016; 43:1059-61. [PMID: 27041065 DOI: 10.1111/1346-8138.13370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 12/01/2022]
Abstract
Plantar warts are one of the most common infectious skin disease caused by the human papillomavirus. In this study, cryotherapy with liquid nitrogen delivered by the physician, up to four treatments 2 weeks apart. Forty percent trichloroacetic acid (TCA) was applied to warts weekly up to four treatments. At the end of 4 weeks, the clinical improvement of the TCA group (n = 30) was six patients (20%) with no change, one patient (3.3%) with a mild response, 13 patients (43.3%) with a moderate response and 10 patients (33.3%) with a good response. In the cryotherapy group, clinical responses were 12 patients (40%) with no change, four patients (13.3%) with a mild response, 12 patients (40%) with a moderate response and two patients (6.7%) with a good response. There was a statistically significant difference in improvement between the two treatment groups (P = 0.027). According to our results, TCA 40% is more effective for clearance of plantar warts with significantly improved long-term safety profile.
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Affiliation(s)
- Fatma Pelin Cengiz
- Department of Dermatology, Bezmialem Vakif University Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Nazan Emiroglu
- Department of Dermatology, Bezmialem Vakif University Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Ozlem Su
- Department of Dermatology, Bezmialem Vakif University Hospital, Bezmialem Vakif University, Istanbul, Turkey
| | - Nahide Onsun
- Department of Dermatology, Bezmialem Vakif University Hospital, Bezmialem Vakif University, Istanbul, Turkey
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Amirnia M, Khodaeiani E, Fouladi DF, Masoudnia S. Intralesional immunotherapy with tuberculin purified protein derivative (PPD) in recalcitrant wart: A randomized, placebo-controlled, double-blind clinical trial including an extra group of candidates for cryotherapy. J DERMATOL TREAT 2015; 27:173-8. [DOI: 10.3109/09546634.2015.1078871] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vlahovic TC, Spadone S, Dunn SP, Fussell T, Hersh I, Green T, Merrill J, Ghosh P, Tran T. Candida albicans Immunotherapy for Verrucae Plantaris. J Am Podiatr Med Assoc 2015; 105:395-400. [PMID: 26429607 DOI: 10.7547/14-062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Verrucae plantaris is a viral disease caused by human papilloma virus that is commonly seen in the office setting and is often challenging to treat owing to its high recurrence rate and recalcitrant profile. Candida albicans intralesional injections have been hypothesized to incite an immunogenic response toward the virus. METHODS We report on the immunotherapeutic effect of intralesional injection of C albicans into plantar verrucae with a retrospective medical record analysis of 80 patients. Using a luer-lock syringe, 0.1 to 0.3 mL of C albicans antigen was injected into either the first known lesion or the largest lesion. RESULTS The success rate of intralesional C albicans, defined as total clearance of the lesion, was 65%, which may be underestimated because patients lost to follow-up were included in the 35% failure rate. It was also found that female patients with a previous tissue-destructive treatment process were more than four times more likely to respond to C albicans therapy, whereas this effect was less pronounced in the male patient population. CONCLUSIONS These results indicate that a series of intralesional injections of C albicans is an effective and efficient method of treatment for verrucae plantaris.
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Affiliation(s)
- Tracey C. Vlahovic
- Temple University School of Podiatric Medicine, Philadelphia, PA. Dr. Ghosh is now with St. Luke's Hospital, Allentown, PA. Dr. Tran is now with Metrowest Medical Center, Framingham, MA
| | - Samuel Spadone
- Temple University School of Podiatric Medicine, Philadelphia, PA. Dr. Ghosh is now with St. Luke's Hospital, Allentown, PA. Dr. Tran is now with Metrowest Medical Center, Framingham, MA
| | | | | | - Ian Hersh
- Ani Orthopaedic Group of the Orthopaedic & Spine Institute of New Jersey, Hazlet, NJ. Dr. Hersh is now with Foot and Ankle Associates of Florida, Altamonte, FL
| | - Tyson Green
- Imperial Health Center for Orthopaedics, Lake Charles, LA
| | - Jeff Merrill
- Podiatry Department, Skylakes Medical Center, Klamath Falls, OR. Dr. Merrill is now with Klamath Falls Foot and Ankle, LLC, Klamath Falls, OR
| | - Payel Ghosh
- Temple University School of Podiatric Medicine, Philadelphia, PA. Dr. Ghosh is now with St. Luke's Hospital, Allentown, PA. Dr. Tran is now with Metrowest Medical Center, Framingham, MA
| | - Tran Tran
- Temple University School of Podiatric Medicine, Philadelphia, PA. Dr. Ghosh is now with St. Luke's Hospital, Allentown, PA. Dr. Tran is now with Metrowest Medical Center, Framingham, MA
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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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Bruggink SC, Gussekloo J, Egberts PF, Bavinck JNB, de Waal MWM, Assendelft WJJ, Eekhof JAH. Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial. J Invest Dermatol 2015; 135:1261-1267. [PMID: 25584800 DOI: 10.1038/jid.2015.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 12/11/2014] [Accepted: 12/17/2014] [Indexed: 11/09/2022]
Abstract
Cryotherapy and salicylic acid (SA) often fail as treatments for skin warts. We examined the effectiveness of monochloroacetic acid (MCA) for patients with common or plantar warts. Consecutive patients aged 4 years and older with one or more newly diagnosed common or plantar warts were recruited in 53 Dutch general practices. We randomly allocated eligible patients to 13-week treatment protocols of office-applied MCA versus liquid nitrogen cryotherapy every 2 weeks for patients with common warts (n=188), and MCA versus cryotherapy combined with daily SA self-application for patients with plantar warts (n=227). The primary outcome was the proportion of patients whose warts were all cured at 13 weeks. In the common wart group, cure rates were 40/92 (43%, 95% confidence interval 34-54) for MCA and 50/93 (54%, 44-64) for cryotherapy (risk difference (RD) -10%, -25-4.0, P=0.16). In the plantar wart group, cure rates were 49/106 (46%, 37-56) for MCA and 45/115 (39%, 31-48) for cryotherapy combined with SA (RD 7.1, 5.9-20, P=0.29). For common warts, MCA is an effective alternative to cryotherapy to avoid pain during the treatment, although pain after the treatment is similar. For plantar warts, office-applied MCA may be preferred over cryotherapy combined with SA, on the basis of comparable effectiveness, less treatment pain, and less treatment burden.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands.
