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Molla A, Tobaiqi M, Elbadawy H, Jannadi R, Eltahir H, Albadawi E, Alzaman N, Aloufi M, Abouzied M, Albadrani M. Comparative Analysis of Intralesional Immunotherapy and Conventional Treatments for Non-Genital Warts: A Systematic Review and Network Meta-Analysis. Dermatol Pract Concept 2024; 14:dpc.1403a215. [PMID: 39122495 PMCID: PMC11313703 DOI: 10.5826/dpc.1403a215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION Warts, benign skin growths caused by various human papillomavirus strains, are categorized as genital and non-genital. Non-genital warts often lack noticeable symptoms but can lead to psychological distress due to factors like embarrassment. Traditional treatments, including physical and chemical methods, show limitations, prompting the exploration of novel approaches like intralesional immunotherapy. The clinical challenge lies in selecting the most effective modality. OBJECTIVE In our study, we used the network meta-analysis (NMA) as a statistical tool to explore the most effective intralesional immunotherapy interventions. METHODS Comprehensive searches of Web of Science, PubMed, Cochrane, and Scopus databases were conducted until December 2023. Eligible studies were analyzed for outcomes presented as risk ratios (RRs) with 95% confidence intervals (CI). Treatments were ranked using the P-score in an NMA performed with R software. RESULTS We included 68 RCTs in our study. For complete response, needling showed a significant difference compared to Candida albicans antigen (RR= 0.13, 95% CI [0.02; 0.99]) and Mw (RR= 0.12, 95% CI [0.02; 0.94]). In overall response, both bleomycin and furosemide with digoxin were significant compared to autoimplantation (RR= 0.46, 95% CI [0.24; 0.88]) and (RR= 0.40, 95% CI [0.18; 0.91]) respectively. Similarly, both were significant compared to cryotherapy (RR= 0.45, 95% CI [0.27; 0.76]) and (RR= 0.40, 95% CI [0.19; 0.82]) respectively. CONCLUSION This NMA indicates needling, furosemide with digoxin, and PBP antigen stimulants as effective for non-genital warts, surpassing traditional treatments in complete and overall response. Direct comparisons in future research are warranted to confirm their superiority.
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Affiliation(s)
- Amr Molla
- Department of Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Muhammad Tobaiqi
- Department of Family and Community Medicine and Medical Education, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Hossein Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Raed Jannadi
- Department of Family and Community Medicine and Medical Education, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Heba Eltahir
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Emad Albadawi
- Department of Basic Medical Sciences, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Naweed Alzaman
- Department of Medicine, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Mohammed Aloufi
- Madinah Health Cluster, Al-Madinah Al-Munawara, Saudi Arabia
| | - Mekky Abouzied
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
- Department of Biochemistry, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Muayad Albadrani
- Department of Family and Community Medicine and Medical Education, College of Medicine, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
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Pak YK, Shin SW. Pediatric Finger Warts Treated Using Taeeumjowi-tang: a case report. J Pharmacopuncture 2024; 27:172-176. [PMID: 38948305 PMCID: PMC11194524 DOI: 10.3831/kpi.2024.27.2.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/13/2024] [Accepted: 04/08/2024] [Indexed: 07/02/2024] Open
Abstract
Warts caused by the human papillomavirus (HPV) are generally treated with cryotherapy, CO2 laser ablation, interferon injections, and bleomycin injections. However, it is sometimes difficult to treat children because the treatment can be painful. In addition, recurrence may occur after treatment. In this study, warts completely disappeared following the administration of herbal medicine in two children, with warts in multiple parts of the hands and around the nails. Two pediatric patients visited the hospital for treatment of warts around their fingers and nails. Both patients received Taeeumjowi-tang (TJT) as a decoction for 60 days. TJT was performed twice per day for the 11-year-old patient and once per day for the 7-year-old patient. Patient progress was observed monthly, and the visual condition of the warts was photographed during the visits. After approximately two months of treatment, the warts disappeared from the fingers and nails of both patients. This case study suggests that the oral administration of TJT may be effective for pediatric patients with warts. Further studies are required to determine the efficacy and safety of these therapies.
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Affiliation(s)
- Yeon-kyoung Pak
- Kyunghee Yeonkyoung Korean Medicine Clinic, Yangsan, Republic of Korea
| | - Sang-won Shin
- Department of Humanities and Social Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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Aryal E, Bhari J, Shrestha PR. Immunotherapy with Intralesional Vit D injection in Recalcitrant wart at a Tertiary Care Center: A Descriptive Cross sectional Study. JNMA J Nepal Med Assoc 2024; 62:378-381. [PMID: 39356863 PMCID: PMC11185302 DOI: 10.31729/jnma.8614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Indexed: 10/04/2024] Open
Abstract
INTRODUCTION Recalcirant warts are resistant to conventional therapeutic option with high recurrence rate. In recent year, treatment of warts with different immunotherapeutic agent has shown good results, as it regulate epidermal cell proliferation and are involved in the formation of anti microbial peptides. Hence, this study was undertaken to evaluate the efficacy of immunotherapy with intralesional vitamin D in wart. METHODS A descriptive cross-sectional study was conducted from 1 January 2021 to 2 February 2023 at Kathmandu Medical College after approval from the Institutional Review Committee (Reference number: 0110202002). Ninety - two patients with recalcitrant wart of varying sizes and duration were included in the study. Injection vitamin D ( 600000 IU, 15mg/ ml) was injected about (0.2-0.5 ml) to the base of the wart. Maximum of five warts were injected per month, and was repeated after 4 weeks for 3 sessions. RESULTS Among 92 patient, complete response was seen in 70 patient (76.08%), partial response was seen in 17 patients ( 18.47%) and 5 patient(5.43%)showed no response. Mild pain as observed at the time of injection. Signs of hypervitaminosis D was not observed. CONCLUSIONS Intralesional administration of Vitamin D is an effective treatment option for reclacitrant warts and is, highly effective, cost-efficient, with minimal adverse effects, and can be perfomed in our clinical set up.
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Affiliation(s)
- Eliz Aryal
- Department of Dermatology, kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - Jyoti Bhari
- Department of Dermatology, kathmandu Medical College, Sinamangal, Kathmandu, Nepal
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Zayan H, Hosny AH, Mamdouh MM, Tawfik YM. Efficacy of Intralesional Candida Antigen Versus Measles, Mumps, and Rubella Vaccine Versus Topical Podophyllin in Treatment of Resistant Genital Warts. J Cutan Med Surg 2024; 28:253-258. [PMID: 38497287 DOI: 10.1177/12034754241238012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND No single treatment is ideal for genital warts with high rate of resistance using conventional modalities as topical podophyllin; however, several intralesional immunotherapies are being tested nowadays, with variable results. In this study, we compared the safety and efficacy of treating resistant and recurrent genital warts by 2 intralesional immunotherapies [Candida antigen and measles, mumps, and rubella (MMR) vaccine] and compared them with topical podophyllin. PATIENTS/METHODS A total of 45 patients with resistant or recurrent genital warts were enrolled in this study. Size and number of warts were detected in each patient, patients were divided into 3 groups. Group A injected with intralesional Candida antigen. Group B with intralesional MMR vaccine. Group C were treated with topical 25% podophyllin. Patients received a session every 2 weeks for 3 treatment sessions. RESULTS With regard to the reduction in size and number of all warts, the best response was obtained in Candida antigen group where 46.7% showed complete clearance and 40% showed partial response followed by MMR group and the last was the podophyllin group, with no significant difference between them. Complete clearance of mother warts was noticed in 86.7% of Candida group, 53.3% in MMR group, and last 40% in podophyllin group, with a significantly better response in the Candida group (P = .027). CONCLUSION Both intralesional Candida antigen and MMR vaccine are simple, safe, and effective treatment options with comparable results and better response than topical podophyllin.
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Affiliation(s)
- Hisham Zayan
- Departments of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed H Hosny
- Department of Andrology and Venereology, Faculty of Medicine, Helwan University, Helwan, Egypt
| | | | - Yasmin M Tawfik
- Departments of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
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Mullen SA, Myers EL, Brenner RL, Nguyen KT, Harper TA, Welsh D, Keffer S, Mueller J, Whitley MJ. Systematic Review of Intralesional Therapies for Cutaneous Warts. JID INNOVATIONS 2024; 4:100264. [PMID: 38585192 PMCID: PMC10990969 DOI: 10.1016/j.xjidi.2024.100264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/12/2023] [Accepted: 01/05/2024] [Indexed: 04/09/2024] Open
Abstract
Intralesional therapies are used for recalcitrant warts, but no Food and Drug Administration-approved treatment exists nor is there consensus regarding the most efficacious therapy. Therefore, this systematic review aims to summarize efficacy and adverse events reported in 62 randomized controlled trials (RCTs) of intralesional therapies for cutaneous warts. The most studied intralesional therapies included measles, mumps, rubella (MMR) vaccine (n = 24 studies), purified protein derivative (PPD) (n = 19 studies), vitamin D3 (n = 15 studies), and Candida antigen (n = 14 studies). Most studies included adult and pediatric patients or adults alone, with only 4 studies on pediatric patients alone. MMR vaccine was the most studied treatment (n = 853 patients). MMR had a complete response rate of 27-90%. The next most common treatment, PPD, had a complete response rate of 45-87%. Other treatments included Candida antigen and vitamin D3, with complete response rates of 25-84% and 40-96%, respectively. The most frequent side effects were injection-site reactions and flu-like symptoms. This systematic review represents a useful summary of intralesional therapy RCTs for clinician reference. This study also highlights the lack of large multi-institutional RCTs, despite many patients being treated for this widespread problem.
