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Nofal H, Omran F, ElKholy B, Nofal S, Nofal A. Tazarotene is as effective and well-tolerated as imiquimod in the treatment of verruca plana: a comparative randomized controlled trial. Clin Exp Dermatol 2024; 49:1197-1204. [PMID: 38618753 DOI: 10.1093/ced/llae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/06/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Plane warts, when multiple and recurrent, present a therapeutic challenge acting as a source of reinfection, causing frustration and affecting a patient's quality of life. For large numbers of lesions in cosmetically significant sites, topical treatment is preferred to avoid potential sequelae. OBJECTIVES To evaluate and compare the efficacy and tolerability of tazarotene 0.1% gel vs. imiquimod 5% cream for the treatment of plane warts. METHODS In a parallel three-arm randomized controlled trial, 60 patients were randomized to imiquimod, tazarotene or placebo groups. Patients applied the corresponding treatment once daily at night for a maximum of 12 weeks. Primary outcomes were the percentage of respondents with complete clearance in the three studied groups, and the type and frequency of side-effects in each group. RESULTS Both active treatments resulted in significant improvement compared with baseline and the placebo group (P = 0.001). The imiquimod 5% treated group showed complete clearance in 50% (10/20) of patients, partial response in 15% (3/20), and no response in 35% (7/20). Tazarotene 0.1% gel showed complete clearance in 40% (8/20) of patients, partial response in 40% (8/20), and no response in 20% (4/20). No significant difference was detected between the imiquimod and tazarotene groups (P = 0.19). CONCLUSIONS Compared with imiquimod, tazarotene 0.1% gel for the treatment of plane warts seems to offer an equivalent treatment response, it maintained efficacy without recurrence and had a safer profile regarding dyspigmentation with an advantageous cheaper cost.
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Affiliation(s)
- Hagar Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
- Biotechnology program, School of Sciences and Engineering, The American University in Cairo, Cairo, Egypt
| | - Fatma Omran
- Dar Alsalam Medical Center, Faculty of Medicine, Omar Almukhtar University, Derna, Libya
| | - Basma ElKholy
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
| | - Sara Nofal
- University of Texas Health Science Center, Houston, TX, USA
| | - Ahmad Nofal
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Zagazig University, Egypt
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Hoeger PH. Dupilumab: Two sides of a side-effect. Pediatr Dermatol 2024; 41:180-181. [PMID: 38284784 DOI: 10.1111/pde.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 01/30/2024]
Abstract
The purported antiviral effect of dupilumab may be considered a positive side effect. Its mechanism, however, points to an underlying immunomodulation with potentially far-reaching consequences.
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Affiliation(s)
- Peter H Hoeger
- Department of Paediatrics and Paediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany
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3
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Redzic N, Pereira AR, Menon S, Bogers J, Coppens A, Kehoe K, Vanden Broeck D. Characterization of type-specific HPV prevalence in a population of persistent cutaneous warts in Flanders, Belgium. Sci Rep 2023; 13:17492. [PMID: 37840107 PMCID: PMC10577142 DOI: 10.1038/s41598-023-44154-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
Cutaneous warts are benign skin lesions caused by the human papillomavirus (HPV). Even though they are considered benign, they can have a considerable impact on the quality of life and cause serious illness in certain immunocompromised populations. Studies have shown that the efficacy of wart treatment is dependent on the causative HPV type. Therefore, in this article, we aim to determine the HPV genotype-specific prevalence in cutaneous warts of a Flemish population as part of the Omnivirol-Salycilic acid randomized controlled trial. Swab samples of cutaneous warts (n = 269) were collected during enrollment. The DNA extraction was performed on the automated NucliSENS® easyMAG® system (bioMérieux). The samples were analyzed with two separate in-house PCR assays capable of detecting the most prevalent cutaneous HPV types (i.e. wart-associated HPV qPCR) as well as the most relevant mucosal types (i.e. RIATOL qPCR assay). In total, the type-specific prevalence of 30 distinct HPV genotypes was determined. The beta-globin gene was used as a cellularity control and for viral load quantification. Data concerning wart persistence, previous treatment, wart type, and other relevant wart and patient characteristics was collected through a baseline questionnaire. The study population consisted mostly of persistent warts considering that 98% (n = 263) of the sampled skin lesions were older than six months and 92% (n = 247) had undergone previous treatment. The most prominent wart type was the mosaic verruca plantaris (42%, n = 113). The most prevalent HPV types were cutaneous HPV types 27 (73%, n = 195), 57 (63%, n = 169), and 2 (42%, n = 113). Only 2% (n = 6) of the lesions was HPV negative. The highest median viral loads were observed with HPV27 and 57 (i.e. 6.29E+04 and 7.47E+01 viral copies per cell respectively). The multivariate analysis found significant associations between wart persistence and certain wart types, the number of warts, and HPV genotypes. Based on these findings, persistent warts are more likely to: (1) be verruca vulgaris, verruca plantaris simple or mosaic, (2) to manifest as multiple warts, (3) and to be negative for HPV type 2 or 4. These characteristics can be useful in the clinical setting for future risk stratification when considering treatment triage and management. Trial registration: NCT05862441, 17/05/2023 (retrospectively registered).
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Affiliation(s)
- Nina Redzic
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium.
- AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium.
| | - A Rita Pereira
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium
| | - Sonia Menon
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Johannes Bogers
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium
- AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
- National Reference Centre for HPV, Brussels, Belgium
- Department of Obstetrics and Gynecology, Women's Clinic, Ghent University Hospital, Ghent, Belgium
| | - Astrid Coppens
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium
| | - Kaat Kehoe
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium
- National Reference Centre for HPV, Brussels, Belgium
| | - Davy Vanden Broeck
- Laboratory of Molecular Diagnostics, AML - Sonic Healthcare Benelux, Antwerp, Belgium
- AMBIOR, Laboratory for Cell Biology and Histology, University of Antwerp, Antwerp, Belgium
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- National Reference Centre for HPV, Brussels, Belgium
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4
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Ho T, Iriarte C, Zuniga J, Huang J. Warts in pediatric oncology patients: A single-institution retrospective study. Pediatr Dermatol 2023; 40:816-819. [PMID: 37253684 DOI: 10.1111/pde.15365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/13/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Pediatric oncology patients undergoing cancer treatment can often have numerous and recalcitrant cutaneous warts due to their underlying immunosuppression. There are little published data on the optimal management of warts in pediatric oncology patients undergoing active cancer treatment compared to patients having completed treatment. Our objective was to analyze the clinical course of warts treated within this patient population at Boston Children's Hospital over a 10-year period. METHODS This was a single-institution retrospective study of 72 pediatric oncology patients from 1 September 2011 to 1 September 2021 who were treated for warts at Boston Children's Hospital. All patients had a diagnosis of cutaneous warts with at least one follow-up visit and were receiving active treatment for cancer either during or after concurrent treatment of their warts. We examined the modality and effectiveness of wart treatments while both on and offactive treatment of their cancer. RESULTS The median age was 12 years (range 4-18). Fifty-four percent of patients were documented to have plantar warts. Sixty percent of patients with a documented number of warts had more than five warts at presentation. For cases in which outcomes were specified, treatment resulted in complete resolution of warts in only 24.0% of patients undergoing active cancer treatment compared to 63.3% of patients not on active treatment. Warts persisted or worsened in 56.0% of patients undergoing active cancer treatment compared to only 13.4% of patients not on active treatment. CONCLUSION These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients.
