Superficial radiotherapy (SRT-100) for refractory plantar warts: An alternative noninvasive treatment strategy

BACKGROUND

Verrucas that occur on the soles of the feet are called plantar warts, most of which can recur repeatedly and are difficult to eradicate. Hypertrophic and refractory plantar warts are often accompanied by pain and discomfort, which cause many inconveniences in patients' daily lives.

AIM

This study aimed to analyze the therapeutic effect of superficial radiotherapy (SRT-100) on refractory plantar warts and further create favorable conditions for the subsequent treatment of this disease with a high recurrence rate.

METHODS

A retrospective analysis was conducted for refractory plantar warts treated with superficial radiotherapy in our outpatient department from January to June 2023.

RESULTS

A total of 30 patients were included in our study (median age, 33 years). The female-to-male ratio was 1:3.29. Two to six months after radiotherapy, all of the warts subsided in 23 (76.67%) patients, most of the warts subsided in 4 (13.33%) patients, 3 (10%) patients did not respond to treatment, and 7 (23.33%) patients had recurrent or new warts after their warts subsided.

CONCLUSIONS

Most patients with refractory plantar warts improved after superficial radiotherapy. Our study presented that men are more susceptible to plantar warts than women, and young and middle-aged people are the main population affected by the disease. Superficial radiotherapy is an effective treatment for refractory plantar warts, which can quickly remove the warts in a short period. It is safe and noninvasive, with minimal adverse reactions. Some patients relapse after the lesion is clear, and superficial radiotherapy can create favorable conditions for the subsequent treatment of viral warts in clinical practice.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cryotherapy versus topical nitric-zinc complex solution for the treatment of plantar warts: A randomized controlled trial

Cryotherapy is commonly regarded as the primary treatment method for plantar warts. A new medical device called nitric-zinc complex solution (NZCS) has also emerged as a potential alternative for wart treatment. The main aim of this study was to analyze and compare the effectiveness of cryotherapy using liquid nitrogen and NZCS in treating plantar warts. We conducted a randomized and controlled clinical trial involving patients with plantar warts. A total of 62 patients were enrolled in the study and monitored for 12 weeks or until their warts were completely resolved. The patients received either cryotherapy or NZCS, with a maximum of six treatment applications. The cure rate was 65.5% in the group treated with cryotherapy and 56.6% in the group treated with NZCS. The average number of treatment applications required for curing warts was significantly lower in the cured group (3.28 ± 1.63) than in the group with unresolved warts (5.5 ± 1.27) (p < 0.01). Moreover, the average number of applications was lower in the cryotherapy group (3.6 ± 1.8) than in the NZCS group (4.8 ± 1.8) (p < 0.01). Based on the findings, NZCS could be considered a favorable first-line treatment option for plantar warts.

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

BACKGROUND

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Clinical observation and study of local hyperthermia for treating plantar warts: A pilot study with 38 patients

Warts are benign lesions caused by infection of the keratinocytes by the human papillomavirus (HPV). There is still no consensus on the standard treatment for plantar warts, and the various treatments (both destructive and non-destructive) have variable efficacy with a long list of shortcomings, such as higher recurrence, pain, and scarring. Local hyperthermia was considered a safe, effective, and promising therapy in the treatment of plantar warts. After getting approval from the hospital's ethics committee, the present study was designed to assess the clinical efficacy of local hyperthermia in the treatment of plantar warts. A total of 38 patients were enrolled in the study, and all patients received a standard regimen in a 5-week schedule, with local 45°C treatment for 30 mins on days 1, 2, 3, 14, 15, 22, 29, and 36. Of the 38 patients, complete resolution of the warts was observed in 13 (34.2%), 8 (21.1%) achieved partial remission, and 17 (44.7%) revealed poor response to the treatment. Patients were followed up for at least 3 months, and there was no recurrence of lesions in the 13 clinically cured patients at the last follow-up. The findings in the current study demonstrate that local hyperthermia is a safe, effective, and promising therapy for the treatment of plantar warts.