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Paulette F Egberts
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | | | - Margot W M de Waal
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
| | - Willem J J Assendelft
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands; Radboud University Nijmegen Medical Centre, Department of Primary and Community Care, 117-hag, Nijmegen, The Netherlands
| | - Just A H Eekhof
- Department of Public Health and Primary Care (V0-P), Leiden University Medical Center, Leiden, The Netherlands
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17
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Ahn CS, Huang WW. Imiquimod in the treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol 2014; 15:387-99. [PMID: 25186654 DOI: 10.1007/s40257-014-0093-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cutaneous warts are highly prevalent lesions caused by the infection of keratinocytes by different types of human papillomaviruses. Although cutaneous warts are capable of resolving spontaneously, these infections can persist for long periods of time by evading the host immune system, and, as a result, many patients choose to seek treatment. Imiquimod is an immune response modifier that is approved as a topical cream for the treatment of anogenital warts by the US Food and Drug Administration. However, the efficacy of imiquimod in the treatment of cutaneous warts has not been well established. OBJECTIVE The purpose of this article is to systematically review the published literature regarding the efficacy of imiquimod in the treatment of cutaneous warts, and to evaluate the quality and outcomes of these studies. METHODS A literature search was performed through clinical queries PubMed (National Library of Medicine) database and the Cochrane database. All completed studies written in English and published through May 2014 were considered. Studies evaluating the use of imiquimod for anogenital warts were excluded. There were no other restrictions based on patient age, sex, ethnicity, or skin type. The studies were evaluated and assessed based on study design, patient population, treatment regimen, clinical outcome, and adverse events. RESULTS A total of 393 records were identified in the initial search; 23 full-text articles were assessed for eligibility and included in the review. Of these studies, six publications reported on immunocompromised individuals only. The highest quality study identified was a grade B, level 3 case-control cohort study in which patients with multiple warts had certain warts treated with imiquimod and others left untreated to serve as a control. The remaining studies identified were level 4 non-controlled case series (grade C) and level 5 case reports (grade D). In immunocompetent patients enrolled in non-controlled studies, the combined rate of patients achieving complete response to therapy was 44%, ranging from 27 to 89%. However, there was variation in the dose frequency and application among these studies. In immunosuppressed patients, two studies and four case reports were identified. Clinical improvement was seen in 33-50% of patients, with no patients experiencing complete clinical clearance. CONCLUSION There have been several studies demonstrating the successful use of imiquimod to treat recalcitrant cutaneous warts, either alone or as combination therapy. However, these studies are limited in number, include small populations, and are non-controlled. Further studies are needed to determine the efficacy of imiquimod, dose frequency and application, and optimal combination with other therapeutic measures such as paring, salicylic acid, or other destructive procedures.