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Affiliation(s)
- Tina Ho
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher Iriarte
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jorge Zuniga
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Huang
- Dermatology Section, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA
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Hagon W, Hagon J, Noble G, Brenton-Rule A, Stewart S, Bristow I. Microwave therapy for the treatment of plantar warts. J Foot Ankle Res 2023; 16:37. [PMID: 37322512 DOI: 10.1186/s13047-023-00638-8] [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: 01/30/2023] [Accepted: 05/28/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Plantar warts, or verrucae plantaris, are common lesions causing considerable pain during weightbearing activity. Although current treatment modalities have low success rates, microwave therapy has been introduced as a promising intervention. This study aimed to determine the effectiveness of microwave therapy for the treatment of plantar warts and to determine the clinical factors associated with plantar wart resolution. METHODS A retrospective analysis of 150 plantar warts from 45 patients treated with microwave therapy was undertaken. Binomial regression was conducted to explore clinical characteristics (age, gender, immunosuppression, impaired healing, multiple vs single wart, location of lesion, lesion diameter) associated with lesion resolution. RESULTS Of the total 150 plantar warts treated with microwave therapy, 125 (83.3%) warts resolved and 25 (17%) warts did not resolve. The mean (SD) total treatment sessions for resolved lesions was 2.8 (1.0). Decreasing age (P = 0.046) was the only clinical characteristic associated with resolution. CONCLUSIONS This retrospective study has shown that plantar warts may be resolved with two to three sessions of microwave therapy, which may be more successful in younger populations.
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Affiliation(s)
- Wendy Hagon
- Shore Footed Podiatry, Milford, Auckland, New Zealand
| | | | - Greer Noble
- Shore Footed Podiatry, Milford, Auckland, New Zealand
| | - Angela Brenton-Rule
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Sarah Stewart
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand.
| | - Ivan Bristow
- Private Practice, Lymington, Hampshire, United Kingdom
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Tao Z, Ran L, Jian-Hua W. Epidemiological survey of warts in Chinese military recruits: A cross-sectional and follow-up study. Heliyon 2023; 9:e16989. [PMID: 37332915 PMCID: PMC10272479 DOI: 10.1016/j.heliyon.2023.e16989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/28/2023] [Accepted: 06/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Warts are very common in military personnel, either at war or during peace times. However, little is known about the prevalence and natural course of warts in military recruits in China. Objective To investigate the prevalence and natural course of warts in Chinese military recruits. Methods In this cross-sectional study, the head, face, neck, hands, and feet of 3093 Chinese military recruits aged 16-25 years in Shanghai were examined for the presence of warts upon enlistment medical examinations. Questionnaires were distributed to collect the general information of the participants before the survey. All the patients were followed up by telephone interview for 11-20 months. Results The prevalence rate of warts in Chinese military recruits was 2.49%. The diagnosis of most cases was common and plantar warts, which were usually less than 1 cm in diameter and with mild discomfort. Multivariate logistic regression analysis showed that smoking and sharing personal items with others were risk factors. Coming from southern China was a protective factor. Over 2/3 of patients recovered within 1 year and the type, number, and size of warts and treatment choice did not predict resolution.Study limitations and Conclusions This study demonstrated that warts had a relative lower morbidity and a higher spontaneous resolution rate in Chinese military recruits. The telephone interviews following the initial survey and the limitations of a cross-sectional study were the main drawbacks.
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Affiliation(s)
| | | | - Wu Jian-Hua
- Corresponding author. Department of Dermatology, Changhai Hospital, 168 chang-hai RD yang-pu district, Shanghai, China.
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Photodynamic Therapy Used to Treat an HIV Patient with an Efflorescence of Viral Warts after HAART Therapy. Diagnostics (Basel) 2023; 13:diagnostics13061098. [PMID: 36980407 PMCID: PMC10047808 DOI: 10.3390/diagnostics13061098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/18/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Healing from viral warts lesions can be hard to achieve in immunocompromised subjects like HIV-positive patients. The therapeutic target in immunocompetent subjects can be reached using different methods, including topical ointments, cryotherapy, laser therapy, imiquimod, and photodynamic therapy (PDT). We present a case of a male HIV-positive patient who came to the Dermatology department with multifocal wart lesions on his face, auricular, and retro-auricular areas after treatment with highly active antiretroviral therapy (HAART). In our case, surprisingly, only one session of PDT proved to induce complete regression of lesions which, despite their thickness, had a much more robust response to treatment than we could have possibly expected. After a brief review of the literature, it is possible to state that PDT revealed itself to be a valid option in immunocompromised patients who have a major risk of relapse.
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Liu B, Fang XY, Yan YL, Wu J, Lv XJ, Zhang J, Qi LW, Qian TT, Cai YY, Fan YG, Ye DQ. Short-term effect of ambient temperature and ambient temperature changes on the risk of warts outpatient visits in Hefei, China: a retrospective time-series study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:19342-19355. [PMID: 36239885 DOI: 10.1007/s11356-022-23522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Concerns are growing about the adverse health effects of ambient temperature and ambient temperature changes. However, the association between ambient temperature and ambient temperature changes on the risk of warts outpatient visits is poorly understood. Our study used the distributed lag non-linear model (DLNM) aimed to evaluate the association between ambient temperature, ambient temperature changes (including temperature change between neighboring days (TCN) and diurnal temperature range (DTR)), and warts outpatient visits. We also performed subgroup analyses in order to find susceptible populations by gender and age groups. The maximum relative risk (RR) of low ambient temperature (0 °C) for warts outpatient visits was 1.117 (95% CI: 1.041-1.198, lag 04 days), and the maximum RR of high ambient temperature (32 °C) for warts outpatient visits was 1.318 (95% CI: 1.083-1.605, lag 07 days). The large temperature drop (TCN = - 3 °C) decreased the risk of warts visits, with the lowest RR value at the cumulative exposure of lag 7 days (RR = 0.888, 95% CI: 0.822-0.959), and the large temperature rise (TCN = 2 °C) increased the risk of warts visits, with the highest RR value at the cumulative exposure of lag 7 days (RR = 1.080, 95% CI: 1.022-1.142). Overall, both low and high ambient temperatures and large temperature rise can increase the risk of warts visits, while large temperature drop is a protective factor for warts visits. However, we did not find any association between DTR and warts visits. Furthermore, subgroup analyses showed that males and the young (0-17 years old) were more sensitive to low and high ambient temperatures, and the elderly (≥ 65 years old) were more susceptible to TCN. The results may provide valuable evidence for reducing the disease burden of warts in the future.
