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Khattab F, Essam R, Elhadidy RF, Anis N. Intralesional combined digoxin and furosemide versus intralesional 5-flurouracil for the treatment of recalcitrant plantar warts: a prospective, randomized study. Arch Dermatol Res 2024; 316:411. [PMID: 38878078 PMCID: PMC11180028 DOI: 10.1007/s00403-024-03014-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 06/19/2024]
Abstract
There are many therapeutic modalities for plantar warts, however treating it remains challenging. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide were observed to be effective and safe, however no comparison study between them was done. Our study was conducted to evaluate the efficacy of both therapies in the treatment of plantar warts. 90 adult patients with multiple recalcitrant plantar warts were included in our study. They were randomly allocated to one of three groups; combined digoxin and furosemide, 5-fluorouarcil, or normal saline group. Fortnightly injections were done into all studied warts till complete clearance or up to 5 sessions. Warts were evaluated clinically and dermoscopically. Clinical response was reported in 24 patients (80%) of the combined digoxin and furosemide group with 40% complete response and in 24 patients (80%) of the 5-fluorouarcil group with 33.3% complete response. No statistically significant difference was observed between the two groups concerning efficacy and safety. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide are nearly equivalent in efficacy and safety for plantar wart treatment. Dermoscopy helps to take the truthful judgment about complete clearance of warts.
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Affiliation(s)
- Fathia Khattab
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Essam
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham F Elhadidy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Nourhan Anis
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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2
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Kim S, Woo YR, Cho SH, Lee JD, Kim HS. Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology. J Clin Med 2024; 13:335. [PMID: 38256469 PMCID: PMC10816055 DOI: 10.3390/jcm13020335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/05/2024] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
Bleomycin and 5-fluorouracil (5-FU) are widely used in various dermatological disorders. Both drugs are well-recognized as antineoplastic drugs and exert their effect by blocking the cell cycle. Topical and intralesional formulations are available and have been studied in both non-neoplastic and cancerous lesions. However, data comparing the effect of bleomycin and 5-FU in the dermatological disorders are limited. This review outlines the action mechanisms of both drugs and compares their clinical efficacies in a wide range of dermatologic diseases including hypertrophic scar, wart, skin cancer, vascular malformation, hemangioma, and vitiligo, and discusses the overall safety of the drugs. Intralesional bleomycin treatment is effective in hypertrophic scars and warts, but intralesional 5-FU may also be considered since it is cheaper and less painful. Moreover, intralesional 5-FU and bleomycin injection is a viable option for premalignant lesions (i.e., actinic keratosis) and inoperable skin cancers. Both bleomycin and 5-FU have been applied as treatment adjuncts for vitiligo, with 5-FU showing a slightly better outcome. Both agents have a good safety profile, and no serious side effects have been reported following their use in the field of dermatology.
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Affiliation(s)
| | | | | | | | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (S.K.); (Y.R.W.); (S.H.C.); (J.D.L.)
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3
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Sepaskhah M, Sarani MB, Bagheri Z. Comparison of the Efficacy of Intralesional 5-Fluorouracil/Lidocaine/Epinephrine Injection with Cryotherapy to Treat Common and Palmoplantar warts: a Randomized, Controlled Trial. Dermatol Ther 2022; 35:e15726. [PMID: 35864578 DOI: 10.1111/dth.15726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Cutaneous warts are treated by different treatments with various efficacy. Intralesional injection of 5-fluorouracil (IL 5-FU) has been compared with placebo and a few other wart treatments. Our objective was to compare the efficacy of IL 5-FU injection with cryotherapy to treat common and palmoplantar warts. Forty-five patients with common and palmoplantar warts were treated with either IL 5-FU admixed with lidocaine and epinephrine (5-FU+LE) or cryotherapy, once weekly for six sessions. The patients were assessed for clinical response score, the thickness of warts, pain score, and quality of life in treatment sessions, two weeks and eight weeks after the last session. Nine patients (64.3%) in the 5-FU+LE group, and 5 patients (35.7%) in cryotherapy group experienced complete response (p=0.285). Both treatments caused improvement of clinical response score in the patients during the treatment time (p<0.001), but the efficacy of treatments was not significantly different (p=0.793). Changes in wart thickness were significantly more marked in the 5-FU+LE group compared to the cryotherapy group (p=0.021). The patients in the cryotherapy group experienced more severe pain compared to the 5-FU+LE group (p=0.011). The quality of life better improved in the 5-FU+LE group compared to the cryotherapy group (p = 0.02). To conclude, most of the patients that experienced complete clinical response had received 5-FU+LE injection, though the difference was not significant. However, 5-FU+LE injection accompanied less pain and caused more reduction in wart thickness and more improvement in quality of life compared to the cryotherapy.