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Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171:696-712. [PMID: 25273231 DOI: 10.1111/bjd.13310] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J C Sterling
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 OQQ, U.K
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Smith EA, Patel SB, Whiteley MS. Evaluating the success of Nd: YAG laser ablation in the treatment of recalcitrant verruca plantaris and a cautionary note about local anaesthesia on the plantar aspect of the foot. J Eur Acad Dermatol Venereol 2014; 29:463-7. [PMID: 24910163 DOI: 10.1111/jdv.12579] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 05/05/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND There are various methods advocated for the treatment of verruca plantaris. However, many verrucas do not respond to simple treatment. OBJECTIVE This study presents our results using Nd: YAG laser ablation therapy for such recalcitrant cases. METHODS We performed a retrospective audit by sending a questionnaire to all patients with recalcitrant verrucas who had been treated with Nd:YAG laser ablation over the previous 12 months. The questionnaire asked whether treatment had been successful, successful but new lesions had emerged, partially successful with improvement or unsuccessful. A Fontana Nd:YAG laser was used at the following specifications; long pulsed mode with pulse width 25 ms, frequency 1.0 Hz; fluence 240 J/cm(2) and spot size 2 mm. Some patients requested local anaesthesia and had direct infiltration with 0.5% plain lidocaine. RESULTS Fifty-three of the original 87 patients responded (60.9% response rate) with a male to female ratio of 24:29, mean age of 47 years and an age range between 22-72. Thirty-seven patients reported complete success post treatment (69.8%) and a further five reported improvement. The remaining 11 felt their treatment was unsuccessful. The cure rate was 81.8% in unilateral single cases, 68.1% in unilateral multiple cases and 65% in bilateral cases. Ten patients requested sublesional lidocaine injections of which 4 had skin breakdown after Nd: YAG ablation. CONCLUSION Nd:YAG laser ablation is effective in the treatment of recalcitrant verruca plantaris. However, we caution against the use of direct local anaesthesia infiltration before laser treatment.
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Affiliation(s)
- E A Smith
- Chiropodist and Podiatrist at the Whiteley Clinic, Guildford, UK
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Kim SY, Jung SK, Lee SG, Yi SM, Kim JH, Kim IH. New alternative combination therapy for recalcitrant common warts: the efficacy of imiquimod 5% cream and duct tape combination therapy. Ann Dermatol 2013; 25:261-3. [PMID: 23717030 PMCID: PMC3662932 DOI: 10.5021/ad.2013.25.2.261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 08/09/2012] [Accepted: 09/01/2012] [Indexed: 11/08/2022] Open
Affiliation(s)
- Sun Yae Kim
- Department of Dermatology, Korea University Ansan Hospital, Ansan, Korea
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Ho CS J, Rydström A, Trulsson M, Bålfors J, Storm P, Puthia M, Nadeem A, Svanborg C. HAMLET: functional properties and therapeutic potential. Future Oncol 2012; 8:1301-13. [DOI: 10.2217/fon.12.122] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Human α-lactalbumin made lethal to tumor cells (HAMLET) is the first member in a new family of protein–lipid complexes that kills tumor cells with high selectivity. The protein component of HAMLET is α-lactalbumin, which in its native state acts as a substrate specifier in the lactose synthase complex, thereby defining a function essential for the survival of lactating mammals. In addition, α-lactalbumin acquires tumoricidal activity after partial unfolding and binding to oleic acid. The lipid cofactor serves the dual role as a stabilizer of the altered fold of the protein and a coactivator of specific steps in tumor cell death. HAMLET is broadly tumoricidal, suggesting that the complex identifies conserved death pathways suitable for targeting by novel therapies. Sensitivity to HAMLET is defined by oncogene expression including Ras and c-Myc and by glycolytic enzymes. Cellular targets are located in the cytoplasmic membrane, cytoskeleton, mitochondria, proteasomes, lysosomes and nuclei, and specific signaling pathways are rapidly activated, first by interactions of HAMLET with the cell membrane and subsequently after HAMLET internalization. Therapeutic effects of HAMLET have been demonstrated in human skin papillomas and bladder cancers, and HAMLET limits the progression of human glioblastomas, with no evidence of toxicity for normal brain or bladder tissue. These findings open up new avenues for cancer therapy and the understanding of conserved death responses in tumor cells.
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Affiliation(s)
- James Ho CS
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Anna Rydström
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Maria Trulsson
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Johannes Bålfors
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Petter Storm
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Manoj Puthia
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Aftab Nadeem
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
| | - Catharina Svanborg
- Department of Microbiology, Immunology & Glycobiology (MIG), Institute of Laboratory Medicine, Lund University, Sölvegatan 23, S-223 62 Lund, Sweden
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Abstract