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Affiliation(s)
- Bo Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Xin-Yu Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Yu-Lu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xiao-Jie Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Jie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Liang-Wei Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Ting-Ting Qian
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Yu-Yu Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Yin-Guang Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Mei-Shan Road, Hefei, Anhui, China.
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, Anhui, China.
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Bristow I. Paediatric Cutaneous Warts and Verrucae: An Update. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16400. [PMID: 36554279 PMCID: PMC9779159 DOI: 10.3390/ijerph192416400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
Cutaneous warts are common lesions in children caused by the Human Papilloma Virus (HPV) and for most lesions spontaneously resolve within months of the initial infection, regardless of treatment. The infection is most prevalent in the second decade of life affecting over 40% of children. Studies have demonstrated wart virus carriage on normal skin is higher in children with active lesions and family members. Subtypes HPV 2, HPV 27, HPV 57 and HPV 63 are particularly common in paediatric populations. Warts arising on the plantar surface of the foot (verrucae) can be particularly problematic owing to the location. They may interfere with daily activities causing pain and embarrassment. Plantar lesions have been shown to be more resistant to treatment than warts elsewhere on the skin. Systematic reviews and studies conducted over the last decade have demonstrated little evidence of innovation or effective improvements in treatment of recalcitrant lesions over the last 30 years. However, newer modalities such as immunotherapy (using injected vaccines) and hyperthermia using microwave treatment may hold promise in improving the treatment of these common and therapeutically frustrating lesions.
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Affiliation(s)
- Ivan Bristow
- Private Practice, Lymington, Hampshire SO41 9AH, UK
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10
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Karki S, Pradhan M, Rai A. Warts among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:770-773. [PMID: 36705137 PMCID: PMC9794928 DOI: 10.31729/jnma.7544] [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: 05/22/2022] [Accepted: 08/22/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Warts are benign epithelial proliferations caused by a double-stranded deoxyribonucleic acid virus called human papillomavirus. They may cause significant concern and frustration on the part of the patient affecting social activities as lesions can be uncomfortable, and treatment is often painful and frustratingly ineffective. The study aimed to find out the prevalence of warts among patients visiting the outpatient Department of Dermatology in a tertiary care centre. METHODS This descriptive cross-sectional study was conducted in a tertiary care centre from 20 January 2021 to 21 February 2022. The ethical approval was taken from the Institutional Review Committee (Reference number: IRC-NMCTH 588/2021). A convenience sampling technique was used. A detailed history including distribution, size, morphology, progression and duration of the lesions was taken. Point estimate and 95% Confidence Interval were calculated. RESULTS Out of 4802 outpatients, 140 (2.92%) (2.44-3.40, 95% Confidence Interval) had warts. Genital wart was found in 24 (17.14%) and non-genital warts in 116 (82.85%) patients. CONCLUSIONS The prevalence of warts among outpatients was similar when compared to other studies from similar settings.
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Affiliation(s)
- Sunita Karki
- Department of Dermatology, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal,Correspondence: Dr Sunita Karki, Department of Dermatology, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal. , Phone: +977-9841828313
| | - Manish Pradhan
- Department of Dermatology, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
| | - Anjan Rai
- Department of Dermatology, Nobel Medical College Teaching Hospital, Biratnagar, Morang, Nepal
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Ferrari J. Verrucae pedis in children with juvenile idiopathic arthritis and other paediatric rheumatic diseases: a cross-sectional study. J Foot Ankle Res 2022; 15:29. [PMID: 35449072 PMCID: PMC9026681 DOI: 10.1186/s13047-022-00526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Verrucae pedis (verrucae / VPs) are a common viral infection of the skin seen in children. There are limited studies of the prevalence, duration and impact of verrucae pedis in children who are immunosuppressed. The studies available suggest that, in these children, the warts are more widespread and are more long-standing. The primary aim of this study was to determine the prevalence of verrucae pedis in children attending rheumatology clinics who may have some degree of immunosuppression due to their prescribed medication and compare this to the reported prevalence in the healthy population. METHOD Children attending out-patient rheumatology appointments were recruited. The young people were aged between four and 17 years old. A visual inspection of both feet was used to identify potential verrucae. Diagnosis of a verruca pedis was confirmed on observation of the typical clinical features. The location, duration of presence, previous treatments, presence of verrucae in other family members and psychological impact was recorded. RESULTS A total of 71 children were included. Of the group, 55 children had no verrucae present, 16 children had one or more verrucae. The prevalence of verrucae was 22.5%. Medication impacting on the immune system was prescribed in 80% of the group. There appeared to be no greater chance of having verrucae if taking immunosuppressive medication than compared to having no medication (OR = 1.1, 95%CI 0.26 to 4.48, p = 0.46). Children with verrucae tended to be between 9 and 12 years old. In total, 37.5% of the young people with verrucae had lesions reportedly present for 24 months or more. Two-thirds of the participants were not concerned about verrucae being present and most participants with a verruca were not aware of what a verruca was, but despite this the majority of participants (81%) had sought treatment for the verrucae. CONCLUSION Children with Juvenile Idiopathic Arthritis and other rheumatic conditions have no greater prevalence of verrucae compared to the general population. The verrucae present were of a similar clinical type and did not seem to be more widespread or have atypical features, which has been reported in other immunocompromised populations. The percentage of lesions remaining beyond 24 months was found to be slightly greater than has been reported in other healthy populations. The children in this study seemed to be less emotionally concerned about their verrucae, despite this most families had sought treatment for the verrucae.
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Affiliation(s)
- Jill Ferrari
- University of East London, Stratford, London, UK.
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12
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Systemic 9-Valent Human Papillomavirus Vaccine for Recalcitrant Common Cutaneous Warts in Preparation for Renal Transplant. JAAD Case Rep 2022; 22:62-63. [PMID: 35321257 PMCID: PMC8935342 DOI: 10.1016/j.jdcr.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mahajan R, Kishore K, Jaswal V. The challenges of interpreting ANOVA by dermatologists. Indian Dermatol Online J 2022; 13:109-113. [PMID: 35198479 PMCID: PMC8809174 DOI: 10.4103/idoj.idoj_307_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
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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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15
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Burli A, Hancock S, Zhao YT, Paul D, Cordisco M. HPV Vaccination Status and Resolution of Warts in Pediatric Patients. Indian J Dermatol 2021; 66:604-608. [PMID: 35283520 PMCID: PMC8906332 DOI: 10.4103/ijd.ijd_30_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Warts are a common dermatologic complaint with an increased incidence within the pediatric population. Warts are caused by multiple strains of the human papillomavirus (HPV). There is little research on how a patient's HPV immunization status affects the response to treatment of warts in pediatric patients. Aims: The purpose of this study is to investigate the relationship between HPV vaccination status and wart resolution. Materials and Methods: This is a retrospective chart review that investigates the relationship between response to routine treatment of warts and a subject's HPV vaccination status. Results: There was no significant relationship found between HPV vaccination status and resolution of warts (p = 0.797). However, there was a significant positive correlation between having the HPV vaccine and number of visits for the treatment of warts (r = 0.180, P = 0.024). Conclusion: This study did not show a significant correlation between HPV vaccination status and wart resolution, although it demonstrated a significant positive relationship between those immunized with the HPV vaccine and an increased number of treatment visits. Possible explanations for this unexpected correlation include the variation in HPV vaccine formulation, vaccination status, and frequency of office visits, since vaccinated patients are more likely to be compliant with office visits.