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Affiliation(s)
- Mozhdeh Sepaskhah
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Bazyar Sarani
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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4
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5-Fluorouracil in Dermatology: The Diverse Uses Beyond Malignant and Premalignant Skin Disease. Dermatol Surg 2021; 47:e66-e70. [PMID: 33587385 DOI: 10.1097/dss.0000000000002879] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND 5-fluorouracil (5-FU) is widely used for treatment of malignant and premalignant skin cancers; however, its use in other common cutaneous conditions has been less widely reported. OBJECTIVE We investigated the off-label uses of 5-FU beyond malignant and premalignant skin disease. METHODS We conducted a literature review searching multiple databases to evaluate the evidence for the off-label uses of 5-FU. The level of evidence was evaluated and selected accordingly listing the studies with the highest level of evidence first using the Oxford Centre of Evidence-Based Medicine 2011 guidance. RESULTS We found underlying evidence to support the use of 5-FU for a wide range of noncancerous cutaneous indications including scarring (keloid, hypertrophic), pigmentary disorders (vitiligo, idiopathic guttate hypomelanosis), cutaneous infections (viral warts, molluscum contagiosum), inflammatory dermatoses (Darier's disease, Hailey-Hailey disease and sarcoidosis), and cosmetic indications (photoaging, treatment of filler nodules and granulomas). CONCLUSION In selected patients, 5-FU can be as effective as more established treatments, with fewer side-effects.
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5
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Ghonemy S, Ibrahim Ali M, Ebrahim HM. The efficacy of microneedling alone vs its combination with 5-fluorouracil solution vs 5-fluorouracil intralesional injection in the treatment of plantar warts. Dermatol Ther 2020; 33:e14179. [PMID: 32785986 DOI: 10.1111/dth.14179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 01/19/2023]
Abstract
Intralesional 5-fluorouracil (IL5-FU) has been used off-label for warts treatment; however, its use was limited by intense pain. Combination treatment can offer a robust therapeutic effect. Was to assess the therapeutic efficacy, safety and tolerability of microneedling vs its combination with 5-FU solution vs IL5-FU in the treatment of plantar warts. Ninety patients with plantar warts were divided randomly into three groups each containing 30 patients. Group A received (intralesional 5-FU), group B (microneedling) while group C (microneedling and 5-FU solution). All groups received treatment for a maximum of six sessions 2 weeks apart. Complete response was observed in 86.7% of the warts treated with 5-FU and microneedling (group C) vs to 76.7% and 70% in group A and B, respectively, with no statistically significant difference (P = .36). A significant increase in the number of sessions (P = .01) and pain score (P = .001) were found among group A compared to groups B and C. Patient's satisfaction was higher in group C (P = .05). No recurrence was reported in all groups. Microneedling can be used as alternative or adjuvant therapeutic modality for plantar warts treatment and significantly associated with less pain. Combination group was superior compared to the others.