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Affiliation(s)
- Sarah A. Mullen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emma L. Myers
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Rebecca L. Brenner
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kim T. Nguyen
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tara A. Harper
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Darby Welsh
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Storm Keffer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jenna Mueller
- Fischell Department of Bioengineering, University of Maryland, College Park, Maryland, USA
| | - Melodi Javid Whitley
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina, USA
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Chaudhary M, Brar A, Agarwal P, Chavda V, Jagati A, Rathod SP. A Study of Comparison and Evaluation of Various Intralesional Therapies in Cutaneous Warts. Indian Dermatol Online J 2023; 14:487-492. [PMID: 37521234 PMCID: PMC10373804 DOI: 10.4103/idoj.idoj_492_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/15/2023] [Accepted: 03/12/2023] [Indexed: 08/01/2023] Open
Abstract
Background The study compares the efficacy of four immunotherapeutic agents, measles mumps and rubella (MMR), purified protein derivative (PPD), Candida extract, and vitamin D3, in the treatment of multiple cutaneous warts. Aim and Objectives To observe the clinical responses and safety of different intralesional immunotherapeutic agents and compare their efficacy. Materials and Methods Hundred patients with multiple (>5) cutaneous warts were enrolled in the study and randomized into four groups: Group A: MMR, Group B: PPD, Group C: Candida extract, and Group D: Vitamin D. Target wart was selected, and the intralesional injections were given at three weekly intervals for a maximum of three doses. Response was observed in target and distant warts three months after the last injection. Results Intralesional vitamin D3 had the highest efficacy, while MMR had the lowest efficacy in clearance of target wart. Intralesional Candida extract had the highest efficacy, while vitamin D3 had the lowest efficacy in clearance of distant warts. Intralesional Candida extract was the most effective treatment for both local and distant warts. Side effects were minimal and transitory in nature. Conclusion Intralesional immunotherapy is a safe, affordable, and efficacious treatment for warts.
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Affiliation(s)
- Malay Chaudhary
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Arwinder Brar
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Pooja Agarwal
- Department of Dermatology, S.V.P. Hospital, Near Ellis-Bridge, Paladi, Ahmedabad, Gujarat, India
| | - Vruti Chavda
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Ashish Jagati
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
| | - Santoshdev P. Rathod
- Department of Dermatology, Smt. Shardaben General Hospital, Saraspur, Gujarat, India
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Herzum A, Ciccarese G, Occella C, Gariazzo L, Pastorino C, Trave I, Viglizzo G. Treatment of Pediatric Anogenital Warts in the Era of HPV-Vaccine: A Literature Review. J Clin Med 2023; 12:4230. [PMID: 37445264 DOI: 10.3390/jcm12134230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 05/28/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Anogenital warts (AWs) represent a therapeutic challenge, especially in infants, due to sensitive skin and frequent disease recurrence. Though the initial wait-and-see approach is often adopted in asymptomatic immunocompetent children, with spontaneous clearing in almost 90% of cases within two years, persistent or symptomatic lesions can be reasonably treated. However, few studies have been conducted on children. Consequently, most treatments on patients under age 12 are not approved by the Food and Drug Administration. Herein, we review possible therapies for pediatric use in AW and report an illustrative case of a two-year-old boy with atopic skin and symptomatic, persistent AWs who was successfully treated with topical podophyllotoxin, without adverse effects or recurrence. Among available therapies for AWs, topical therapies, such as immunomodulating-agents (topical imiquimod 5% and 3.75% cream, sinecatechins 15% ointment) and cytotoxic agents (podophyllotoxin and cidofovir) are considered manageable in children because of their low aggressiveness. In particular, podofillotoxin gel 5% and imiquimod 5% cream have been reported to be safe and efficacious in children. Currently, HPV vaccination is not recommended as a treatment for established HPV infection and AWs, yet a possible therapeutic role of HPV vaccination was recently suggested in the literature and deserves mention.
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Affiliation(s)
- Astrid Herzum
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Giulia Ciccarese
- Dermatology Unit, Department of Medical and Surgical Sciences, University of Foggia and Ospedali Riuniti, Viale Luigi Pinto, 71122 Foggia, Italy
| | - Corrado Occella
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Lodovica Gariazzo
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Carlotta Pastorino
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
| | - Ilaria Trave
- Department of Dermatology, DISSAL, University of Genova, 16132 Genova, Italy
| | - Gianmaria Viglizzo
- Dermatology Unit, U.O.C. Dermatologia e Centro Angiomi, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147 Genova, Italy
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Lawson ML, Szari SM, Beachkofsky TM, Hrncir DE. Heterologous effect of influenza vaccination on molluscum contagiosum infection; a case report of siblings. BMC Pediatr 2023; 23:208. [PMID: 37127556 PMCID: PMC10150547 DOI: 10.1186/s12887-023-04019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND Molluscum contagiosum virus (MCV) is a benign, common cutaneous infection predominantly affecting the younger pediatric population. Traditional treatments may be time consuming with variable efficacy. Time to spontaneous resolution is variable and treatment is often sought to shorten duration of infection, prevent further autoinoculation, prevent infectious spread to others and treat cosmetic intolerability. CASE PRESENTATION We present the case of two patients with complete, simultaneous clearance of their molluscum contagiosum infections after receiving a routine 2018 quadrivalent influenza vaccination. Neither patient has had recurrence of molluscum contagiosum or permanent scarring. We review trials of intralesional immunotherapy in treatment of cutaneous infections to theorize the mechanism of MCV infection clearance post influenza vaccination. CONCLUSION We propose a delayed-type hypersensitivity reaction was induced as a heterologous effect of the influenza vaccination, similar to that seen in current immunotherapy treatments. This is the first reported case of MCV-directed immune reaction with infection clearance after influenza vaccination.
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Affiliation(s)
- Michelle L Lawson
- Division of Adolescent Medicine, Department of Pediatrics, San Antonio Uniformed Services Health Education Consortium (SAUSHEC), 3100 Schofield Road Fort Sam Houston, TX, 78234, San Antonio, US.
| | - Sofia M Szari
- Department of Allergy and Immunology, SAUSHEC, San Antonio, TX, US
| | | | - David E Hrncir
- Defense Health Agency Public Health, Immunization Healthcare Division, San Antonio, TX, US
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Topical Calcipotriol for the Treatment of Cutaneous Warts: An Assessor-Blind Randomized Placebo-Controlled Trial. Dermatol Ther 2023. [DOI: 10.1155/2023/3427026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Background. Cutaneous warts are common epidermal proliferations caused by human papillomavirus (HPV). We aimed to determine the safety and efficacy of topical calcipotriol for the treatment of cutaneous warts. Methods. This assessor-blind randomized placebo-controlled trial included 56 patients with cutaneous warts referred to a dermatology clinic from January 21 to March 20, 2020. Patients were randomized into two groups (n = 28). One group received calcipotriol 0.05% ointment twice a day on the lesions with a uniform thickness of 1 mm, and the other group received a placebo. The duration of treatment was twomonths, which continued for another two months if resolution did not occur. The primary outcome was complete response to treatment evaluated four months after the initiation of therapy. Secondary outcomes were the number and size of warts assessed at 1, 2, and 4 months and adverse events, including erythema, pruritus, burning sensation, and scaling. Results. Patients in both groups were comparable regarding previous treatment, underlying disease, and disease duration. However, patients in the control group were older. Also, a higher proportion of patients in the calcipotriol group were male and had warts on their palms and toes. Moreover, a higher percentage of controls had moderate disease. The mean number and the size of lesions did not differ between groups before intervention; however, both were significantly lower in the calcipotriol group than in controls at 1st, 2nd, and 4th months. In addition, complete response to treatment was significantly higher in the calcipotriol group (85.7% vs. 16%;
). On the other hand, the frequency of adverse events was not different between groups (
). Conclusions. Calcipotriol can be considered a safe and effective treatment option for cutaneous warts. Trial Registration: This trial is registered with IRCT20170818035762N2, available at https://www.irct.ir/trial/45716.
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Lahoria U, Singh S, Bhardwaj A, Budania A, Chhajed N, Rajagopal SV, Singh S. A prospective randomized controlled study of Mycobacterium Indicus Pranii vaccine, Measles Mumps Rubella vaccine and Vitamin D3 in extragenital cutaneous warts. J Cosmet Dermatol 2023; 22:1400-1409. [PMID: 36762385 DOI: 10.1111/jocd.15564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 02/11/2023]
Abstract
DESIGN Interventional, prospective, four arm randomized control. SETTING Outpatient department, Department of Dermatology, Venereology and Leprology, AIIMS Jodhpur (Rajasthan), India. PARTICIPANTS Two hundred patients. METHODS The intervention administered in the groups were normal saline (A), vitamin D3 (B), MIP (C), and MMR (D). The injections were given into the largest wart at 2-weekly intervals until complete clearance or for a maximum of seven sittings. Post-treatment clearance of the injected wart and the distant wart was compared on the basis of change in wart number, percentage clearance, and mean time to complete clearance. Side effects were recorded. RESULTS A total of 197 patients were recruited. The mean percentage improvement in the injected and non-injected warts was 68.4% and 66.8%, respectively. Intention to treat analysis (ITT) showed that complete clearance of lesions in injected wart occurred in placebo, vit D3 , MMR, and MIP arms in 64%, 66%, 58%, and 55% patients, respectively (p > 0.05), while in the non-injected warts in 62%, 64%, 52%, and 53%, respectively (p > 0.05). The mean time to achieve complete clearance of wart was fastest in MIP at 7.1 weeks followed by MMR at 7.2 weeks, VIT D3 at 7.4 weeks and in placebo group 7.8 weeks (p > 0.05). Side effects noted were fever, pain, erythema, and swelling which was highest in VIT D3 group (p < 0.05). CONCLUSION The efficacy of immunotherapies was comparable to placebo with minimal side effects.