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Affiliation(s)
- Anuk Burli
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Sarah Hancock
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Yu Tina Zhao
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Deborah Paul
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
| | - Maria Cordisco
- Department of Dermatology, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States
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16
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Kost Y, Deutsch A, Zhu TH, Hulur I, Blasiak RC. Vaccination against human papillomavirus is not associated with resolution of verruca vulgaris in immunocompetent 9- to 21-year olds. J Am Acad Dermatol 2021; 87:250-252. [PMID: 34418514 DOI: 10.1016/j.jaad.2021.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Yana Kost
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Alana Deutsch
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Tian Hao Zhu
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Imge Hulur
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel C Blasiak
- Department of Medicine, Division of Dermatology, Albert Einstein College of Medicine, Bronx, New York; Division of Dermatology, Jacobi Medical Center, Bronx, New York.
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17
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Erkayman MH, Bilen H. Clearance of longstanding treatment-resistant warts during COVID-19 in a transplant recipient. Transpl Infect Dis 2021; 23:e13572. [PMID: 33507618 PMCID: PMC7994983 DOI: 10.1111/tid.13572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/10/2023]
Abstract
Human papillomavirus (HPV), a DNA virus, infects basal keratinocytes and causes common warts and as well as malignancies of skin and mucous membranes. Although many treatment options are available, persistent HPV infections are common among transplant recipients. Herein, we present a patient with a 15‐year history of treatment‐resistant warts that regressed during COVID‐19 (Coronavirus disease 2019) treatment.
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Affiliation(s)
- Merve H Erkayman
- Department of Dermatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Handan Bilen
- Department of Dermatology, Faculty of Medicine, Atatürk University, Erzurum, Turkey
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18
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Oren-Shabtai M, Snast I, Noyman Y, Lapidoth M, Sherman S, Mimouni D, Hodak E, Levi A. Topical and systemic retinoids for the treatment of cutaneous viral warts: A systematic review and meta-analysis. Dermatol Ther 2020; 34:e14637. [PMID: 33278051 DOI: 10.1111/dth.14637] [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: 11/01/2020] [Revised: 11/18/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cutaneous viral warts (CVW), caused by human papillomavirus, often have a self-limited course. However, some patients experience a recalcitrant disease despite treatment. Retinoids are considered the mainstay of therapy in many dermatologic diseases. Data on their use for viral warts are limited. To systematically review the published evidence on the efficacy and safety of retinoids for the treatment of CVW. A systematic review and meta-analysis of topical or systemic retinoid treatment for CVW was performed in accordance with the PRISMA statement. The primary outcome was clinical response; secondary outcomes were recurrence rate and adverse events. Fourteen publications including 399 patients treated exclusively with retinoids (65% topical, 35% systemic) were evaluated. The complete response rate was 64% (95% CI, 46-78%; I2 =80%) for topical treatment and 61% (95% CI, 44-76%; I2 =69%) for systemic treatment. The most common side effects were irritant contact dermatitis and cheilitis, respectively. Relapse rates were 6% and 17%, respectively. The reviewed studies were considerably heterogenous and most lacked a control group. Both topical and systemic retinoids are effective and safe as monotherapy for CVW. Further studies are required to determine their exact role in this setting.
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Affiliation(s)
- Meital Oren-Shabtai
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Igor Snast
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehonatan Noyman
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Lapidoth
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shany Sherman
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Mimouni
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Levi
- Division of Dermatology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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19
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Soenjoyo KR, Chua BWB, Wee LWY, Koh MJA, Ang SB. Treatment of cutaneous viral warts in children: A review. Dermatol Ther 2020; 33:e14034. [PMID: 32683782 DOI: 10.1111/dth.14034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 12/14/2022]
Abstract
Viral warts or verruca are very common skin infections in children. Although benign, lesions can be extensive, painful, bleed, or lead to cosmetic disfigurement. Although spontaneous resolution can occur, parents often bring their children for treatment, especially when they are symptomatic. Many publications have assessed the efficacy and safety of treatment of warts in adults. However, treatment in children can be challenging due to their immune responses and lower threshold for pain. We review the current literature on the methods, efficacy, and side effect profile of common treatment modalities for cutaneous viral warts in children. There is evidence that salicylic acid and cryotherapy are effective, and although cryotherapy is more effective, there is a higher risk of side effects such as pain and blistering. Combination treatment with salicylic acid and cryotherapy may reduce these side effects. Although there is limited data, other treatment options such as cantharidin, immunotherapy and other mechanical therapies, for example, carbon dioxide lasers, may also be considered, especially for recalcitrant lesions.
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Affiliation(s)
| | | | - Lynette Wei Yi Wee
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mark Jean Aan Koh
- Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Seng Bin Ang
- Duke-NUS Medical School, Singapore, Singapore.,Dermatology Service, KK Women's and Children's Hospital, Singapore, Singapore.,Family Medicine Service, KK Women's and Children's Hospital, Singapore, Singapore
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20
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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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21
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Comparison of the Efficacy and Safety of Two Cryotherapy Protocols in the Treatment of Common Viral Warts: A Prospective Observational Study. Dermatol Res Pract 2020; 2020:2309309. [PMID: 32765598 PMCID: PMC7374216 DOI: 10.1155/2020/2309309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/11/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cryotherapy (freezing by liquid nitrogen) is an effective and widely used method for treatment of common warts. Patients often need multiple sessions at variable intervals. Protocols used by different dermatologists vary in terms of freezing time, the number of cycles, and the intervals between sessions. Aim To compare the efficacy (cure rates) and safety (complications, early and late) of two cryotherapy treatment protocols for common viral warts. Method A prospective observational study was conducted; it involved 80 patients with common warts on the hands and feet who were treated with cryotherapy done by two dermatologists who use different protocols; group 1 (45 patients) were treated by a single cycle of 10 seconds of freezing at 2 weekly intervals, and group 2 (35 patients) received a single cycle of 20 seconds of freezing at 4-weeks intervals. The two protocols were compared in terms of cure rate and complications 1-2 months after the final treatment. Recurrence rate and late complications were assessed at 9-12 months after the final treatment. Results Group 1 patients achieved higher cure rate than group 2, 77.8% and 54.3%, respectively (P=0.001). Early (blistering) and late complications (dyspigmentation and scarring) were comparable in both groups. Pain score associated with protocol 1 (5.2/10) was less than protocol 2 (6.4/10) (P=0.004). Recurrence rate (17%) was comparable in both groups. Association between cure rate and duration of warts (P=0.022) and also association between cure rate and the mean number of warts (P=0.001) were demonstrated. Conclusions Cryotherapy is an effective and safe treatment for common viral warts of hands and feet. The impact of shorter intervals on cure rate was more significant than increasing freezing time with longer intervals between freezing sessions. The study was approved by the local IRB committee (285-2018).