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Affiliation(s)
- Soheir Ghonemy
- Faculty of Medicine, Department of Dermatology, Zagazig University, Zagazig, Egypt
| | - Mahitab Ibrahim Ali
- Faculty of Medicine, Department of Dermatology, Zagazig University, Zagazig, Egypt
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6
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Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenital cutaneous warts - clinical presentation, diagnosis and treatment. J Dtsch Dermatol Ges 2020; 17:613-634. [PMID: 31241843 DOI: 10.1111/ddg.13878] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/28/2019] [Indexed: 11/28/2022]
Abstract
Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self-limiting condition, a wait-and-see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps-measles-rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.
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Affiliation(s)
| | | | | | - Tilo Biedermann
- Department of Dermatology and Allergology, Munich Technical University, Munich, Germany
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7
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Hodeib AAE, Al-Sharkawy BG, Hegab DS, Talaat RAZ. A comparative study of intralesional injection of Candida albicans antigen, bleomycin and 5-fluorouracil for treatment of plane warts. J DERMATOL TREAT 2019; 32:663-668. [DOI: 10.1080/09546634.2019.1688236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Doaa Salah Hegab
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Raghda Ahmed Zaki Talaat
- Medical Microbiology and Immunology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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8
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Xiao ZP, Liu QP, Xie HF, Li J, Chen ML, Jian D. Risk factors for cutaneous warts and the influence factors of curative effect of 5-flurouracil therapy in southern China. J DERMATOL TREAT 2019; 32:350-354. [PMID: 31403355 DOI: 10.1080/09546634.2019.1654073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND To systematically explore the risk factors of cutaneous warts and influence factor for the effectiveness of 5-fluorouracil (5-FU). METHODS This is a case-control study of 408 cutaneous warts patients and 408 controls of Chinese Han population in southern China. In addition, 244 patients who presented with an initial episode of warts without treatment were treated with intralesional 5-FU. The influence factors of 5-FU therapeutic effects were analyzed. RESULTS After adjustment, we found age (≤14 years old), lower education attainment, alcohol intake, smoking, less daily sleeping hours, severe psychological stress, hyperhidrosis, living in house or apartment, having cutaneous warts roommates, and sharing personal items with other persons to be risk factors for warts. Importantly, physical fitness played a protective role against warts. Two hundred and twenty-seven patients in 244 (93.03%) were successfully treated with 5-FU. Multivariate analysis indicated that smoking, alcohol intake, severe psychological stress, more than six months' duration of cutaneous warts, lesions on foot and warts diameter ≥5 mm adversely affected the effectiveness of 5-FU. CONCLUSIONS The newly identified risk factors for cutaneous warts and influence factors for efficacy of 5-FU provided clues for warts prevention and treatment of Chinese Han population.
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Affiliation(s)
- Zhi P Xiao
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China.,Bao'an People's Hospital of Bao'an District Shenzhen, Shenzhen, China
| | - Que P Liu
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China
| | - Hong F Xie
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China
| | - Ming L Chen
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China
| | - Dan Jian
- Department of Dermatology, Xiang-Ya Hospital, Central South University, Changsha, China
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9
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Abeck D, Tetsch L, Lüftl M, Biedermann T. Extragenitale kutane Warzen – Klinik, Diagnose und Therapie. J Dtsch Dermatol Ges 2019; 17:613-636. [DOI: 10.1111/ddg.13878_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 05/28/2019] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | - Tilo Biedermann
- Klinik und Poliklinik für Dermatologie und Allergologie der Technischen Universität München
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10
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Zhao Y, Chen W, Zhu W, Li J, Su J, Zhao S, Chen M, Zhang J, Guo A, Yan S, Zhou X, Kuang X, Liu Z, Luo D, Knepper TC, He Y, Chen X. Tandem repeats of TSER significantly influence the efficacy of 5-fluorouracil in the treatment of plantar warts. Per Med 2016; 13:233-240. [PMID: 29767611 DOI: 10.2217/pme-2015-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIM To identify potential genetic risk markers associated with 5-fluorouracil (5-FU) treatment outcomes in plantar warts patients. METHODS In this study, 126 plantar warts patients were treated with an intralesional mixture of 5-FU, lidocaine and epinephrine. Treatment outcomes were compared with DNA mutation analysis. RESULTS More patients with TSER 3R/3R genotype failed 5-FU treatment than TSER 2R/3R+2R/2R (72.1 vs 43.8%; odds ratio: 3.32; 95% CI: 1.26-8.72; p = 0.013). In addition, the regression modeling identified patient age and TSER 3R allele as covariates of the risk of 5-FU treatment failure (p = 0.025). CONCLUSION TSER 3R/3R of TYMS gene was found to be the major risk of treatment failure. This genetic marker provides a potential treatment stratification target to modulate 5-FU treatment in plantar wart patients.