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Affiliation(s)
- Utkrist Lahoria
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Saurabh Singh
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Abhishek Bhardwaj
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Anil Budania
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | - Neelam Chhajed
- Department of Dermatology, All India Institute of Medical Sciences, Jodhpur, India
| | | | - Surjit Singh
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
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Muacevic A, Adler JR, Marfatia Y. Efficacy of Intralesional Measles Mumps Rubella Vaccine in the Treatment of Verruca Vulgaris: An Interventional Study. Cureus 2023; 15:e34338. [PMID: 36865954 PMCID: PMC9973536 DOI: 10.7759/cureus.34338] [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] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
Background A wart is a mucocutaneous illness caused by the growth of HPV-infected skin or mucosal cells. Intralesional immunotherapy makes use of the immune system's ability to identify injected antigens, which might cause a delayed-type hypersensitivity reaction not just to the antigen but also to the wart virus. This, in turn, improves the immune system's ability to identify and eliminate HPV not just at the treated wart but also at distant places, as well as prevent recurrences. Aims and objectives To study the efficacy of the intralesional measles, mumps, and rubella (MMR) vaccine in verruca vulgaris and its side effects. Materials and methods Interventional research with a 94-case sample size was conducted over a period of seven months. A volume of 0.3 ml of the MMR vaccination was reconstituted with sterile water and injected into the largest wart at three-week intervals until complete clearance or for a maximum of three treatments. Following a six-month observation period, patients were evaluated to look for recurrence, and the degree of response was categorized as total, partial, or none at all. Results The youngest case included in the study was of age 10 years and the eldest case was of 45 years. The mean age was 28.22± 10.98. Of 94 patients, 83 (88.3%) were men and 11 (11.7%) were women. Complete remission was reported in 38 (40.42%) cases, a partial response in 46 (48.94%) cases, and no response in 10 (10.63%) cases. All 38 patients who showed complete clearance had a duration of warts in six months or less. The pain was a universal complaint (100%) after each visit followed by bleeding at 25.53%. Flu-like symptoms were noted in three cases after the first dose and two cases after the second dose, while urticaria was seen in one case during all visits. Cervical lymphadenopathy was observed in two cases after the first dose. Erythema multiforme minor was seen only in one patient after the first dose. Conclusion Intra-lesional MMR vaccine therapy proved to be a simple and safe treatment option in cases having multiple warts. The response rate may increase if a higher concentration of vaccine (0.5ml) and additional doses (maximum of five doses) are given.
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Youssef EMK, Eissa MAA, Bakr RM. Intralesional Candida albicans antigen versus intralesional zinc sulfate in treatment of cutaneous warts. Arch Dermatol Res 2022; 315:1305-1314. [PMID: 36567351 DOI: 10.1007/s00403-022-02499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Immunotherapy represents a promising therapeutic option for treatment of warts. Different concentrations of Candida antigen (1/100 and 1/1000) and zinc sulfate 2% were not previously compared regarding their efficacy in treatment of cutaneous warts. The present study compared the safety and efficacy of intralesional candida antigen versus intralesional 2% zinc sulfate for treatment of cutaneous warts. This prospective controlled clinical trial included one hundred and five patients presented with common, plantar, and plane warts. Patients were divided randomly into three groups, each group included 35 patients. Group 1 were treated with intralesional candida antigen (Ag) 1/100, Group 2 were treated with intralesional candida Ag 1/1000, and Group 3 were treated with intralesional zinc sulfate 2%. This study found that target warts of group 1 displayed higher rate of complete clearance compared to group 2 and group 3 (94.3%, 77.1, 74.2%), respectively. The present study concluded that intralesional immunotherapy with Candida antigen was more effective than Intralesional 2% zinc sulfate in treatment of cutaneous warts and less painful. Clinical trial registration number is (Clinical Trials.gov Identifier: NCT03158168).
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Affiliation(s)
- Eman M Kamal Youssef
- Department of Dermatology, Faculty of Medicine, Assiut University, Asyût, Egypt.
| | | | - Radwa M Bakr
- Department of Dermatology, Faculty of Medicine, Assiut University, Asyût, Egypt
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Ju HJ, Park HR, Kim JY, Kim GM, Bae JM, Lee JH. Intralesional immunotherapy for non-genital warts: A systematic review and meta-analysis. Indian J Dermatol Venereol Leprol 2022; 88:724-737. [DOI: 10.25259/ijdvl_1369_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/01/2022] [Indexed: 12/30/2022]
Abstract
Background
Intralesional immunotherapy has been reported to be effective for warts and to show good safety profiles, but this has not yet been systematically studied.
Aims
To determine the efficacy and safety of intralesional immunotherapy for treating non-genital warts.
Methods
We comprehensively searched the MEDLINE, Embase, Web of Science and Cochrane Library databases from the times of their inception to January 3, 2020. The primary outcome was the rate of complete response of all lesions. The distant complete response rate of warts located in an anatomically different body part and the recurrence rate were also analyzed.
Results
A total of 54 prospective studies was ultimately included. The immunotherapeutic agents used were Mycobacterium w vaccine, measles, mumps and rubella vaccine, purified protein derivative, Candida antigen, interferon, bacillus Calmette-Guérin vaccine and others. The pooled rate of complete response among all patients with non-genital warts treated using intralesional immunotherapy was 60.6% (95% confidence interval 54.8–66.5%). The pooled recurrence rate was 2.0% (95% confidence interval, 1.1–2.9%). All reported adverse events were mild and transient.
Limitations
The heterogeneity among studies
Conclusion
Intralesional immunotherapy is suggested for use in patients with multiple warts, given its promising results, good safety profile and low recurrence rate.
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Eldahshan RM, Ashry WMO, Elsaie ML. Comparative study between intralesional injection of MMR, BCG, and candida albicans antigen in treatment of multiple recalcitrant warts. J Cosmet Dermatol 2022; 21:1120-1126. [PMID: 34998000 DOI: 10.1111/jocd.14737] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/20/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cutaneous warts represent a challenging condition to treat. OBJECTIVE To evaluate the safety and efficacy of intralesional injection of MMR (mumps, measles, and rubella) antigen, BCG (bacillus Calmette-Guerin) vaccine, and candida antigen for the treatment of multiple warts. METHODS A total of ninety (90) clinically confirmed adult patients complaining of recalcitrant extragenital warts of various sizes and durations were recruited in this randomized clinical trial. They were divided into three groups (A, B, and C). Each group consisted of (30) patients. Group (A) subjects received intralesional MMR injections. Group (B) subjects received intralesional BCG injection and Group (C) received intralesional candida antigen injection. RESULTS Full clearance of warts was observed in (73.33%, 70%, and 43.33%) in groups A, B, and C, respectively. Infrequent side effects including pain, erythema, and minimal induration were reported in all groups but did not necessitate termination of treatment. CONCLUSION All the three modalities used demonstrated a simple, safe modality with low adverse events, and with no recurrence. To achieve an optimal response with an ideal immunotherapeutic agent and ideal dose, further comparative studies are warranted and on different populations and larger sample sizes.
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Affiliation(s)
- Ramadan Mohamed Eldahshan
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Walaa Mohamed Omar Ashry
- Medical Microbiology and Immunology Department, Damietta Faculty of Medicine (Girls), Al-Azhar University, Damietta, Egypt
| | - Mohamed L Elsaie
- Department of Dermatology, Medical Research and Clinical Studies Institute- National Research Centre, Cairo, Egypt
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Ibrahim H, El Taieb M, Nada E, Kamal E, Hegazy E. Combined intralesional injection of tuberculin purified protein derivative (PPD) plus cryotherapy versus each alone in the treatment of multiple common warts. Dermatol Ther 2022; 35:e15350. [PMID: 35103366 DOI: 10.1111/dth.15350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Different modalities are used for treatment of common warts, but none of them had been proved to be the best in achieving complete cure. We aim to compare the effect of cryotherapy, intralesional injection of tuberculin PPD and cryotherapy combined with intralesional injection of tuberculin PPD in the treatment of multiple common warts. This study is a randomized clinical trial in which the patients were randomly divided into three groups; group (A) included 25 patients subjected to cryotherapy, group (B) included 25 patients subjected to intralesional injection of tuberculin PPD and group (C) included 25 patients subjected to cryotherapy plus intralesional injection of tuberculin PPD. All the three groups showed a significant clinical improvement (p < 0.001) with statistically significant difference between cryotherapy group (A) and intralesional injection of tuberculin PPD group (B) (p < 0.001) & between cryotherapy group (A) and cryotherapy plus intralesional injection of tuberculin PPD group (C) (p < 0.001). However, there was no statistically significant difference between both intralesional injection of tuberculin PPD group alone (B) and cryotherapy plus intralesional injection of tuberculin PPD group (C) (p = 0.213). In Conclusion the cryotherapy combined with intralesional injection of PPD and intralesional injection of PPD alone are better than cryotherapy alone in treatment of multiple common warts. However, better response could be reached in combination of both cryotherapy and intralesional PPD with fewer number of sessions.