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22
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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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23
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Eshtiaghi P, Weinstein M. Where in the World Did You Get That Rash? Pediatr Rev 2020; 41:184-195. [PMID: 32238547 DOI: 10.1542/pir.2018-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Panteha Eshtiaghi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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24
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Abstract
Cutaneous warts are a common pediatric complaint with modest response to first-line treatments. Warts are a manifestation of human papillomavirus (HPV) infection and are cleared by cell-mediated immunity (CMI). Intralesional immunotherapy treatments have been studied as alternative therapies, particularly for recalcitrant or multiple warts, including Candida antigen, mumps antigen, the combined measles, mumps, and rubella (MMR) vaccine, tuberculin purified protein derivative (PPD), and bacille Calmette-Guerin (BCG) vaccine. These treatments are thought to increase HPV recognition by stimulating CMI. In this review, we evaluate and compare the efficacy and adverse effects of intralesional immunotherapy in the treatment of pediatric warts. Articles met inclusion criteria if they specifically evaluated the effects of intralesional immunotherapy (candida, MMR, tuberculin PPD, or BCG) as treatment for cutaneous warts in a pediatric population, and if they quantified treatment effect in a reproducible manner. Twenty-one studies met criteria. Many studies demonstrated complete clearance of injected common warts in pediatric patients with clearance rates ranging from 23.3% to 95.2%. Distant wart resolution was common. Intralesional immunotherapy is a promising treatment option for cutaneous warts in children.
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Affiliation(s)
- Jaime R Fields
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Sami K Saikaly
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Jennifer J Schoch
- Department of Dermatology, College of Medicine, University of Florida, Gainesville, FL, USA
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25
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Nguyen AL, Quint KD, Bouwes Bavinck JN, Erceg A, de Kort WJA, Körver JEM. Real-life treatment of cutaneous warts with cantharidin podophyllin salicylic acid solution. Dermatol Ther 2019; 32:e13143. [PMID: 31664756 PMCID: PMC6916542 DOI: 10.1111/dth.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/18/2019] [Accepted: 10/26/2019] [Indexed: 11/30/2022]
Abstract
Patients often request treatment of their burdensome cutaneous warts. However, a safe and effective treatment for cutaneous warts is lacking. This study evaluates treatment outcome, side effects, and patient satisfaction after topical application of cantharidin 1% podophyllin 2% salicylic acid 30% (CPS1) solution in a large series of children and adults with cutaneous warts. Fifty‐two children and 83 adults with warts, treated with CPS1 solution between October 2012 and October 2014, were included. Complete clearance of warts occurred in 86.5% of children and 62.7% of adults treated with CPS1 solution (p < .01). Resolution of warts was partial in 3.9 and 24.1% and absent in 9.6 and 13.2% of children and adults respectively. Side effects were present in 41.2% of children and 46.3% of adults (p = .7). Most common side effects were blistering, pain, and burning sensation. No serious adverse events occurred. On a 10‐point scale, median patient satisfaction score was 9.0 (interquartile range 7.8–10.0) and 8.0 (interquartile range 5.1–9.7) for children and adults respectively (p < .01). CPS1 solution is a safe and promising treatment modality with a high clearance and high patient satisfaction rate for the management of cutaneous warts, particularly in children.
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Affiliation(s)
- Anh Ly Nguyen
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands.,Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Koen D Quint
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Dermatology, Roosevelt Clinics, Leiden, The Netherlands
| | | | - Angelina Erceg
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - Wim J A de Kort
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
| | - John E M Körver
- Department of Dermatology, Amphia Hospital, Breda, The Netherlands
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26
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Rijsbergen M, Niemeyer-van der Kolk T, Hogendoorn G, Kouwenhoven S, Lemoine C, Klaassen ES, de Koning M, Beck S, Bouwes Bavinck JN, Feiss G, Burggraaf J, Rissmann R. A randomized controlled proof-of-concept trial of digoxin and furosemide in adults with cutaneous warts. Br J Dermatol 2019; 180:1058-1068. [PMID: 30580460 PMCID: PMC6850412 DOI: 10.1111/bjd.17583] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Background Topical ionic contraviral therapy (ICVT) with digoxin and furosemide inhibits the potassium influx on which DNA viruses rely for replication. Therefore, ICVT was hypothesized to be a potential novel treatment for cutaneous warts. Objectives To assess the clinical efficacy, safety and tolerability of ICVT in adults with cutaneous warts. The secondary objective was to gain insight into the underlying working mechanism of ICVT. Methods Treatment with ICVT was assessed for efficacy, safety and tolerability in a single‐ centre, randomized, double‐blind, placebo‐controlled phase IIA trial. Eighty adult patients with at least two cutaneous warts (plantar or common) were randomized to one of four treatments: digoxin + furosemide (0·125%), digoxin (0·125%), furosemide (0·125%) or placebo. The gel was administered once daily for 42 consecutive days. Predefined statistical analysis was performed with a mixed‐model ancova. The trial was registered at ClinicalTrials.gov with number NCT02333643. Results Wart size and human papillomavirus (HPV) load reduction was achieved in all active treatment groups. A statistically significant reduction in wart diameter of all treated warts was shown in the digoxin + furosemide treatment group vs. placebo (−3·0 mm, 95% confidence interval −4·9 to −1·1, P = 0·002). There was a statistically significant reduction in the HPV load of all treated warts in the digoxin + furosemide group vs. placebo (−94%, 95% confidence interval −100 to −19, P = 0·03). With wart size reduction, histologically and immunohistochemically defined viral characteristics disappeared from partial and total responding warts. Conclusions This study demonstrates the proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. What's already known about this topic? Cutaneous warts are caused by the human papillomavirus (HPV). Ionic contraviral therapy (ICVT) might be a potential treatment for cutaneous warts. A previous phase I/II open‐label study demonstrated the safety and efficacy of ICVT.