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Affiliation(s)
- Yue Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Department of Dermatology, Heping Hospital, Changzhi Medical College, Changzhi, Shanxi, China
| | - Wangqing Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Wu Zhu
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jie Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Juan Su
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Shuang Zhao
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mingliang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Jianglin Zhang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Aiyuan Guo
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Siyu Yan
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingchen Zhou
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinwei Kuang
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhaoqian Liu
- Institute of Clinical Pharmacology, Xiangya Hospital, Central South University Changsha, Hunan, China
| | - Dan Luo
- Department of Social Medicine & Health Management, Public Health School, Central South University, Changsha, Hunan, China
| | - Todd C Knepper
- Moffitt Cancer Center, DeBartolo Family Personalized Medicine Institute, Tampa, FL, USA
| | - Yijing He
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Moffitt Cancer Center, DeBartolo Family Personalized Medicine Institute, Tampa, FL, USA
| | - Xiang Chen
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Hunan Key Laboratory of Skin Cancer & Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan, China
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11
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Aktaş H, Ergin C, Demir B, Ekiz Ö. Intralesional Vitamin D Injection May Be an Effective Treatment Option for Warts. J Cutan Med Surg 2015; 20:118-22. [DOI: 10.1177/1203475415602841] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Plantar warts are typically resistant to treatment. In recent years, treatments have included administration of intralesional tuberculin; measles, mumps, rubella vaccine; and Candida albicans antigen immunotherapy. To the best of our knowledge, there are no reports of intralesional vitamin D administration for the treatment of warts. Aim: To evaluate the efficacy and safety of intralesional vitamin D treatment for plantar warts. Methods: Twenty patients with single or multiple plantar warts were included in this study. Vitamin D3 (0.2 mL, 7.5 mg/mL) was injected into the base of the warts after prilocaine (0.1 mL, 20 mg/mL) injection. A maximum of 5 warts were treated in 1 session, with at maximum 2 injections performed at 4-week intervals. Results: In total, 16 of 20 patients (80%) showed complete resolution of warts, and 1 patient showed partial resolution. Three patients failed to show any response. No recurrence or serious adverse effects were observed. Conclusion: Intralesional vitamin D3 may be an effective treatment option for warts.