BACKGROUND Viral warts are a common skin condition, which can range in severity from a minor nuisance that resolve spontaneously to a troublesome, chronic condition. Many different topical treatments are available. OBJECTIVES To evaluate the efficacy of local treatments for cutaneous non-genital warts in healthy, immunocompetent adults and children. SEARCH METHODS We updated our searches of the following databases to May 2011: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library, MEDLINE (from 2005), EMBASE (from 2010), AMED (from 1985), LILACS (from 1982), and CINAHL (from 1981). We searched reference lists of articles and online trials registries for ongoing trials. SELECTION CRITERIA Randomised controlled trials (RCTs) of topical treatments for cutaneous non-genital warts. DATA COLLECTION AND ANALYSIS Two authors independently selected trials and extracted data; a third author resolved any disagreements. MAIN RESULTS We included 85 trials involving a total of 8815 randomised participants (26 new studies were included in this update). There was a wide range of different treatments and a variety of trial designs. Many of the studies were judged to be at high risk of bias in one or more areas of trial design.Trials of salicylic acid (SA) versus placebo showed that the former significantly increased the chance of clearance of warts at all sites (RR (risk ratio) 1.56, 95% CI (confidence interval) 1.20 to 2.03). Subgroup analysis for different sites, hands (RR 2.67, 95% CI 1.43 to 5.01) and feet (RR 1.29, 95% CI 1.07 to 1.55), suggested it might be more effective for hands than feet.A meta-analysis of cryotherapy versus placebo for warts at all sites favoured neither intervention nor control (RR 1.45, 95% CI 0.65 to 3.23). Subgroup analysis for different sites, hands (RR 2.63, 95% CI 0.43 to 15.94) and feet (RR 0.90, 95% CI 0.26 to 3.07), again suggested better outcomes for hands than feet. One trial showed cryotherapy to be better than both placebo and SA, but only for hand warts.There was no significant difference in cure rates between cryotherapy at 2-, 3-, and 4-weekly intervals.Aggressive cryotherapy appeared more effective than gentle cryotherapy (RR 1.90, 95% CI 1.15 to 3.15), but with increased adverse effects.Meta-analysis did not demonstrate a significant difference in effectiveness between cryotherapy and SA at all sites (RR 1.23, 95% CI 0.88 to 1.71) or in subgroup analyses for hands and feet.Two trials with 328 participants showed that SA and cryotherapy combined appeared more effective than SA alone (RR 1.24, 95% CI 1.07 to 1.43).The benefit of intralesional bleomycin remains uncertain as the evidence was inconsistent. The most informative trial with 31 participants showed no significant difference in cure rate between bleomycin and saline injections (RR 1.28, 95% CI 0.92 to 1.78).Dinitrochlorobenzene was more than twice as effective as placebo in 2 trials with 80 participants (RR 2.12, 95% CI 1.38 to 3.26).Two trials of clear duct tape with 193 participants demonstrated no advantage over placebo (RR 1.43, 95% CI 0.51 to 4.05).We could not combine data from trials of the following treatments: intralesional 5-fluorouracil, topical zinc, silver nitrate (which demonstrated possible beneficial effects), topical 5-fluorouracil, pulsed dye laser, photodynamic therapy, 80% phenol, 5% imiquimod cream, intralesional antigen, and topical alpha-lactalbumin-oleic acid (which showed no advantage over placebo).We did not identify any RCTs that evaluated surgery (curettage, excision), formaldehyde, podophyllotoxin, cantharidin, diphencyprone, or squaric acid dibutylester. AUTHORS' CONCLUSIONS Data from two new trials comparing SA and cryotherapy have allowed a better appraisal of their effectiveness. The evidence remains more consistent for SA, but only shows a modest therapeutic effect. Overall, trials comparing cryotherapy with placebo showed no significant difference in effectiveness, but the same was also true for trials comparing cryotherapy with SA. Only one trial showed cryotherapy to be better than both SA and placebo, and this was only for hand warts. Adverse effects, such as pain, blistering, and scarring, were not consistently reported but are probably more common with cryotherapy.None of the other reviewed treatments appeared safer or more effective than SA and cryotherapy. Two trials of clear duct tape demonstrated no advantage over placebo. Dinitrochlorobenzene (and possibly other similar contact sensitisers) may be useful for the treatment of refractory warts.
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Affiliation(s)
- Chun Shing Kwok
- Norwich Medical School, University of East Anglia, Norwich, UK
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Na CH, Park HP, Song IG, Choi H, Kim MS, Shin BS. A comparison of therapeutic efficacy of a melamine foam sponge and conventional cotton wool bud in the cryotherapy of viral warts: a paired comparison study. Pediatr Dermatol 2012; 29:555-9. [PMID: 22353042 DOI: 10.1111/j.1525-1470.2011.01707.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Many therapies have been studied for the treatment of viral warts, but none are uniformly effective. The aim of this study was to compare the efficacy of conventional cotton wool bud with that of melamine foam sponge as applicators in the treatment of warts with liquid nitrogen. A paired comparison study was conducted in 27 patients with at least two similar clinical types of warts. Similar clinical lesions were allocated to have liquid nitrogen applied with cotton wool bud or melamine foam sponge. Mean size reduction rate after the first treatment was 30.5% in the cotton wool bud group and 59.1% in the melamine foam sponge group. Mean number of total treatments was 3.05 in the cotton wool bud group and 2.29 in the melamine foam sponge group. Melamine foam sponge was found to be more effective in comparison to conventional cryotherapy with cotton wool bud.