What does this study add? Proof of concept for the efficacy of topical ICVT in adults with cutaneous warts. Topical ICVT demonstrates a favourable safety profile, with the effects most pronounced when it is combined in a formulation for common warts. Wart size reduction was related to HPV load reduction measured by quantitative polymerase chain reaction (qPCR) in swabs. qPCR is a valuable disease biomarker for drug development in cutaneous warts.
https://doi.org/10.1111/bjd.17803 available online https://www.bjdonline.com/article/
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Affiliation(s)
- M Rijsbergen
- Center for Human Drug Research, Leiden, the Netherlands
| | | | - G Hogendoorn
- Center for Human Drug Research, Leiden, the Netherlands
| | - S Kouwenhoven
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - C Lemoine
- Center for Human Drug Research, Leiden, the Netherlands
| | - E S Klaassen
- Center for Human Drug Research, Leiden, the Netherlands
| | - M de Koning
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - S Beck
- DDL Diagnostic Laboratory, Rijswijk, the Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, U.S.A
| | - J Burggraaf
- Center for Human Drug Research, Leiden, the Netherlands
| | - R Rissmann
- Center for Human Drug Research, Leiden, the Netherlands
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Essa N, Saleh MA, Mostafa RM, Taha EA, Ismail TA. Prevalence and factors associated with warts in primary school children in Tema District, Sohag Governorate, Egypt. J Egypt Public Health Assoc 2019; 94:6. [PMID: 30774146 PMCID: PMC6351504 DOI: 10.1186/s42506-018-0007-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 12/20/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Warts are one of the most common, persistent, and frustrating cutaneous problems encountered in dermatology clinical practice especially in younger generations. OBJECTIVE To determine the prevalence of warts in primary school children in Tema District, Sohag, Egypt, and to determine possible factors associated with transmission. PARTICIPANTS AND METHODS A school-based cross-sectional (prevalence) study was carried out during the academic year 2015-2016 in six primary schools in Tema District, Sohag Governorate, Egypt. A total of 1045 students were examined. Data was collected using a self-administered semi-structured questionnaire which was taken home by the student to be completed by his/her caregiver. RESULTS Among 1045 examined school students, 108 students were diagnosed as having warts with a prevalence rate of 10.3%. Common wart was the most common type among students (49.0%) followed by plantar and plane warts (24.1%, each) while genital wart was the least one (2.8%). There was no significant sex or age difference. The prevalence of warts was significantly higher among students from public schools, rural areas, and big families; students with lower paternal education level; and students who were sharing shoes, walking barefoot, having contact with house pets, or exposed to water channels. CONCLUSION Warts, especially the common variant, are highly prevalent in primary school children. The significant factors associated with the development of warts in these children were big family size and sharing shoes. Other significant associated factors included living in rural areas, attending public schools, illiterate parents, fathers with manual work, and swimming in water canals.
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Affiliation(s)
- Nagwa Essa
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Medhat A. Saleh
- Department of Public Health and Community Medicine, Faculty of Medicine, Assuit University, Asyut, Egypt
| | - Rasha M. Mostafa
- Dermatology Clinic, Tema General Hospital, Tema District, Sohag Governorate Egypt
| | - Emad A. Taha
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Asyut, Egypt
| | - Taghreed A. Ismail
- Department of Public Health and Community Medicine, Faculty of Medicine, Assuit University, Asyut, Egypt
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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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Deeb M, Levy R, Pope E, Lara-Corrales I. Sinecatechins ointment for the treatment of warts in children. Pediatr Dermatol 2019; 36:121-124. [PMID: 30168174 DOI: 10.1111/pde.13653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sinecatechins ointment, a green tea derivative, is a novel agent approved for the treatment of anogenital warts in immunocompetent adults and has been reported to be effective in treating extragenital warts as well. Data are lacking in children. We sought to determine the efficacy and tolerability of sinecatechins ointment for treating warts in children. METHODS A retrospective cohort study was conducted of children with anogenital and/or extragenital warts treated with sinecatechins ointment for at least 1 month. The primary outcome was frequency of complete response (total resolution of warts at follow-up). Secondary outcomes included frequency of partial response (reduction in number and/or size of warts) and adverse events. There was no control group for comparison. RESULTS Of 24 patients who met the inclusion criteria, 14 (58.3%) had anogenital warts, 7 (29.2%) had extragenital warts, and 3 (12.5%) had both anogenital and extragenital warts. Mean age at treatment initiation was 8.0 years (SD = 3.9). Median duration of warts at treatment initiation was 1.2 years (range 0.09-12.62). Sixteen patients (66.7%) experienced a reduction in the number and/or size of the warts. Four patients (16.7%) had complete resolution. Median treatment duration was 4.5 months (range 0.6-21.8) overall. Median time to complete resolution was 2.9 months (range 1.3-7.7). Fifty-four percent of patients used sinecatechins ointment as prescribed. Adverse events were limited to mild local irritation (7 patients; 29.2%). CONCLUSION Sinecatechins ointment is a promising therapy for warts in children, and its use should be evaluated in prospective controlled clinical trials.
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Affiliation(s)
- Maya Deeb
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Rebecca Levy
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Elena Pope
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario.,University of Toronto, Toronto, Ontario
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Liu J, Li H, Yang F, Ren Y, Xia T, Zhao Z, Cao X, Wang Z, Yin M, Lu S. Epidemiology and Clinical Profile of Cutaneous Warts in Chinese College Students: A Cross-Sectional and Follow-Up Study. Sci Rep 2018; 8:15450. [PMID: 30337549 PMCID: PMC6194033 DOI: 10.1038/s41598-018-33511-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/26/2018] [Indexed: 11/09/2022] Open
Abstract
In this study, the hands and feet of 15,384 undergraduate and postgraduate students in 3 colleges in Beijing were examined for the presence of cutaneous warts at college-entry, and those diagnosed with warts were followed up 2-3 years later. We identified totally 215 (1.4%; 95% CI, 1.2-1.6%) students with warts. The prevalence was significantly higher in male than in female students (2.0% vs. 0.9%, P < 0.0001). Of the 215 patients, 66.9% and 62.1% had only one wart and 98.3% and 93.2% had warts <1 cm in diameter, on the hands and feet, respectively. Of the 130 patients with a follow-up visit, 78 did not receive any treatment (44 recovered within 2 years). Patients aged 21-25 compared to those aged ≤20 were more likely to be free of warts (hazard ratio = 1.76; 95% CI, 1.07-2.89), while lower father's education (hazard ratio = 0.19; 95% CI, 0.04-0.98) and poor sleep quality (hazard ratio = 0.41; 95% CI, 0.18-0.92) decreased the likelihood of resolution. The prevalence of warts is 1.4% in college students. The majority of patients have warts <1 cm and approximately 2/3 patients has one wart. Slightly over half of patients recover spontaneously within 2 years. Patients' age, sleep quality, and paternal education may affect the resolution.
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Affiliation(s)
- Jianjun Liu
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Hongtian Li
- Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, 100191, China
| | - Fan Yang
- Department of Dermatology, The Second People's Hospital of Wuqing, Tianjin, 301700, China
| | - Yingyun Ren
- Department of Dermatology, The Third People's Hospital of Foshan, Foshan, 528000, China
| | - Tianbao Xia
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Zigang Zhao
- Department of Dermatology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaojia Cao
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Zekun Wang
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Mengmeng Yin
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China
| | - Shichao Lu
- Department of Dermatology, 306 Hospital of PLA, Beijing, 100101, China.