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Affiliation(s)
- Habibullah Aktaş
- Department of Dermatology, Education and Research Hospital, Karabük University, Karabük, Turkey
| | - Can Ergin
- Department of Dermatology, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Betül Demir
- Department of Dermatology, Fırat University Hospital, Elazığ, Turkey
| | - Özlem Ekiz
- Department of Dermatology, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
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12
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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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13
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Mahajan BB, Singla M. Evaluation of intralesional 5% 5-fluorouracil in resistant localized plaque psoriasis. Indian Dermatol Online J 2014; 5:287-90. [PMID: 25165645 PMCID: PMC4144213 DOI: 10.4103/2229-5178.137779] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Psoriasis is a chronic, autoimmune, inflammatory papulosquamous disorder, the treatment of which remains challenging. A variety of therapeutic modalities have been used with varying degree of success. But, there is no such therapeutic modality till date that can prevent the relapse in psoriasis. Aims: The present study is being undertaken to evaluate the therapeutic efficacy of intralesional 5% 5-fluorouracil (5-FU) as well as its role in preventing relapse in resistant localized plaque psoriasis. Study Design: An open, prospective, randomized-controlled study. Materials and Methods: A total of 40 patients of resistant localized plaque psoriasis were enrolled for the study. Intralesional injection of 5% 5-FU was given in a dosage of 0.1 mL/cm2 of each plaque using an insulin syringe. In all patients, a single plaque was kept as control and was given intralesional injection of distilled water. A total of three injections were given in each plaque at weekly intervals. After that, patients were followed-up regularly at the interval of 2 weeks up to 12 weeks. All the lesions (both treated and control) were assessed clinically as well as photographically at each visit and graded using psoriasis severity index scoring. Results were analyzed statistically at the end of the follow-up period. Results: At 12 weeks follow-up, out of 40 patients treated, 4 (10%) patients had clearance (>90% resolution), 19 (47.5%) had excellent (70%-90%) improvement, whereas 12 (30%) patients were moderately (30%-70%) improved, and only 5 (12.5%) patients had mild or no improvement. Results were statistically significant in treated group in comparison to control group. Almost all patients complained of pain at the site of injection which subsided within 1-2 h. A total of 10 (25%) patients had necrosis after one or two injections which healed during the follow-up period within 6-8 weeks. Conclusion: Intralesional 5% 5-FU is found to be an effective therapeutic modality in resistant localized plaque psoriasis without much side effects.
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Affiliation(s)
- Bharat Bhushan Mahajan
- Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Monika Singla
- Department of Dermatology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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14
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Abstract
Warts are the most common nail tumor generally caused by human papilloma virus (HPV) 1, 2, 4, 27, and 57. HPV 16 and 18 are associated with malignant transformation to squamous cell carcinoma, while HPV 2 and 7 are associated with "butcher's warts." Current treatments range from topical and intralesional therapies to systemic agents and surgical procedures. Despite the numerous available possibilities for treatment, intralesional bleomycin appears to be the most effective treatment for periungual warts.
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Affiliation(s)
- Jordana Herschthal
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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15
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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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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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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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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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Théon AP, Wilson WD, Magdesian KG, Pusterla N, Snyder JR, Galuppo LD. Long-term outcome associated with intratumoral chemotherapy with cisplatin for cutaneous tumors in equidae: 573 cases (1995–2004). J Am Vet Med Assoc 2007; 230:1506-13. [PMID: 17504043 DOI: 10.2460/javma.230.10.1506] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine outcome associated with cutaneous tumors treated via intratumoral chemotherapy with cisplatin and identify risk factors affecting local tumor control and complications in equidae. DESIGN Retrospective case series. ANIMALS 573 equidae with 630 cutaneous tumors. PROCEDURES Medical records of horses, mules, donkeys, and ponies with cutaneous tumors treated via intratumoral chemotherapy with cisplatin were analyzed. RESULTS 549 horses, 13 mules, 8 donkeys, and 3 ponies with 630 histologically confirmed cutaneous tumors were included. Tumors included sarcoids (n = 409), squamous cell carcinomas (151), soft tissue sarcomas (28), cutaneous lymphomas (26), and melanomas (16). Overall cure rate, defined as local control at 4 years, was 93.3%. For all tumor stages combined, cure rates after 1 course of treatment were 96.3% for sarcoids, 96% for lymphomas, 88% for squamous cell carcinomas, 85% for soft tissue sarcomas, and 81% for melanomas. Treatment protocol, tumor stage, and prior treatment were significant prognostic factors for tumor control. Treatment efficacy was lower for large tumors, those with gross postoperative residual disease, and those that had been treated previously with other modalities. Treatment was well tolerated. Local reactions were more likely to occur and to be more severe after the third and fourth treatment sessions. CONCLUSIONS AND CLINICAL RELEVANCE Results confirmed the value of intratumoral chemotherapy with cisplatin for treatment of cutaneous tumors in equidae. The results cannot be extrapolated to other formulations of cisplatin or other protocols that might be used.