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Affiliation(s)
- Chan Ho Na
- Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea
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&NA;. Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.2165/11608610-000000000-00000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Treat cutaneous warts on a case-by-case basis, taking into account patient factors and the available clinical evidence. DRUGS & THERAPY PERSPECTIVES 2012. [DOI: 10.1007/bf03262114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Alghamdi KM, Khurram H. Successful Treatment of Plantar Warts with Very Diluted Bleomycin Using a Translesional Multipuncture Technique: Pilot Prospective Study. J Cutan Med Surg 2012; 16:250-6. [DOI: 10.1177/120347541201600406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Plantar warts are common and often painful. Treatment of plantar warts is difficult and requires multiple treatments. Several clinical trials have proven the efficacy of bleomycin, but relatively high concentrations have been required and considerable side effects have been experienced. Objective: To evaluate the efficacy and safety of low-concentration (0.1 U/mL) bleomycin using a translesional injection technique for the treatment of plantar warts. Methods: The study included 23 patients with single or multiple plantar warts. Very low-concentration bleomycin was injected into a single wart or the largest plantar wart in the case of multiple lesions. Injections were performed at 4-week intervals until resolution of the warts or development of side effects. The translesional multipuncture technique was used. Results: Thirteen patients were male (56.5%), and the mean age was 27.7 years. The results revealed complete clearance of warts in 17 of 23 (74%) patients, partial response in 1 (4.3%) patient, and no response in 3 (13%) patients. Recurrence was observed in 2 patients at 3 months of follow-up. Among those two, one patient showed complete clearance after the second injection at 6 months of follow-up. All patients were followed for 6 months after the initial treatment. No significant long-term adverse effects were noted. Only three patients (13%) had localized moderate pain for 2 to 3 days after the injection. Conclusion: Translesional injection by very low-concentration (0.1 U/mL) bleomycin appears to be a simple, effective, and safe treatment modality for plantar warts.
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Affiliation(s)
- Khalid M. Alghamdi
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Huma Khurram
- Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Dall'oglio F, D'Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol 2012; 13:73-96. [PMID: 22292461 DOI: 10.2165/11594610-000000000-00000] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cutaneous warts are common skin lesions caused by human papillomavirus infection. Treatment is aimed at relieving the patient's physical and psychological discomfort and at preventing the spread of infection by autoinoculation. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases their safety and efficacy has not been assessed in double-blind, controlled clinical trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. The aim of this article is to describe the outcome of current therapies for each clinical wart type according to evidence-based medicine studies published in the literature. For each clinical form, the existing treatments are classified as first-, second-, and third-line therapy. First-line therapy includes medical treatments (salicylic acid, silver nitrate, glutaraldehyde) that are useful to treat a single wart or a few and/or small common warts of short duration (less than 1 year). If these treatments have failed or are contraindicated, cryotherapy may be considered as second-line therapy. For recurrent or difficult-to-treat lesions, third-line therapy includes a variety of alternative therapeutic options (topical, intralesional, systemic, and physical destruction) that are generally off-label (not US FDA approved), and whose use is limited by drawbacks or adverse effects. From pooled evidence-based medicine data, it is possible to conclude that significantly higher remission rates may be expected only with cryotherapy and salicylic acid used in combination.
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Choi JW, Cho S, Lee JH. Does immunotherapy of viral warts provide beneficial effects when it is combined with conventional therapy? Ann Dermatol 2011; 23:282-7. [PMID: 21909196 PMCID: PMC3162255 DOI: 10.5021/ad.2011.23.3.282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 01/05/2011] [Accepted: 01/05/2011] [Indexed: 11/17/2022] Open
Abstract
Background Cryotherapy has been accepted as the mainstay in treating periunugal and palmoplantar warts. The major drawback of cryotherapy is the requirement of several unbearably painful treatment sessions. Objective This study aims to assess the efficacy of immunotherapy in viral wart treatment, as an adjunctive method to cryotherapy. Methods Retrospective chart review was performed on 124 patients visiting the hospital from January to December 2009 for the treatment of periungual and plantar warts. We analyzed the number of cryotherapy sessions necessary for treating warts and assessed the clinical benefits from the addition of other treatment modalities, by adjusting the various confounding factors. Results Of the 124 investigated patients, immunotherapy with diphenylcyclopropenone (DPCP) was performed in 14 patients (11%), together with cryotherapy. After adjusting the factors related to the therapeutic difficulties of wart, the average number of cryotherapy sessions for the immunotherapy-combined group was significantly lower (3.58±1.25) than that for the cryotherapy only group (5.10±0.44) (p=0.026). However, there were no differences in the number of treatment sessions of cryotherapy when topical 5-FU/salicylic acid agents were added to the treatment. Conclusion Immunotherapy may be a successful adjuvant to cryotherapy in reducing the number of agonizing cryotherapy sessions.