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van der Kolk T, Dillingh MR, Rijneveld R, Klaassen ES, de Koning MNC, Kouwenhoven STP, Genders RE, Bouwes Bavinck JN, Feiss G, Rissmann R, Burggraaf J. Topical ionic contra-viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts. J Eur Acad Dermatol Venereol 2017; 31:2088-2090. [PMID: 28833595 PMCID: PMC5763383 DOI: 10.1111/jdv.14527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Background DNA viruses such as HPV rely on K+ influx for replication. Both digoxin and furosemide inhibit the K+ influx by interacting with cell membrane ion co‐transporters (Na+/K+‐ATPase and Na+‐K+‐2Cl− co‐transporter‐1, respectively). We therefore hypothesized that these two compounds in a topical formulation may be valuable in the treatment of HPV‐induced warts. This new approach is called Ionic Contra‐Viral Therapy (ICVT). Objective To evaluate systemic exposure, safety and tolerability of ICVT with a combination of furosemide and digoxin after repeated topical application in subjects with common warts. Furthermore, we aimed to evaluate pharmacodynamics effects of ICVT. Methods Twelve healthy subjects with at least four common warts on their hands were included in the study and treated with a fixed dose of 980 mg topical gel containing 0.125% (w/w) digoxin and 0.125% (w/w) furosemide for 7 consecutive days on their lower back to assess safety and systemic exposure. Two warts were treated with 10 mg each and two served as negative controls to obtain preliminary evidence of treatment effect. Results ICVT was well tolerated topically, and there was no evidence of systemic exposure of digoxin or furosemide. There were no clinical relevant safety findings and no serious adverse events (SAEs). A rapid and statistically significant reduction in diameter, height and volume of the warts was already observed at day 14. Conclusion ICVT was found to be safe for administration to humans and 7 days of active treatment showed a statistical significant wart reduction compared to untreated control lesions, clearly indicating pharmacological activity.
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Affiliation(s)
| | - M R Dillingh
- Centre for Human Drug Research, Leiden, The Netherlands
| | - R Rijneveld
- Centre for Human Drug Research, Leiden, The Netherlands
| | - E S Klaassen
- Centre for Human Drug Research, Leiden, The Netherlands
| | | | - S T P Kouwenhoven
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - R E Genders
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J N Bouwes Bavinck
- Department of Dermatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G Feiss
- Cutanea Life Science, Wayne, PA, USA
| | - R Rissmann
- Centre for Human Drug Research, Leiden, The Netherlands
| | - J Burggraaf
- Centre for Human Drug Research, Leiden, The Netherlands
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Nowak K, Linzner D, Thrasher AJ, Lambert PF, Di WL, Burns SO. Absence of γ-Chain in Keratinocytes Alters Chemokine Secretion, Resulting in Reduced Immune Cell Recruitment. J Invest Dermatol 2017. [PMID: 28634034 DOI: 10.1016/j.jid.2017.05.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Loss-of-function mutations in the common gamma (γc) chain cytokine receptor subunit give rise to severe combined immunodeficiency characterized by lack of T and natural killer cells and infant death from infection. Hematopoietic stem cell transplantation or gene therapy offer a cure, but despite successful replacement of lymphoid immune lineages, a long-term risk of severe cutaneous human papilloma virus infections persists, possibly related to persistent γc-deficiency in other cell types. Here we show that keratinocytes, the only cell type directly infected by human papilloma virus, express functional γc and its co-receptors. After stimulation with the γc-ligand IL-15, γc-deficient keratinocytes show significantly impaired secretion of specific chemokines including CXCL1, CXCL8, and CCL20, resulting in reduced chemotaxis of dendritic cells and CD4+ T cells. Furthermore, γc-deficient keratinocytes also exhibit defective induction of T-cell chemotaxis in a model of stable human papilloma virus-18 infection. These findings suggest that persistent γc-deficiency in keratinocytes alters immune cell recruitment to the skin, which may contribute to the development and persistence of warts in this condition and would require different treatment approaches.
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Affiliation(s)
- Karolin Nowak
- Molecular and Cellular Immunology, Institute of Child Health, University College London, London, UK
| | - Daniela Linzner
- Molecular and Cellular Immunology, Institute of Child Health, University College London, London, UK
| | - Adrian J Thrasher
- Molecular and Cellular Immunology, Institute of Child Health, University College London, London, UK; Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Paul F Lambert
- Department of Oncology, McArdle Laboratory for Cancer Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Wei-Li Di
- Immunobiology, Institute of Child Health, University College London, London, UK
| | - Siobhan O Burns
- Institute of Immunity and Transplantation, University College London, London, UK; Department of Immunology, Royal Free Hospital Foundation Trust, London, UK.
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DallʼOglio F, Luca M, Barresi S, Micali G. Treatment of Multiple-Resistant and/or Recurrent Cutaneous Warts With Squaric Acid Dibutylester: A Randomized, Double-blind, Vehicle-controlled Clinical Trial. Dermatitis 2017; 28:308-312. [PMID: 28885314 DOI: 10.1097/der.0000000000000317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Contact immunotherapy with squaric acid dibutylester (SADBE) for cutaneous warts has been reported to be effective, although no controlled studies are available so far. OBJECTIVE The aim of this study was to evaluate the efficacy of SADBE on cutaneous warts by a randomized, double-blind, vehicle-controlled, clinical trial. METHODS Thirty-six patients were randomly assigned to SADBE (18 cases) or vehicle (18 cases) group. At 8 weeks, subjects were clinically evaluated for number/size reduction rate and for Investigator Global Assessment. Those who showed improvement extended therapy up to 40 weeks, whereas those who showed unresponsiveness were either switched to SADBE application for up to 48 weeks (if in the vehicle group) or withdrawn from the study (if under SADBE). RESULTS At 8 weeks, a significant reduction in wart number (P = 0.020) and size (P = 0.010) in the SADBE group, with clearing rates of 41.2% versus 12.5% in the SADBE and vehicle groups, respectively, was observed. Nine remaining SADBE responders who underwent treatment extension up to 40 weeks achieved clearing versus 2 patients of the vehicle group who remained unresponsive. Clearing was obtained in 81.8% of patients who underwent previous ineffective vehicle treatment and had been switched to SADBE. CONCLUSIONS Squaric acid dibutylester is an effective therapeutic option and is significantly more effective than vehicle.
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Finley C, Korownyk C, Kolber MR. What works best for nongenital warts? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2016; 62:997. [PMID: 27965335 PMCID: PMC5154650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Caitlin Finley
- Master's student in epidemiology in the School of Public Health, in the Department of Family Medicine, at the University of Alberta in Edmonton
| | - Christina Korownyk
- Associate Professor in the Department of Family Medicine, at the University of Alberta in Edmonton
| | - Michael R Kolber
- Associate Professor in the Department of Family Medicine, at the University of Alberta in Edmonton
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Lux-Battistelli C, Muller C, Moragny J, Henquinet T. [Caustic necrosis due to topical formic acid 85% (Objectif ZeroVerrue(®))]. Ann Dermatol Venereol 2016; 143:543-6. [PMID: 27174715 DOI: 10.1016/j.annder.2016.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 01/07/2016] [Accepted: 03/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Formic acid 85% constitutes the active substance of a new wart removal agent marketed in France under the name of Objectif ZeroVerrue(®), a product sold over-the-counter for adults and children aged over four years, and on a doctor's recommendation for children aged under four years. Its mechanism of action may involve cellular destruction through dehydration. PATIENTS AND METHODS Herein we report two cases of cutaneous necrosis following application of formic acid 85%. One case was severe, affecting the extremity of the middle finger and involving the underlying extensor apparatus in a girl aged 3 and a half years. This necrosis required the creation of a pedicled fasciocutaneous flap and temporary arthroereisis. DISCUSSION The precautions for use set out in the information leaflet for this preparation based on formic acid must be strictly adhered to by patients. In particular, only one application should be made per week, taking care to avoid adjacent skin. It is essential to suspend treatment if the skin is still erythematous after the previous application, and the treated area must not be occluded with bandages. Doctors must be aware of the risk of necrosis, since their recommendation is required for children under the age of four years.