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Affiliation(s)
- Alain P Théon
- Department of Surgery, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
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Abstract
Patients and clinicians experience the frustration of cutaneous viral warts caused by infection with the human papilloma virus (HPV).Warts appear in various forms on different sites of the body and include common warts (verruca vulgaris), plane or flat warts, myrmecia, plantar warts, coalesced mosaic warts, filiform warts, periungual warts, anogenital warts (venereal or condyloma acuminata), oral warts and respiratory papillomas. Cervical infection with HPV is now known to cause cervical cancer if untreated. A review of the medical literature reveals a huge armamentarium of wart monotherapies and combination therapies. Official evidence-based guidelines exist for the treatment of warts, but very few of the reported treatments have been tested by rigorous blinded, randomized controlled trials.Therefore, official recommendations do not often include treatments with reportedly high success rates, but they should not be ignored when considering treatment options. It is the purpose of this review to provide a comprehensive overview of the wart treatment literature to expand awareness of the options available to practitioners faced with patients presenting with problematic warts.
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Affiliation(s)
- Michelle M Lipke
- MPAS, PA-C, Department of Dermatology, Marshfield Clinic-Wausau Center, Wausau, WI 54401, USA.
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Abstract
BACKGROUND Viral warts are common and usually harmless but very troublesome. A very wide range of local treatments are used. OBJECTIVES To assess the effects of different local treatments for cutaneous, non-genital warts in healthy people. SEARCH STRATEGY We searched the Cochrane Skin Group Specialised Register (March 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 1, 2005), MEDLINE (1966 to March 2005), EMBASE (1980 to March 2005) and a number of other biomedical databases. The references of all trials and selected review articles were also searched. In addition, we contacted pharmaceutical companies involved in local treatments for warts and experts in the field SELECTION CRITERIA Randomised controlled trials of local treatments for cutaneous non-genital viral warts in immunocompetent (healthy) people. DATA COLLECTION AND ANALYSIS Data was extracted and two authors independently selected the trials and assessed methodological quality. MAIN RESULTS Sixty trials were identified that fulfilled the criteria for inclusion. The evidence provided by these studies was generally weak due to poor methodology and reporting. In 21 trials with placebo groups that used participants as the unit of analysis, the average cure rate of placebo preparations was 27% (range 0 to 73%) after an average period of 15 weeks (range 4 to 24 weeks). The best available evidence was for simple topical treatments containing salicylic acid, which were clearly better than placebo. Data pooled from five placebo-controlled trials showed a cure rate of 117/160 (73%) compared with 78/162 (48%) in controls, which translates to a risk ratio of 1.60 (95% confidence interval 1.16 to 2.23), using a random effects model. Evidence for the absolute efficacy of cryotherapy was surprisingly lacking. Two trials comparing cryotherapy with salicylic acid and one comparing duct tape with cryotherapy showed no significant difference in efficacy. Evidence for the efficacy of the remaining treatments reviewed was limited. AUTHORS' CONCLUSIONS There is a considerable lack of evidence on which to base the rational use of topical treatments for common warts. The reviewed trials are highly variable in method and quality. Cure rates with placebo preparations are variable but nevertheless considerable. There is certainly evidence that simple topical treatments containing salicylic acid have a therapeutic effect. There is less evidence for the efficacy of cryotherapy, but reasonable evidence that it is only of equivalent efficacy to simpler and safer treatments. The benefits and risks of topical dinitrochlorobenzene and 5-fluorouracil, intralesional bleomycin and interferons, photodynamic therapy and other miscellaneous treatments remain to be determined.
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Affiliation(s)
- S Gibbs
- Ipswich Hospital NHS Trust, Department of Dermatology, Ipswich, UK IP4 5PD.
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