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Affiliation(s)
- Jae Woo Choi
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea
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Cockayne S, Hewitt C, Hicks K, Jayakody S, Kang'ombe AR, Stamuli E, Turner G, Thomas K, Curran M, Denby G, Hashmi F, McIntosh C, McLarnon N, Torgerson D, Watt I. Cryotherapy versus salicylic acid for the treatment of plantar warts (verrucae): a randomised controlled trial. BMJ 2011; 342:d3271. [PMID: 21652750 PMCID: PMC3109952 DOI: 10.1136/bmj.d3271] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts. DESIGN A multicentre, open, two arm randomised controlled trial. SETTING University podiatry school clinics, NHS podiatry clinics, and primary care in England, Scotland, and Ireland. PARTICIPANTS 240 patients aged 12 years and over, with a plantar wart that in the opinion of the healthcare professional was suitable for treatment with both cryotherapy and salicylic acid. INTERVENTIONS Cryotherapy with liquid nitrogen delivered by a healthcare professional, up to four treatments two to three weeks apart. Patient self treatment with 50% salicylic acid (Verrugon) daily up to a maximum of eight weeks. MAIN OUTCOME MEASURES Complete clearance of all plantar warts at 12 weeks. Secondary outcomes were (a) complete clearance of all plantar warts at 12 weeks controlling for age, whether the wart had been treated previously, and type of wart, (b) patient self reported clearance of plantar warts at six months, (c) time to clearance of plantar wart, (d) number of plantar warts at 12 weeks, and (e) patient satisfaction with the treatment. RESULTS There was no evidence of a difference between the salicylic acid and cryotherapy groups in the proportions of participants with complete clearance of all plantar warts at 12 weeks (17/119 (14%) v 15/110 (14%), difference 0.65% (95% CI -8.33 to 9.63), P=0.89). The results did not change when the analysis was repeated but with adjustment for age, whether the wart had been treated previously, and type of plantar wart or for patients' preferences at baseline. There was no evidence of a difference between the salicylic acid and cryotherapy groups in self reported clearance of plantar warts at six months (29/95 (31%) v 33/98 (34%), difference -3.15% (-16.31 to 10.02), P=0.64) or in time to clearance (hazard ratio 0.80 (95% CI 0.51 to 1.25), P=0.33). There was also no evidence of a difference in the number of plantar warts at 12 weeks (incident rate ratio 1.08 (0.81 to 1.43), P=0.62). CONCLUSIONS Salicylic acid and the cryotherapy were equally effective for clearance of plantar warts. TRIAL REGISTRATION Current Controlled Trials ISRCTN18994246, National Research Register N0484189151.
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Affiliation(s)
- Sarah Cockayne
- Department of Health Sciences, York Trials Unit, University of York, UK.
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Kwok C, Holland R, Gibbs S. Efficacy of topical treatments for cutaneous warts: a meta-analysis and pooled analysis of randomized controlled trials. Br J Dermatol 2011; 165:233-46. [DOI: 10.1111/j.1365-2133.2011.10218.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eassa BI, Abou-Bakr AA, El-Khalawany MA. Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women. Dermatol Ther 2011; 24:137-43. [PMID: 21276168 DOI: 10.1111/j.1529-8019.2010.01388.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Immunotherapy for treatment of recalcitrant warts was used through different modalities including intralesional injection of purified protein derivative (PPD), which is an extract of Mycobacterium tuberculosis, used for testing exposure to tuberculin protein, either from a previous vaccination or from the environment. This method is used to evaluate the efficacy of a new approach of intradermal injection of PPD in the treatment of anogenital warts in pregnant women. A total of 40 pregnant women, aged 20-35 years, and presented with anogenital warts were enrolled in this study. Human papillomavirus (HPV) typing was done using the GP5+/GP6+ PCR assay. The patients were treated with weekly injections of PPD given intradermally in the forearms, and evaluated for the response regularly. HPV type-6 was the predominant genotype (67.5%). Overall, the improvement in this study was 85% and was related to the extent of tuberculin reactivity. Nineteen (47.5%) patients demonstrated complete clearance, 15 (37.5%) had partial response, and three (7.5%) had minimal response. Three (7.5%) cases did not respond to treatment. Side effects were minimal and insignificant. Treatment of anogenital warts in pregnant women with intradermal injection of PPD was found to be a unique, safe, and effective modality of immunotherapy.
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Affiliation(s)
- Bayoumy I Eassa
- Department of Dermatology and Venereology, Al-Hussein University Hospital, Al-Azhar University, Tanta, Gharbia Governorate, Egypt
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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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Youn SH, Kwon IH, Park EJ, Kim KH, Kim KJ. A Two-week Interval Is Better Than a Three-week Interval for Reducing the Recurrence Rate of Hand-foot Viral Warts after Cryotherapy: A Retrospective Review of 560 Hand-foot Viral Warts Patients. Ann Dermatol 2011; 23:53-60. [PMID: 21738363 DOI: 10.5021/ad.2011.23.1.53] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 10/25/2010] [Accepted: 10/25/2010] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Viral warts are a common infectious disease and liquid nitrogen cryotherapy is one of the most common methods for treatment of these warts. Hand-foot viral warts frequently recur and reduce quality of life as well. OBJECTIVE To find the ideal treatment interval between cryotherapy sessions that can influence not only the cure rate but also the recurrence rate for hand-foot viral warts. METHODS A retrospective study was designed to compare a 2 week interval and a 3 week interval between cryotherapy sessions on hand-foot viral warts with respect to cure rate, recurrence rate, treatment number, duration of treatment, mean time to recurrence and adverse events. RESULTS A total of 560 patients were enrolled. The overall cure rate was 75.7% and the recurrence rate was 19.6%. The mean time to recurrence was 7.8 months (range 1~26 months). For the 2-week and 3-week groups, cure rates were, respectively, 76.6% (196) and 75.0% (228); recurrence rates were 13.3% (26) and 25.0% (57). The mean time to recurrence was 9.8 months and 6.9 months, respectively. Adverse events were not statistically different. CONCLUSION We suggested that 2-week cryotherapy is optimal not only because of the rapid cure but also because of the lower recurrence rate and similar adverse events.