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Affiliation(s)
- Hassan Ibrahim
- Venereology and Andrology, Qna Faculty of Medicine ,South Valley University, Egypt
| | - Moustafa El Taieb
- Venereology and Andrology, Aswan Faculty of Medicine, Aswan University
| | - Essam Nada
- Venereology and Andrology, Sohag Faculty of Medicine, Sohag University, Egypt
| | - Ebtehal Kamal
- Venereology and Andrology, Dermatology Clinic, Egypt
| | - Eisa Hegazy
- Venereology and Andrology, Qna Faculty of Medicine ,South Valley University, Egypt
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Mohta A, Kushwaha RK, Agrawal A, Sharma MK, Gautam U, Jain SK. Evaluation of the Efficacy of Intralesional Measles, Mumps, and Rubella Vaccine with Intralesional Vitamin D3 as Immunotherapies in the Treatment of Recalcitrant Cutaneous Warts in Adult- A Randomized Placebo-Controlled Study. Indian Dermatol Online J 2021; 12:879-887. [PMID: 34934726 PMCID: PMC8653728 DOI: 10.4103/idoj.idoj_573_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/19/2020] [Accepted: 08/31/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction: Currently, various destructive and ablative treatment options are conventionally used for warts, but all of them are limited in some form by their adverse effects, high recurrences, suboptimal effectiveness, and the need to treat every wart. Lately, immunotherapy has emerged as a safe treatment relying on biological substances that modulate the immune system to achieve disease control. Aims and Objectives: We aimed at conducting a placebo-controlled study to compare the rate of efficacy of intralesional MMR vaccine with vitamin D3 in the management of recalcitrant extragenital warts in immune-competent adults. Follow-up was done at third and sixth month. Materials and Methods: Patients were divided into three groups, namely, group A, B, and C. Groups A, B, and C received intralesional MMR vaccine, vitamin D3 and normal saline, respectively, in the largest wart. The injections were repeated every 2 weeks, for a maximum of four injections. Results: Among injected warts, in group A, complete clearance was seen in 29 (87.8%) patients, partial clearance in two (6.1%) and no response in two (6.1%) patients. In group B, 24 (77.4%) patients, five (16.1%) patients, and two (6.5%) patients showed signs of complete, partial, and no clearance, respectively, in injected warts. Complete response in distant warts was seen in 25 (75.7%) patients in group A and 20 (64.5%) patients in group B. There was no statistically significant difference between responses of the two groups. In group C, only three (12.5%) patients had complete clearance in injected warts, and none in distant warts. Recurrence was seen in two (6.4%) patients, each in group B and C. However, for management of verruca plana MMR was found to be superior to vitamin D3. Limitations: Our study was limited by a small sample size, absence of immunological analysis, and limited follow-up period. Conclusion: MMR vaccine and vitamin D3 are equally effective and safe treatment option for multiple, recalcitrant warts, as well as warts on difficult to treat sites with minimal recurrence.
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Affiliation(s)
- Alpana Mohta
- Department of Dermatology, Venereology and Leprology, Sardar Patel Medical College, Kota, Rajasthan, India
| | - Ramesh K Kushwaha
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Aditi Agrawal
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Manoj K Sharma
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Umesh Gautam
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
| | - Suresh K Jain
- Department of Dermatology, Venereology and Leprology, Government Medical College, Kota, Rajasthan, India
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Sakhiya J, Sakhiya D, Kaklotar J, Hirapara B, Purohit M, Bhalala K, Daruwala F, Dudhatra N. Intralesional Agents in Dermatology: Pros and Cons. J Cutan Aesthet Surg 2021; 14:285-295. [PMID: 34908770 PMCID: PMC8611707 DOI: 10.4103/jcas.jcas_109_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Since introduced in 1961, intralesional (IL) agent has become an essential part of the dermatological practice. The term IL referred to the direct delivery of agent percutaneously into skin lesions. This therapeutic approach is relatively safe, easy to perform and applicable for a broad range of dermatological conditions. On the other hand, immediate side effects, including pain during administration, bleeding, high risk of infection and allergic reaction, and subsequent side effects involving skin changes such as atrophy, telangiectasia, pigmentary changes, and striae are usually associated with this modality. This review paper highlights the pros and cons of IL agents in modern dermatology practice.
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Affiliation(s)
- Jagdish Sakhiya
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Dhruv Sakhiya
- B.J. Medical College, New Civil Hospital Asarwa, Ahmedabad, Gujarat, India
| | - Jitesh Kaklotar
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Bansi Hirapara
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Madhav Purohit
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Krishna Bhalala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Feral Daruwala
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
| | - Nimish Dudhatra
- Sakhiya Skin Clinic, 2nd Floor, Ayush Doctor House, Station-Lal Darwaja Road, Surat, Gujarat, India
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Płaszczyńska A, Sławińska M, Sobjanek M. Regression of common viral warts after ChAdOx1-S COVID-19 vaccine. J Eur Acad Dermatol Venereol 2021; 36:e162-e164. [PMID: 34699635 PMCID: PMC8657016 DOI: 10.1111/jdv.17771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/22/2021] [Indexed: 01/08/2023]
Affiliation(s)
- A Płaszczyńska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sławińska
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - M Sobjanek
- Department of Dermatology, Venereology and Allergology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Yaghoobi R, Soghrati M, Tavakoli S, Pazyar N, Abounoori M, Abounoori A, Houshmand G. Efficacy of viable BCG vaccine paste in the treatment of common warts: a double-blind randomized control trial. J DERMATOL TREAT 2021; 33:2198-2202. [PMID: 34060416 DOI: 10.1080/09546634.2021.1937482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Treatment of common warts may be painful or leaves scars, mainly using traditional destructive methods. This study aimed to evaluate the efficacy of the viable Bacillus Calmette-Guérin (BCG) vaccine in paste formula as an immunotherapeutic modality for common warts treatment. METHODS This double-blind and randomized, parallel-group, placebo-controlled trial was conducted at the Ahvaz Imam Hospital Dermatology Department from November 2014 to 2015. Overall 80 patients with common warts in two groups (case and control) received BCG vaccine paste once weekly for eight consecutive weeks. Follow-up was done every two weeks during treatment and six months after the treatment to evaluate recurrence in patients with complete resolution. RESULTS In group A, eight patients (20%) had a complete response, 15 patients (37.5%) partial response, four patients (10%) low response, and 13 patients (32.5%) no response (p < .001). All patients in group B had no response to treatment (p < .001). After six months of follow-up, no recurrence was seen. Duration of disease less than 12 months (p = .001) and the number of lesions less than three (p = .01) were determining factors of response to treatment. CONCLUSION Topical BCG vaccine paste was an effective treatment for common warts, without recurrence and significant complications.
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Affiliation(s)
- Reza Yaghoobi
- Dermatology Department, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Mehrnaz Soghrati
- Dermatology Department, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Sedighe Tavakoli
- Dermatology Department, Hormozgan University of Medical Science, Bandar Abbas, Iran
| | - Nader Pazyar
- Dermatology Department, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Mahdi Abounoori
- Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ali Abounoori
- Student Research Committee, Department of Laboratory Sciences, Faculty of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Gholamreza Houshmand
- Department of Pharmacology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Management of Difficult-to-Treat Warts: Traditional and New Approaches. Am J Clin Dermatol 2021; 22:379-394. [PMID: 33432476 DOI: 10.1007/s40257-020-00582-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/24/2022]
Abstract
Warts are regularly treated by dermatologists, and while many respond readily to first-line treatments, others may represent a therapeutic challenge. Large, deep, numerous, and extensive warts; treatment-resistant lesions with higher risk for side effects, such as hypopigmentation; or patients unable to tolerate or comply with our treatment regimen, may need alternative treatment options. In this work we review the characteristics of select modalities that should be considered for difficult-to-treat warts. We discuss efficacy and tolerability data as well as practical features that can guide us to select the best treatment for every scenario. Novel approaches, still in an investigational phase, are also discussed to illustrate potential future directions of wart treatment.
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Autoimplantation – An Immunological Treatment For Multiple Warts. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.2478/sjdv-2020-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Warts are benign epithelial lesions that involve skin and mucosa. Successful management depends on the patient’s immunity, site and type of wart. In spite of huge therapeutic armory available, no treatment has been found to be effective so far.
Objective. To evaluate the effectiveness of autoimplantation in the management of multiple warts.
Material and Methods. This is a hospital based prospective study of forty patients with multiple warts. A prospective, hospital-based study included forty cases of multiple warts for autoimplantation. Resolution of warts within three months was taken as complete clearance; the follow up of any recurrence lasted six months.
Results. The majority of patients were males (69.7%), belonging to 21–30 years age group (57.6%). Complete resolution was observed in 25 patients, partial response was achieved in 5 patients and there was no response in 3 patients. The majority of patients did not have any complication or recurrence
Conclusion. Autoimplantation is a simple, daycare, effective procedure. It provides resistance by inducing cell mediated immunity and also prevents recurrence to a great extent.