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Affiliation(s)
| | - C Muller
- Centre régional de pharmacovigilance, hôpital Civil, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - J Moragny
- Centre régional de pharmacovigilance, CHU Amiens Sud, 80054 Amiens cedex 1, France
| | - T Henquinet
- Cabinet, 36, rue de Lectoure, 68300 Saint-Louis, France
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Wang JW, Jiang R, Peng S, Chang YN, Hung CF, Roden RBS. Immunologic Control of Mus musculus Papillomavirus Type 1. PLoS Pathog 2015; 11:e1005243. [PMID: 26495972 PMCID: PMC4619818 DOI: 10.1371/journal.ppat.1005243] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/30/2015] [Indexed: 12/11/2022] Open
Abstract
Persistent papillomas developed in ~10% of out-bred immune-competent SKH-1 mice following MusPV1 challenge of their tail, and in a similar fraction the papillomas were transient, suggesting potential as a model. However, papillomas only occurred in BALB/c or C57BL/6 mice depleted of T cells with anti-CD3 antibody, and they completely regressed within 8 weeks after depletion was stopped. Neither CD4+ nor CD8+ T cell depletion alone in BALB/c or C57BL/6 mice was sufficient to permit visible papilloma formation. However, low levels of MusPV1 were sporadically detected by either genomic DNA-specific PCR analysis of local skin swabs or in situ hybridization of the challenge site with an E6/E7 probe. After switching to CD3+ T cell depletion, papillomas appeared upon 14/15 of mice that had been CD4+ T cell depleted throughout the challenge phase, 1/15 of CD8+ T cell depleted mice, and none in mice without any prior T cell depletion. Both control animals and those depleted with CD8-specific antibody generated MusPV1 L1 capsid-specific antibodies, but not those depleted with CD4-specific antibody prior to T cell depletion with CD3 antibody. Thus, normal BALB/c or C57BL/6 mice eliminate the challenge dose, whereas infection is suppressed but not completely cleared if their CD4 or CD8 T cells are depleted, and recrudescence of MusPV1 is much greater in the former following treatment with CD3 antibody, possibly reflecting their failure to generate capsid antibody. Systemic vaccination of C57BL/6 mice with DNA vectors expressing MusPV1 E6 or E7 fused to calreticulin elicits potent CD8 T cell responses and these immunodominant CD8 T cell epitopes were mapped. Adoptive transfer of a MusPV1 E6-specific CD8+ T cell line controlled established MusPV1 infection and papilloma in RAG1-knockout mice. These findings suggest the potential of immunotherapy for HPV-related disease and the importance of host immunogenetics in the outcome of infection. While most patients clear human papillomavirus (HPV) infection, some develop persistent papillomas, especially if immunocompromised. Likewise, we find a fraction of outbred SKH-1 mice challenged with Mus musculus papillomavirus type 1 (MusPV1/MmuPV1) develop persistent papillomas, whereas most SKH-1 mice, as seen for the inbred C57BL/6 and BALB/c strains, clear the infection. Viral clearance requires both CD4+ and CD8+ T cells, and depletion of either subset permits persistent but subclinical infection. In C57BL/6 mice, CD8+ T cell epitopes were mapped to MusPV1 E6 and E7; however the CD8+ T cell response to E6 dominated and correlated with spontaneous regression. A MusPV1 E6-specific CD8+ T cell line was developed by vaccination and culture in vitro, and its systemic administration once was sufficient to effect papilloma clearance in an immunodeficient mouse. Our observations in inbred and outbred mice challenged with MusPV1 suggest promise for immunotherapy to treat HPV-associated disease.
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Affiliation(s)
- Joshua W. Wang
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Rosie Jiang
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Shiwen Peng
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Yung-Nien Chang
- Research and Development Department, Papivax LLC, Rockville, Maryland, United States of America
- Immunotherapy Division, Papivax Biotech Inc., Taipei, Taiwan, Republic of China
| | - Chien-Fu Hung
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Richard B. S. Roden
- Department of Pathology, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Oncology, The Johns Hopkins University, Baltimore, Maryland, United States of America
- Department of Gynecology and Obstetrics, The Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
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Kuwabara AM, Rainer BM, Basdag H, Cohen BA. Children with Warts: A Retrospective Study in an Outpatient Setting. Pediatr Dermatol 2015; 32:679-83. [PMID: 25879618 DOI: 10.1111/pde.12584] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The purpose is to investigate the demographics and course of common warts in children in an outpatient setting. METHODS A retrospective medical chart review and telephone survey study were completed on an outpatient cohort of children (0-17 yrs) with a clinical diagnosis of warts at a single-center, university-based pediatric dermatology practice. The main outcome measures included management, time to resolution, and associated factors of warts in children. RESULTS Of the 254 patients we contacted, 214 agreed to participate in the survey. The most commonly involved sites were the hands and the head and neck area. Most children received some form of therapy, but it is unclear that any form of treatment altered the course. However, children with a medical history of childhood infections or more than one anatomic site had significantly greater risk of having a longer time to resolution. CONCLUSION Warts resolved in 65% of children by 2 years and in 80% within 4 years, regardless of treatment. With the exception of a history of childhood infections and having more than one anatomic site, time to resolution was not altered by wart or patient characteristics. Thus counseling without aggressive destructive treatment is a reasonable approach to managing warts in most children. Our findings will provide guidance in the process of shared decision making with parents and children.
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Affiliation(s)
- Anne M Kuwabara
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Barbara M Rainer
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Hatice Basdag
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Bernard A Cohen
- Division of Pediatric Dermatology, Departments of Pediatrics and Dermatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Goldberg DJ, Beckford AN, Mourin A. Verruca vulgaris: Novel treatment with a 1064 nm Nd:YAG laser. J COSMET LASER THER 2015; 17:116-9. [DOI: 10.3109/14764172.2015.1007068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sterling JC, Gibbs S, Haque Hussain SS, Mohd Mustapa MF, Handfield-Jones SE. British Association of Dermatologists' guidelines for the management of cutaneous warts 2014. Br J Dermatol 2014; 171:696-712. [PMID: 25273231 DOI: 10.1111/bjd.13310] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J C Sterling
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 OQQ, U.K
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