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Affiliation(s)
- Sung Hwan Youn
- Department of Dermatology, College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
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Klinischer Algorithmus zur Therapie von kutanen, extragenitalen HPV-induzierten Warzen. Hautarzt 2011; 62:6-16. [DOI: 10.1007/s00105-010-2027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tomson N, Sterling J, Ahmed I, Hague J, Berth-Jones J. Human papillomavirus typing of warts and response to cryotherapy. J Eur Acad Dermatol Venereol 2010; 25:1108-11. [PMID: 21812829 DOI: 10.1111/j.1468-3083.2010.03906.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cutaneous warts are common and caused by a number of different types of human papillomaviruses (HPVs). OBJECTIVE The aim of this study was to investigate the HPV types causing common warts and to determine any association between the HPV type and the duration of warts and response to cryotherapy. METHODS Eighty wart samples from 76 immunocompetent patients were taken from warts by paring prior to cryotherapy and analysed by in situ hybridization (ISH) with HPV probes specific to HPV 1, 2, 3, 4, 7, 10 and 57 and PCR analysis using degenerate cutaneous HPV primers with subsequent DNA sequencing. Each patient's details, including site, duration and response of the wart to cryotherapy were recorded. Cryotherapy was performed at 2 week intervals for a maximum of 12 weeks. RESULTS An HPV type was identified in 65 samples. The majority of warts (58 samples) were typed as HPV 2/27/57 by ISH and/or PCR. Three of the 18 samples that were HPV negative with ISH were HPV positive by PCR. Response to treatment did not correlate with HPV type, duration or location. In the 21 wart parings taken from patients aged 16 and under, response to treatment did not correlate with HPV type but warts of shorter duration were more likely to resolve with cryotherapy treatment than longer standing lesions. CONCLUSION This study demonstrates that HPV type can be determined from wart parings. HPV-2 related viruses are the prevalent HPV types causing common warts on the hands and feet in this population.
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Affiliation(s)
- N Tomson
- Department of Dermatology, West Suffolk Hospital NHS Trust, Suffolk, UK.
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Viral infections of the hand. CURRENT ORTHOPAEDIC PRACTICE 2010. [DOI: 10.1097/bco.0b013e3181f6bfd3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bruggink SC, Waagmeester SC, Gussekloo J, Assendelft WJJ, Eekhof JAH. Current choices in the treatment of cutaneous warts: a survey among Dutch GP. Fam Pract 2010; 27:549-53. [PMID: 20610491 DOI: 10.1093/fampra/cmq047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND GPs apply several treatments for patients with cutaneous warts. Available evidence recommends salicylic acid application. OBJECTIVE We investigated whether current choices of GPs in the treatment of warts are in agreement with available evidence. METHODS A nationwide random sample of 700 Dutch GPs received a postal questionnaire on their choices in the treatment of warts. In addition, factors that influence these choices, their view on the effectiveness of treatments and their view on the natural history of warts were assessed. RESULTS The questionnaire was returned by 280 GPs (40%). Cryotherapy was first choice treatment in 73% of GPs for hand warts, 49% of GPs for plantar warts and 72% of GPs for warts on other locations. Salicylic acid application or the combination of cryotherapy and salicylic acid were used less frequently, followed by an expectant awaiting policy and (electro) surgery. Most important factors influencing their treatment choice were GPs' routine and GPs' views on effectiveness. CONCLUSIONS In contrast to available evidence, most GPs apply cryotherapy as first choice treatment of cutaneous warts. Pragmatic high-quality trials on the effectiveness of wart treatments conducted in primary care might solve this discrepancy between evidence and practice.
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
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Bruggink SC, Gussekloo J, Berger MY, Zaaijer K, Assendelft WJJ, de Waal MWM, Bavinck JNB, Koes BW, Eekhof JAH. Cryotherapy with liquid nitrogen versus topical salicylic acid application for cutaneous warts in primary care: randomized controlled trial. CMAJ 2010; 182:1624-30. [PMID: 20837684 DOI: 10.1503/cmaj.092194] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cryotherapy is widely used for the treatment of cutaneous warts in primary care. However, evidence favours salicylic acid application. We compared the effectiveness of these treatments as well as a wait-and-see approach. METHODS Consecutive patients with new cutaneous warts were recruited in 30 primary care practices in the Netherlands between May 1, 2006, and Jan. 26, 2007. We randomly allocated eligible patients to one of three groups: cryotherapy with liquid nitrogen every two weeks, self-application of salicylic acid daily or a wait-and-see approach. The primary outcome was the proportion of participants whose warts were all cured at 13 weeks. Analysis was on an intention-to-treat basis. Secondary outcomes included treatment adherence, side effects and treatment satisfaction. Research nurses assessed outcomes during home visits at 4, 13 and 26 weeks. RESULTS Of the 250 participants (age 4 to 79 years), 240 were included in the analysis at 13 weeks (loss to follow-up 4%). Cure rates were 39% (95% confidence interval [CI] 29%-51%) in the cryotherapy group, 24% (95% CI 16%-35%) in the salicylic acid group and 16% (95% CI 9.5%-25%) in the wait-and-see group. Differences in effectiveness were most pronounced among participants with common warts (n = 116): cure rates were 49% (95% CI 34%-64%) in the cryotherapy group, 15% (95% CI 7%-30%) in the salicylic acid group and 8% (95% CI 3%-21%) in the wait-and-see group. Cure rates among the participants with plantar warts (n = 124) did not differ significantly between treatment groups. INTERPRETATION For common warts, cryotherapy was the most effective therapy in primary care. For plantar warts, we found no clinically relevant difference in effectiveness between cryotherapy, topical application of salicylic acid or a wait-and-see approach after 13 weeks. (ClinicalTrial.gov registration no. ISRCTN42730629).