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Nofal A, El-Arab RE, Nasr M, Alakad R. Intralesional Measles, Mumps, and Rubella Vaccine Versus Intralesional Candida Antigen in the Treatment of Common and Plantar Warts. J Cutan Med Surg 2021; 25:377-383. [PMID: 33533654 DOI: 10.1177/1203475421991130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited. OBJECTIVE To evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts. METHODS Sixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. RESULTS The overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period. CONCLUSION Intralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.
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Affiliation(s)
- Ahmad Nofal
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt.,Interactive Dermatology Research Group, Interactive Dermatology Foundation, Cairo, Egypt
| | - Reda Ezz El-Arab
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
| | - Mohamed Nasr
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
| | - Rania Alakad
- 6879968865 Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt.,Interactive Dermatology Research Group, Interactive Dermatology Foundation, Cairo, Egypt
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Kadnur M, Jartarkar S, Mamatha P, Mishra S, Spoorthy B. A comparative study of therapeutic efficacy of intralesional measles, mumps, and rubella vaccine and intralesional Vitamin D3 in the treatment of recurrent warts. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2021. [DOI: 10.4103/jdds.jdds_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Poojary S, Bhalala K, Shah K. Comparative study of efficacy of intralesional purified protein derivative (PPD) versus intralesional measles, mumps, and rubella (MMR) vaccine in management of multiple viral warts. J Cutan Aesthet Surg 2021; 14:397-403. [PMID: 35283602 PMCID: PMC8906278 DOI: 10.4103/jcas.jcas_166_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaur A, Brar BK, Kumar S, Brar SK, Boparai AS, Puri N. A Randomized Comparative Study of MIP and MMR Vaccine for the Treatment of Cutaneous Warts. Indian J Dermatol 2021; 66:151-158. [PMID: 34188270 PMCID: PMC8208270 DOI: 10.4103/ijd.ijd_700_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Objectives To evaluate and compare the efficacy of MMR vaccine and MIP vaccine for resolution of Cutaneous warts (Cw). Methods The hospital-based prospective randomized interventional study was done where a total of 60 patients of Cw were divided into two groups of 30 patients each: Group A received 0.1 ml of intralesional injection of MIP vaccine and Group B received 0.5 ml of MMR vaccine. The treatment protocol involved three intralesional injection of vaccines at intervals of 3 weeks (maximum of three injections). The follow-up was done every 4 weeks for at least 24 weeks for the comparison of the two groups. The primary outcomes were the decrease in size of the wart or clearance of primary warts. The secondary outcomes were the improvement in the distant warts and any complications related to the use of vaccines. The data were entered in MS Excel and analyzed using SPSS 17.0 version. A P value of <0.05 was considered statistically significant. Results The baseline demographic and wart characteristics were comparable between the two groups (P > 0.05). As compared to MMR, MIP showed an early (9.41 vs 11.71 weeks, P = 0.027), and a significantly higher complete response (90% vs 76.67%) with P < 0.05. The less duration of the warts was significantly associated with the higher complete response (P < 0.05) in both the groups. The common side effects were erythema/inflammation [19 (63.34%)] in Group A and pain during the injection [19 (63.34%)] in Group B with P < 0.0001. Conclusion In conclusion, MIP intralesional injections have a quicker response and are more efficacious compared to MMR in the treatment of Cw, though each vaccine carries its own sets of side effects.
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Affiliation(s)
- Amandeep Kaur
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Balvinder Kaur Brar
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Sumir Kumar
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | | | - Amarbir Singh Boparai
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
| | - Neerja Puri
- Department of Dermatology, Venereology and Leprology, Guru Gobind Singh Medical College, Faridkot, Punjab, India
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Abstract
BACKGROUND Although there are multiple treatments for warts, wart management remains a challenge. Ozone therapy is an emerging treatment for infectious and noninfectious dermatological diseases. OBJECTIVE To assess intralesional ozone gas safety and efficacy in multiple warts management. MATERIALS AND METHODS Seventy-four adult patients with multiple common warts were included in this study. They were randomly assigned into 2 groups: first group comprised 44 patients treated with intralesional ozone gas, and the second group comprised 30 patients who received intralesional saline injection. In both groups, warts in all patients were directly injected weekly until complete clearance occurred or for a maximum of 10 treatment sessions. The subjects were followed for 6 months to record any recurrences. RESULTS In the ozone group, 25 patients (56.8%) had a complete response with an excellent cosmetic outcome, 15 patients (34.1%) showed a partial response, and 4 patients (9.1%) had no response. More subjects responded to ozone than to saline (p < .001). Ozone therapy was associated with mild side effects, including pain at time of injection, numbness, and fatigue. CONCLUSION Intralesional ozone is effective and safe for the treatment of multiple warts.
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Chauhan P, Jindal R, Meena D. Intralesional measles, mumps, and rubella vaccine immunotherapy in molluscum contagiosum: A retrospective observational study from a tertiary care center in north India. Dermatol Ther 2020; 34:e14615. [PMID: 33283407 DOI: 10.1111/dth.14615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
Molluscum contagiosum (MC) is a mucocutaneous viral infection, often self-limiting but untreated lesions can often last for 2 months to 2 years. Previously intralesional measles, mumps, and rubella (MMR) vaccine has been tried for the treatment of warts but no studies exist of its use in MC. We report our experience with intralesional MMR in 22 patients of MC. The study was carried out to assess the efficacy and safety of intralesional MMR vaccine in patients of MC. We retrospectively analyzed records of patients who received intralesional MMR for MC from September 2018 to September 2019. Demographic characteristics, number, size, and site of molluscum lesions, number of MMR injections given, and response were recorded. Records of 22 patients were analyzed. There were 10 males and 12 females. The age of the patients ranged from 6 to 50 years with a mean of 19.72 ± 10.92. At the end of 12 weeks, 18 patients (81.8%) had complete clearance of lesions, with 4 patients (18.18%) having a partial response of more than 50%. No patient showed less than 50% or no response. In only one patient who had giant molluscum, postinflammatory hyperpigmentation was noted. No other adverse effect was seen in any of the patients. MMR is a safe, effective, easy to administer, time-saving, and inexpensive therapy for lesions of MC.
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Affiliation(s)
- Payal Chauhan
- Department of Dermatology, Venereology and Leprology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, India
| | - Rashmi Jindal
- Department of Dermatology, Venereology and Leprology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan Institute, Dehradun, India
| | - Dilip Meena
- Department of Dermatology, Venereology & Leprology, Teerthanker Mahaveer University Medical College & Research Centre, Moradabad, India
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Rao AG, Haqqani R. Study of BCG Immunotherapy in the Management of Multiple, Extensive Non-Genital Cutaneous Common Warts. Indian Dermatol Online J 2020; 11:784-788. [PMID: 33235846 PMCID: PMC7678529 DOI: 10.4103/idoj.idoj_461_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/28/2019] [Accepted: 11/26/2019] [Indexed: 11/25/2022] Open
Abstract
Background and Aims: Most of the available treatment therapeutic modalities for warts are aimed at destruction of virus. However, despite adequate treatment, the virus may persist in the surrounding tissues leading to recurrence. Owing to side effects such as pain, scarring, and risk of secondary infection, these modalities may not be suitable for multiple lesions, extensive involvement and for the treatment of warts in the paediatric age group. The aim of the study was to evaluate the efficacy and safety of intra lesional BCG vaccine in the management of patients with multiple extensive non-genital common warts. Methods: Thirty patients with multiple, extensive non-genital cutaneous common warts, with age ranging from 6 to 60 years who were not on any treatment for warts and did not have any active infections (including HIV) or past history of tuberculosis attending the department of dermatology of our hospital in a 2-year period were included. Mantoux test was performed in all patients and positive responders were taken up for study. BCG vaccine was administered into the largest wart intradermally and the injection was repeated every 3 weeks for a maximum of five injections or till the complete clearance of warts, whichever was earlier . The efficacy was assessed every 3 weeks and a final assessment was done at the end of the 12th week. Patients were followed up for another 6 months. Observations: Majority of patients were in the age group of 5-14 years. Males (63.3%) were afflicted more than females. Most patients (63.3%) exhibited partial response at the site of injected wart at the end of one month and 70% patients showed complete clearance at the end of 3 months and 36.6% responded with 3 injections and 26.6% patients required 4 for response followed 23.3% requiring 5 injections. Conclusion: Intralesional immunotherapy using by BCG vaccine appears to be is a promising treatment modality for the treatment of warts, particularly the multiple and recalcitrant ones. The advantages include the resolution of both the injected and distant warts with negligible recurrence and with minimal side effects.
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Affiliation(s)
| | - Ruhi Haqqani
- Department of Dermatology, SVS Medical College, Mahbubnagar, Telangana, India
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El-Amawy HS, Sarsik SM. Saline in Dermatology: A literature review. J Cosmet Dermatol 2020; 20:2040-2051. [PMID: 33098717 DOI: 10.1111/jocd.13813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Saline, with its different concentrations, is the most used crystalloid solution in medicine. In dermatology, no large studies investigated the benefits of saline. The aim of this article is to review the different possible uses of saline in dermatology, in order to give final recommendations based on the literature review and our experience. METHODS We performed a literature search based on PubMed, EMBASE, WHO Global Health Library, Virtual Health Library, Web of Science, Scopus, Google Scholar, and Research gate. using the keywords: saline, physiological, hypertonic, isotonic, hypotonic, salt solution, sodium chloride, 0.9% NaCl, solvent, drug delivery, injection mixtures, diluent, sclerosant, intravenous, intralesional, injection, topical, soaks, fomentation, inhalation, alopecia, psoriasis, scars, atopic dermatitis, eczema, bromoderma, iododerma, lipodystrophy, in various combinations with the Boolean operators AND, OR and NOT. We also hand-searched textbooks. RESULTS Saline was used as a diluent with intralesional injection of steroids to minimize the risk of steroid-induced atrophy, being safe and free from preservatives that may precipitate steroids at site of injection and maximize their side effects. Saline has also been used after surgery, when atrophic scars take place or anticipated, and through injection in leishmaniasis, granuloma annulare, atrophic acne scars before using other expensive and less tolerated treatment options. CONCLUSIONS The saline represents a helpful option as a diluent with intralesional injection of steroids in various dermatologic therapeutic indications. Moreover, the use of saline in this setting could help to minimize the risk of steroid-induced atrophy. We encourage the use of saline after surgery, when atrophic scars take place or anticipated. Also, we encourage a trial of saline injection in leishmaniasis, granuloma annulare, atrophic acne scars before using other expensive and less tolerated treatment options.
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Affiliation(s)
- Heba Saed El-Amawy
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Sameh Magdy Sarsik
- Dermatology and Venereology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Nofal A, Fouda I. Switching between intralesional antigens: A promising therapeutic approach for recalcitrant warts. JAAD Case Rep 2020; 6:1032-1035. [PMID: 32995438 PMCID: PMC7509367 DOI: 10.1016/j.jdcr.2020.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ahmad Nofal
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interactive Dermatology Research Group, Cairo, Egypt
| | - Ibrahim Fouda
- Dermatology, Venereology and Andrology Department, Damietta Faculty of Medicine, Al-Azhar University, Egypt.,Interactive Dermatology Research Group, Cairo, Egypt
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31
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Marei A, Alakad R, Wahid RM. Evaluation of intralesional Candida antigen in diabetic patients with multiple warts. J Cosmet Dermatol 2020; 20:1248-1253. [PMID: 32924256 DOI: 10.1111/jocd.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Treatment of warts in diabetic patients with ablative modalities poses a significant risk owing to increased possibility of secondary infection, slow healing, and recurrence. Intralesional immunotherapy has gained popularity in the treatment of warts due to its proven efficacy and good tolerability compared with destructive methods. AIM To evaluate the intralesional Candida antigen injection for the treatment of multiple warts in diabetic patients. PATIENTS/METHODS Fifty diabetic patients with multiple genital/nongenital warts were divided into two groups. The first group (30 patients) received intralesional Candida antigen, and the second group (20 patients) had intralesional saline as control. The treatments were injected into the largest wart every 2 weeks until complete clearance of warts or for a maximum of five sessions. RESULTS Complete clearance of warts was observed in 80% of the diabetic patients in the Candida antigen group compared with 15% in the control group (P < .001). Side effects to Candida antigen included pain during injection in all patients, flu-like symptoms, and localized reaction at the injection site in few patients. CONCLUSION Intralesional Candida antigen injection can be a promising effective and safe therapeutic option for the treatment of warts in diabetic patients.
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Affiliation(s)
- Ayman Marei
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interventional Research Lab, Interventional Immunology and Allergy Center, Zagazig, Egypt
| | - Rania Alakad
- Interventional Research Lab, Interventional Immunology and Allergy Center, Zagazig, Egypt.,Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham M Wahid
- Physiology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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32
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Mohta A, Kushwaha RK, Gautam U, Sharma P, Nyati A, Jain SK. A comparative study of the efficacy and safety of intralesional measles, mumps, and rubella vaccine versus intralesional vitamin D3 for the treatment of warts in children. Pediatr Dermatol 2020; 37:853-859. [PMID: 32681688 DOI: 10.1111/pde.14280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Intralesional vitamin D3 has recently emerged as a new treatment for cutaneous warts. The use of the measles, mumps, and rubella (MMR) vaccine for this purpose is an established modality. However, relevant data on the efficacy of either the MMR vaccine or vitamin D3 as immunotherapy for cutaneous warts in the pediatric population are limited. OBJECTIVES To compare the efficacy and safety of intralesional injections of MMR vaccine to intralesional injections of vitamin D3 in children aged 8-16 years with multiple warts. METHODS A total of 74 children were randomly allocated into two groups. Group A patients received intralesional MMR vaccine into the largest wart, and group B received intralesional vitamin D3 into the largest wart. The injections were repeated every 4 weeks until clearance or for a maximum of three treatments. After the last injection, children were followed up every 2 weeks for 3 months, and at the sixth month, a final clinical assessment was conducted. RESULTS Of 74 children, 60 completed the study, with 30 children in each group. Complete clearance of the injected wart was observed in 26 (86.67%) patients in the MMR group (group A) and 23 (76.7%) patients in the vitamin D3 group (group B). Distant warts cleared in 23 (76.7%) patients in group A compared to 20 (66.6%) patients in group B. There was no significant difference between groups. No recurrence was seen in group A, whereas two (6.6%) children in group B exhibited recurrence in the ensuing 6-month follow-up. The most common adverse events were injection site pain and swelling. CONCLUSION Both intralesional MMR and vitamin D3 are safe, generally well-tolerated, and equally effective in children for the treatment of cutaneous warts.
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Affiliation(s)
- Alpana Mohta
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | | | - Umesh Gautam
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Pritee Sharma
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Asha Nyati
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
| | - Suresh Kumar Jain
- Department of Dermatology, Venereology and Leprosy, GMC, Kota, India
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Gupta P, Tegta GR, Verma GK, Gupta A, Gupta M, Sharma S. A Study to Evaluate the Role of Intradermal and Intralesional Measles, Mumps, Rubella (MMR) Vaccine in Treatment of Common Warts. Indian Dermatol Online J 2020; 11:559-565. [PMID: 32832442 PMCID: PMC7413434 DOI: 10.4103/idoj.idoj_144_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 12/27/2019] [Accepted: 03/16/2020] [Indexed: 11/06/2022] Open
Abstract
Background: Warts are common cutaneous viral infection with a wide range of therapeutic modalities. Various agents have been tried for immunotherapy in warts. Objectives: Determine the role of intralesional and intradermal measles, mumps, rubella (MMR) vaccine in the treatment of common warts; to compare the efficacy of intralesional versus intradermal MMR vaccine. Methods and Materials: Patients diagnosed with verruca vulgaris were divided into two groups. In study group A, the individuals were injected with an intralesional MMR vaccine of 0.3 mL in the representative wart (largest) once in 3 weeks till there is complete clearance or maximum of four injections whichever is earlier, while in study group B, the individuals were injected with an intradermal MMR vaccine of 0.3 mL over the unilateral deltoid muscle area at similar intervals. Results: There were 33 patients in each group. In group A, 10 (30.3%) patients showed complete, 9 (27.3%) marked, 6 (18.2%) moderate, 3 (9.1%) mild, and 5 (15.2%) no response. In group B, seven (21.2%) patients showed complete, one (3.0%) marked, one (3.0%) moderate, four (12.1%) mild, and 20 (60.6%) no response. There were minimal side effects in the form of pain, erythema, itching at the injection site in a few patients, only one patient had syncope. Conclusion: We conclude that the MMR vaccine is an effective and safe modality of treatment for verruca vulgaris without any serious adverse effects. Also, the intralesional route showed better results in comparison to the intradermal route when we consider the treatment of a representative wart.
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Affiliation(s)
- Pragya Gupta
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
| | - Geeta Ram Tegta
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
| | - G K Verma
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
| | - Abhishek Gupta
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
| | - Mudita Gupta
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
| | - Shikha Sharma
- Department of Dermatology, Venereology and Leprosy, IGMC Shimla, District Sirmour, Himachal Pradesh, India
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Nassar A, Mostafa M, Khashaba SA. Photodynamic therapy versus candida antigen immunotherapy in plane wart treatment: a comparative controlled study. Photodiagnosis Photodyn Ther 2020; 32:101973. [PMID: 32841751 DOI: 10.1016/j.pdpdt.2020.101973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/09/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Plane warts, mostly found on the face, present a challenge to treat as most destructive methods can lead to unpleasant cosmetic outcome. Alternative therapeutic methods should be evaluated. The aim of this study is to evaluate the clinical efficacy and adverse effects of photodynamic therapy with methylene blue and intense pulsed light in comparison to candida antigen immunotherapy in the treatment of plane warts. METHODS The study included 39 patients with plane warts assigned into 3 groups. Group I received photodynamic therapy using methylene blue followed by IPL illumination, group II received immunotherapy using 0.1 ml of candida albicans antigen and group III received 0.1 ml saline as a control. RESULTS Complete response was detected in (46.1%) of patients in group I compared to (61.5%) in group II and no response in group III. CONCLUSION Candida antigen immunotherapy is superior to photodynamic therapy in plane warts treatment with absence of recurrence and comparable side effects in both groups.
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Affiliation(s)
- A Nassar
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
| | - M Mostafa
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
| | - S A Khashaba
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, 44519, Egypt.