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Affiliation(s)
- Sjoerd C Bruggink
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
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Han TY, Lee JH, Lee CK, Ahn JY, Seo SJ, Hong CK. Long-pulsed Nd:YAG laser treatment of warts: report on a series of 369 cases. J Korean Med Sci 2009; 24:889-93. [PMID: 19794989 PMCID: PMC2752774 DOI: 10.3346/jkms.2009.24.5.889] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 10/25/2008] [Indexed: 11/23/2022] Open
Abstract
Various treatment methods have been adopted in the management of warts; however, there is still no consensus on first-line treatment. This study was designed to evaluate the efficacy of long-pulsed Nd:YAG laser in the treatment of warts. Over the course of 1 yr, 369 patients with recalcitrant or untreated warts were exposed to a long-pulsed Nd:YAG laser. The following parameters were used: spot size, 5 mm; pulse duration, 20 msec; and fluence, 200 J/cm(2). No concomitant topical treatment was used. In all, 21 patients were lost during follow up; hence, the data for 348 patients were evaluated. The clearance rate was 96% (336 of the 348 treated warts were eradicated). The clearance rate of verruca vulgaris after the first treatment was very high (72.6%), whereas the clearance rate of deep palmopantar warts after the first treatment was low (44.1%). During a median follow-up period of 2.24 months (range, 2-10 months), 11 relapses were seen (recurrence rate, 3.27%). In conclusion, long-pulsed Nd:YAG laser is safe and effective for the removal or reduction of warts and is less dependent on patient compliance than are other treatment options.
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Affiliation(s)
- Tae Young Han
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Ji Ho Lee
- Gowoonsesang Dermatology Clinic, Seoul, Korea
| | | | - Ji Young Ahn
- Department of Dermatology, National Medical Center, Seoul, Korea
| | - Seong Jun Seo
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Chang Kwun Hong
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
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Erkens AMJL, Kuijpers RJAM, Knottnerus JA. Treatment of verrucae vulgares in general practice — a randomized controlled trial on the effectiveness of liquid nitrogen and the Histofreezer. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639209088722] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Veien NK, Madsen SM, Avrach W, Hammershøy O, Lindskov R, Niordson AM, Stahl D. The treatment of plantar warts with a keratolytic agent and occlusion. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639109086776] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Benton EC, Nolan MW, Kemmett D, Cubie HA. Trial of inosine pranobex in the management of cutaneous viral warts. J DERMATOL TREAT 2009. [DOI: 10.3109/09546639109086761] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Treatment of Common Warts with an Intralesional Mixture of 5-Fluorouracil, Lidocaine, and Epinephrine. Dermatol Surg 2008. [DOI: 10.1097/00042728-200805000-00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yazdanfar A, Farshchian M, Fereydoonnejad M, Farshchian M. Treatment of common warts with an intralesional mixture of 5-fluorouracil, lidocaine, and epinephrine: a prospective placebo-controlled, double-blind randomized trial. Dermatol Surg 2008; 34:656-9. [PMID: 18261100 DOI: 10.1111/j.1524-4725.2007.34123.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND 5-Fluorouracil is an antimetabolite that has been known to be effective for the treatment of common warts. OBJECTIVE The objective was to evaluate the efficacy of a combination of 5-fluorouracil, lidocaine, and epinephrine (5-FU+LE) for the treatment of common warts. MATERIALS AND METHODS Of the 40 patients initially enrolled, 34 patients with at least 68 verruca vulgaris (one pair for each subject) completed the study. The selected warts were randomized into two treatment groups, with one wart on each patient receiving intralesional 5-FU+LE (4 mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL [2%] lidocaine and 0.0125 mg/mL epinephrine) and the other receiving intralesional normal saline placebo using a Mantoux needle. Patients received up to four injections at weekly intervals and were followed at 1 and 6 months after the initial injection. RESULTS Complete response was observed in 64.7% of the warts treated with 5-FU+LE compared to 35.3% in the warts treated with placebo (p<.05). Systemic reaction or treatment-related adverse medical events and recurrence rate did not differ significantly between two groups. CONCLUSION The results show that intralesional 5-FU+LE is a safe and effective approach for common warts with high success rate.
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