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35
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Nofal A, Alakad R. Intralesional immunotherapy for the treatment of anogenital warts in pediatric population. J DERMATOL TREAT 2020; 33:1042-1046. [PMID: 32703042 DOI: 10.1080/09546634.2020.1800573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The prevalence of anogenital warts is increasing in adults as well as in pediatric population. The treatment of anogenital warts is challenging, particularly in children as most conventional modalities are painful and associated with high recurrence rates. OBJECTIVES To evaluate the efficacy and safety of intralesional immunotherapy for the treatment of anogenital warts in pediatric patients. METHODS Forty child presenting with multiple anogenital warts were randomly assigned into 3 groups. The first group (15 patients) received intralesional MMR vaccine, the second group (15 patients) received intralesional Candida antigen and the third group (10 patients) received intralesional saline as a control. Each modality was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. RESULTS Highly significant difference was found between the therapeutic response of anogenital warts to both MMR vaccine and Candida antigen compared to intralesional saline (p = .005). No significant difference was observed between MMR vaccine and Candida antigen groups (p = .885). Side effects were mild and no recurrence was detected in the 6 month follow-up period. CONCLUSIONS Intralesional immunotherapy is a promising effective and well-tolerated treatment modality for multiple anogenital warts in children.
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Affiliation(s)
- Ahmad Nofal
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interactive Dermatology Research Foundation, Cairo, Egypt
| | - Rania Alakad
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interactive Dermatology Research Foundation, Cairo, Egypt
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36
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Kansal NK. Immunotherapy of anogenital warts with measles, mumps, and rubella vaccine. Dermatol Ther 2020; 33:e13987. [PMID: 32638481 DOI: 10.1111/dth.13987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/19/2020] [Accepted: 07/06/2020] [Indexed: 01/02/2023]
Abstract
Anogenital warts, caused by the human papillomavirus, are a cause of significant discomfort and psychological concern for the patients. Despite the availability of multiple treatment options, they are a challenge to manage and may be quite refractory. An easy-to-use therapeutic method with low adverse event profile and low-recurrence rate, therefore, remains highly desirable. In this brief paper, an attempt is made to review the intralesional immunotherapy of anogenital warts with measles, mumps, and rubella vaccine.
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Affiliation(s)
- Naveen Kumar Kansal
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, India
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37
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Nofal A, Fouda I, Aboelwafa H, Fawzy MM. Successful treatment of doughnut warts with intralesional Candida antigen immunotherapy. J Cosmet Dermatol 2020; 20:295-299. [PMID: 32432375 DOI: 10.1111/jocd.13496] [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: 04/19/2020] [Revised: 05/07/2020] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Doughnut warts, also called ring or annular warts, are a distinctive type of warts with central clearing and annular recurrence. There are very few studies illustrating this uncommon phenomenon and its treatment. AIMS To present 15 cases of doughnut warts and evaluate the efficacy and safety of Candida antigen intralesional immunotherapy in their treatment. METHODS The study included 15 patients presenting with doughnut warts who were previously treated with destructive modalities for their original warts. All patients were injected intralesionally by Candida antigen at a dose of 0.2 mL into the base of doughnut wart until complete clearance or for a maximum of 5 sessions. RESULTS Complete clearance was achieved in 12 patients (80%), partial response in 2 patients (13.3%), and no response in 1 patient (6.7%). Complete response was observed after two sessions in 5 patients, after three sessions in 4 patients, and after four sessions in 3 patients. Adverse effects were minimal and insignificant. CONCLUSIONS Doughnut warts represent a unique and rare type of wart recurrence. Intralesional Candida antigen immunotherapy seems to be a promising and effective therapeutic modality for the treatment of such a rare entity.
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Affiliation(s)
- Ahmad Nofal
- Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Interactive Dermatology Research Group, Cairo, Egypt
| | - Ibrahim Fouda
- Interactive Dermatology Research Group, Cairo, Egypt.,Dermatology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Hany Aboelwafa
- Interactive Dermatology Research Group, Cairo, Egypt.,Dermatology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed M Fawzy
- Interactive Dermatology Research Group, Cairo, Egypt.,Dermatology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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38
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Zhang S, Xu X, Liu Y, Xue R, Li C, Chen P, Zhang X, Liang J. Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study. Dermatol Ther 2020; 33:e13390. [PMID: 32268448 DOI: 10.1111/dth.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/25/2020] [Accepted: 04/04/2020] [Indexed: 11/30/2022]
Abstract
Most available options for the treatment of warts are limited by the potential for scarring, pain, lack of response, or recurrences, and the patients are often unable to tolerate and accept those experiences. The aim of this study was to evaluate the clinical efficacy and safety of oral systemic acitretin monotherapy in patients with extensive/recalcitrant cutaneous warts. The patients were given a dose of acitretin of 0.8 mg kg-1 day-1 , and the clinical efficacy and safety of acitretin was assessed every 2 weeks for 2 months. A total of 14 patients (12 males and 2 females) were included, with an age of 14-60 years (mean 33 ± 14.7 years) and a course of 4-48 months (mean 21.6 ± 13.4 months). After 2 months of acitretin treatment, 42.9% (6/14) of patients (including warts of the feet, legs, and hands) exhibited complete response, 28.6% (4/14) excellent response, and 28.6% (4/14) good response. All patients demonstrated significant improvement, and the drug was well tolerated, with no patients discontinuing therapy due to side effects. Common mild side effects included dry skin and cheilitis. There were no recurrences during a follow-up period of 6 months. Acitretin monotherapy is an effective, safe, and well-tolerated treatment for patients with extensive/recalcitrant cutaneous warts who are unsuitable for or unwilling to accept traditional treatment methods.
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Affiliation(s)
- Sanquan Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Xiao Xu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Yumei Liu
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Rujun Xue
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Changxing Li
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Pingjiao Chen
- Department of Dermatology, Nanfang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Xibao Zhang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
| | - Jingyao Liang
- Institute of Dermatology, Guangzhou Medical University, Guangzhou, People's Republic of China.,Department of Dermatology, Guangzhou Institute of Dermatology, Guangzhou, People's Republic of China
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Leerunyakul K, Thammarucha S, Suchonwanit P, Rutnin S. A comprehensive review of treatment options for recalcitrant nongenital cutaneous warts. J DERMATOL TREAT 2020; 33:23-40. [PMID: 32116076 DOI: 10.1080/09546634.2020.1737635] [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] [Indexed: 12/16/2022]
Abstract
Introduction: The treatment of recalcitrant nongenital cutaneous warts has always been challenging for dermatologists as they often recur and relapse. Multiple treatment options have been investigated to improve the outcome. This review provides an overview of the current treatment modalities and summarizes the efficacy and side effects of each treatment option for recalcitrant nongenital cutaneous warts.Methods: A PubMed search was performed through July 2019 to include all English language reports investigating the treatment for recalcitrant nongenital cutaneous warts, regardless of design.Results: A total of 144 studies were included in this review. The treatment options for recalcitrant nongenital cutaneous warts can be divided into three groups: destructive treatment, immunotherapy, and cytotoxic agents. Although both destructive therapies and cytotoxic agents demonstrated high complete response rates, immunotherapy, which is a minimally invasive method, was superior in terms of the clearance of distant warts. Intralesional mumps-measles-rubella injections and purified protein derivatives currently demonstrate high efficacy with well-established clinical evidence.Conclusions: Many upcoming treatment modalities, especially immunotherapy, are promising. However, more comparative studies are required to verify the efficacy and safety profile.
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Affiliation(s)
- Kanchana Leerunyakul
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasima Thammarucha
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Poonkiat Suchonwanit
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthinee Rutnin
- Division of Dermatology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Tantawy EA, El-Beyali AA, Gohar MK, Ibrahim ZS, Nasr M, Marei A. Association of TLR2 and TLR4 gene polymorphism with susceptibility to wart infections and their response to candida antigen immunotherapy. J DERMATOL TREAT 2020; 33:166-172. [DOI: 10.1080/09546634.2020.1732285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Enas A. Tantawy
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Abdallah A. El-Beyali
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Maha K. Gohar
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Zynab S. Ibrahim
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Nasr
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Ayman Marei
- Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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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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Abd El‐Magiud EM, Abd El‐Samea GM, Gaber HD. Intralesional injection of measles, mumps, and rubella vaccine versus cryotherapy in treatment of warts: A randomized controlled trial. Dermatol Ther 2020; 33:e13257. [DOI: 10.1111/dth.13257] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/02/2020] [Accepted: 02/05/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Ensaf M. Abd El‐Magiud
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Assiut University Asyut Egypt
| | - Gehad M. Abd El‐Samea
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Assiut University Asyut Egypt
| | - Hisham D. Gaber
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Assiut University Asyut Egypt
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Vania R, Pranata R, Tan ST. Intralesional measles-mumps-rubella is associated with a higher complete response in cutaneous warts: a systematic review and meta-analysis of randomized controlled trial including GRADE qualification. J DERMATOL TREAT 2020; 32:1010-1017. [PMID: 31985307 DOI: 10.1080/09546634.2020.1716931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Warts can be difficult to treat and progressing to chronic and resistant disease. Several studies have reported the successful application of mumps-measles-rubella (MMR) vaccine resulting in clearance of warts via immunomodulation and induction of immune system. METHODS We performed a comprehensive search on the role of intralesional MMR in warts from several electronic databases. Complete response is defined as complete clearance of warts lesion. RESULTS There were a total of 425 subjects from five studies. Intralesional injection of MMR was associated with an increased complete response (OR 9.43 [5.78, 15.37], p < .001; I2: 5%, p = .38). Subgroup analysis on patients receiving injection for every 2 weeks for a maximum of five injections revealed an OR of 11.70 [6.40, 21.38], p < .001; I2: 20%, p = .29. Patients receiving intralesional MMR were associated with a lower partial response (OR 0.54 [0.33, 0.88], p = .01; I2: 0%, p = .66). Intralesional MMR was associated with a reduced no-response (OR 0.16 [0.06, 0.43], p < .001; I2: 69%, p = .01). Funnel plot analysis for complete response was asymmetrical, indicating the risk of publication bias. There were statistically significant small-study effects for intralesional MMR on complete response upon analysis using Harbord's test (p = .047). Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment showed that intralesional MMR injection has high level of certainty (quality of evidence) for complete response in warts with an absolute increase of 505 per 1000. CONCLUSION Intralesional MMR injection was associated with a higher complete response and lower no-response with a high level of certainty.
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Affiliation(s)
- Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Sukmawati Tansil Tan
- Department of Dermatovenerology, Faculty of Medicine, Universitas Tarumanegara, Jakarta, Indonesia
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44
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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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45
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Elmaadawy EH, Shams SS, Hegab DS, Zaki RA. Pulsed-dye laser versus intralesional Candida albicans. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2019. [DOI: 10.15570/actaapa.2019.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Jaisinghani AK, Dey VK, Suresh MS, Saxena A. Bacillus Calmette-Guerin Immunotherapy for Recurrent Multiple Warts: An Open-Label Uncontrolled Study. Indian J Dermatol 2019; 64:164. [PMID: 30983619 PMCID: PMC6440180 DOI: 10.4103/ijd.ijd_558_16] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: Cutaneous warts present a therapeutic challenge because of recurrence and multiplicity and may become a frustrating condition for both patients and physicians. In the past few years, there has been an increase in intralesional immunotherapy for recurrent multiple warts not only because of its encouraging results in the treatment but also due to its ability to clear distant warts and preventing recurrence. Objective: The objective of this study was to evaluate the efficacy and safety of intralesional bacillus Calmette–Guerin (BCG) vaccine immunotherapy in the treatment of recurrent multiple warts. Materials and Methods: This study included 40 adult patients with multiple recurrent extragenital warts of different sizes, numbers, and duration, with or without distant warts. Patients were injected intralesionally with 0.1 ml BCG vaccine into the largest wart at a 3-week interval, directly without a pre-sensitization skin test, until complete clearance or for a maximum of three sessions. Follow-up was done every month for 3 months to detect any recurrence. Results: Out of the 40 patients enrolled in the study, 34 patients completed the treatment protocol of three injections and 3 months of follow-up and six patients discontinued for various reasons. Complete clearance of the lesions was achieved in 25 (73.53%) patients, partial clearance in 8 (23.53%) patients, and no response in 1 (2.94%) patient. Complete response was demonstrated in 75% of those presenting with distant warts. Therapy-related side effects were mild in the form of pain during injection, itching, erythema at the site of injection, and flu-like symptoms. None of the patients with complete response showed recurrence of lesions in a 3-month follow-up period. Conclusion: Intralesional BCG immunotherapy is a safe, effective, and promising treatment modality for recurrent multiple warts.
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Affiliation(s)
- Avtar Kishan Jaisinghani
- Department of Dermatology, People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Vivek Kumar Dey
- People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - M S Suresh
- People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Animesh Saxena
- People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India
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Ringin SA. The Effectiveness of Cutaneous Wart Resolution with Current Treatment Modalities. J Cutan Aesthet Surg 2019; 13:24-30. [PMID: 32655247 PMCID: PMC7335473 DOI: 10.4103/jcas.jcas_62_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-venereal warts are a frequent dermatological presentation with potential spontaneous regression in immunocompetent adults and children within 2 years. Evidence shows that conventional wart treatments are not a guaranteed treatment modality and can carry concerns regarding safety. The aim of this literature review was to identify the most effective treatments for wart resolution to guide clinical practice while identifying areas for further research. A systematic literature review was performed to determine the current treatment modalities for non-anogenital cutaneous warts in immunocompetent individuals and their effectiveness. Articles were categorized into one of eight groups depending on anatomical location, population age, or recalcitrant status with ranked levels of evidence. This literature review highlights a variety of treatments for non-venereal warts shown to be effective. In this instance where optimal evidence-based treatments are not available, clinical experience determines the most appropriate clinical practice. Further reproducible immunotherapy research on wart resolution is required to enable clear comparisons of these treatment modalities to conventional methods. Future clinical practice will require the human papillomavirus type to target the wart treatment accordingly; however, further research is required to determine these correlations.
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Affiliation(s)
- Sarah A Ringin
- Department of Medicine, University of Notre Dame, Sydney, NSW, Australia
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Rezai MS, Ghasempouri H, Asqary Marzidareh O, Yazdani Cherati J, Rahmatpour Rokni G. Intralesional Injection of the Measles-Mumps-Rubella Vaccine into Resistant Palmoplantar Warts: A Randomized Controlled Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:10-17. [PMID: 30666071 PMCID: PMC6330524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Common resistant-to-therapy warts pose a challenge to both clinicians and patients. Among many destructive and immunotherapeutic options, no single, fully effective treatment has been suggested yet. Many investigations, including those using intralesional antigen administrations, have demonstrated that cellular immunity plays a major role in the clearance of human papilloma virus (HPV) infection. The aim of the present study was to evaluate the effects of the intralesional injection of the measles-mumps-rubella (MMR) vaccine into resistant-to- treatment palmoplantar warts and its complications. METHODS In this single-blind, randomized, controlled clinical trial, 60 cases with resistant-to-therapy palmoplantar warts referring to the Dermatology Clinic of Bou-Ali Sina Hospital of Sari between June 2015 and 2016 were randomly assigned to 2 equal groups: the MMR Group received intralesional MMR and the Placebo Group was given saline injection. The injections were administered at 2-week intervals until complete clearance was achieved or for a maximum of 5 injections (<5 injections at 2-week intervals). The study protocol was registered in the Iranian Registry of Randomised Clinical Trials (ID: IRCT2016101027636N3), and the statistical analyses were performed using SPSS, version 17.0. The χ2 test and the F-test were used as appropriate, and a P value less than 0.05 was considered statistically significant. RESULTS Complete clearance was observed in 65.2% (14⁄23) of the patients presenting with resistant-to-therapy palmoplantar warts in the MMR Group and 23.85% (5/21) in the Placebo Group (P=0.021). Recurrence was not observed in any of the completely cured patients at 6 months' follow-up. CONCLUSION Intralesional immunotherapy with the MMR vaccine may result in a desirable therapeutic response and can be used as an effective and safe treatment option for palmoplantar warts, particularly persistent ones. Trial Registration Number: IRCT2016101027636N3.
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Affiliation(s)
- Mohammad Sadegh Rezai
- Pediatric Infectious Diseases Superspecialist, Infectious Diseases Research Center with focus on Nosocomial Infections, Mazandaran University of Medical Sciences, Sari, Iran;
| | - Hiva Ghasempouri
- General physician, Mazandaran University of Medical Sciences, Sari, Iran;
| | | | - Jamshid Yazdani Cherati
- Epidemiologist, Department of Biostatistics, Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran;
| | - Ghasem Rahmatpour Rokni
- General physician, Mazandaran University of Medical Sciences, Sari, Iran;
,Dermatologist, Clinical Research Development Unit of Bou-Ali Sina Hospital, Mazandaran University of Medical Sciences, Sari, Iran
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49
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Jain S, Mohta A, Gautam U, Kushwaha R. A curious case of development of verruca vulgaris over the site of autoimplantation: Subsequently treated with measles, mumps and rubella vaccine. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2019. [DOI: 10.4103/ijdd.ijdd_47_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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50
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Agrawal C, Vyas K, Mittal A, Khare AK, Gupta LK. A Randomized double Blind Controlled Study Comparing the Efficacy of Intralesional MMR Vaccine with Normal Saline in the Treatment of Cutaneous Warts. Indian Dermatol Online J 2018; 9:389-393. [PMID: 30505777 PMCID: PMC6233005 DOI: 10.4103/idoj.idoj_111_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Recently, with better understanding of the immunology of warts, immunotherapeutic approaches have emerged as an effective treatment option for the management of cutaneous warts. Intralesional immunotherapy with MMR vaccine is one such modality but there are still lack of enough placebo-controlled studies. AIM To evaluate the efficacy of intralesional MMR in patients of extragenital warts in a double-blinded manner using normal saline as control. PATIENTS AND METHODS One hundred patients of extragenital cutaneous warts were randomly allocated into two groups, the interventional (MMR) group and control (normal saline) group. MMR vaccine was injected intralesionally in the patients belonging to interventional group, a similar volume of normal saline (NS) was injected in the control group. The outcome in terms of treatment response, adverse effects, and recurrences were evaluated and compared. RESULTS Eighteen of thirty (60%) patients in the interventional group achieved complete response as against 7 (23.3%) in the control group (P = 0.01). Distant warts cleared in 69.5% patients in the interventional groupcompared to none in the control group. Adverse effects seen in both groups were injection site pain and mild erythema. A total of 57.1% patients showed recurrences in the control group compared to 16.6% in the interventional group. CONCLUSION Intralesional MMR vaccine is an effective treatment option in patients with multiple extragenital warts. It is suggested that it should be used as first-line therapy for multiple warts and a second-line therapy for warts recalcitrant to standard therapies.
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Affiliation(s)
- Chesta Agrawal
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Kapil Vyas
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Asit Mittal
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Ashok K. Khare
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
| | - Lalit K. Gupta
- Department of Dermatology, Venereology and Leprosy, RNT Medical College, Udaipur, Rajasthan, India
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