Successful Treatment of Multiple Plantar and Periungual Warts by Local Hyperthermia Treatment: A Case Report

Local hyperthermia treatment, a common immunoadjuvant therapy, has been used in treating various human papillomavirus (HPV) infections. For multiple warts, it can clear off all warts of the body through targeted irradiation on one wart. We reported a case of a 22-year-old patient with multiple plantar warts combined with periungual warts, in which previous treatments were ineffective. Therefore, we utilized local hyperthermia treatment at 44°C using the largest fused-wart plaque on the right plantar as the treatment target for 30-minute irradiation each time. The hyperthermia induction therapy was performed on day 1, 2, 3, 12 and 13, followed by weekly maintenance therapy for 6 times. After 2 months of treatment, both irradiated and non-irradiated lesions disappeared, and no recurrence occurred during the follow-up period. This case indicates that local hyperthermia treatment may be a safe and effective approach for patients with multiple, recalcitrant, and site-specific viral warts due to the ineffectiveness of conventional treatment.

Efficacy of cryotherapy for plantar warts: a systematic review and meta-analysis

Recent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than alternative treatments. A systematic review using meta‐analyses of the efficacy of cryotherapy in plantar warts treatment was performed. Systematic electronic searches were conducted. The primary endpoint was complete clearance of plantar warts. Risk‐of‐bias assessment was based on Cochrane Handbook recommendations. Meta‐analyses used Review Manager v5.4.1 software. Cryotherapy appears to have lower cure rates than other treatments (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12–0.78) with substantial heterogeneity (I² = 80%). A second subgroup analysis had low heterogeneity (I² = 28.2%). Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to the physical treatment group (OR 0.05, 95% CI 0.01–0.49) with substantial heterogeneity (I² = 79%), and antiviral, chemotherapy, and retinoid group (OR 0.30, 95% CI 0.14–0.66) without heterogeneity (I² = 0%). Intralesional versus spray‐on cryotherapy appears to be more effective (OR 0.21, 95% CI 0.09–0.48). No difference in efficacy between two rounds of 10‐s and four rounds of 5‐s freeze–thaw cycles in cryotherapy was found. Evidence of the superiority of antivirals and chemotherapy over cryotherapy in the treatment of plantar warts was found. However, no evidence supports the superiority or inferiority of cryotherapy compared to other treatments.

Efficacy of the Treatment of Plantar Warts Using 1064 nm Laser and Cooling

Cutaneous plantar warts may be treated using several optional methods, with the use of laser surgery having increased in the last few years. This work examined the efficacy of laser treatment combined with simple cooling to reduce pain. The cure rate was approximately 84%. There were no significant differences in the efficacy of treatment for different viral genotypes. The laser parameters were 500 msec pulses, 30 W of power, and a fluence of 212 J/cm² delivered in up to four sessions. Successful treatment was achieved after an average of 3.6 sessions.

A non-invasive method for diagnosing plantar warts caused by human papillomavirus (HPV)

The methods that are used for the diagnostic confirmation of human papillomavirus (HPV) include excisional biopsy and histopathological studies or polymerase chain reaction (PCR). They are invasive, laborious, and subject to ethical restrictions due to the benign nature of these warts. This study aims to analyse the accuracy of noninvasive swab samples to diagnose plantar warts. Fifty plantar warts were included in the study. Skin swabs and hyperkeratosis skin scales were collected from each wart. Multiplex PCR was performed to detect and type the HPVs. The prevalence of HPV in this study was 90% when the sample was obtained using the wart scraping method and 94% when it was obtained using swabs and the new method. In 45 of the 45 positive samples (sensitivity: 100%), the result between the wart scab and wart swab were almost identical. The genotyping result was identical in all 46 patients who had a positive result using both methods. The swab method appears to be a simple and accurate technique to diagnose plantar warts due to HPV. It is a noninvasive technique that could be performed even by inexperienced professionals and in patients with pain or a fear of needles.

Diagnostic techniques in HPV infections and the need to implement them in plantar lesions: A systematic review

INTRODUCTION

Human papillomavirus has been reported as the etiological cause of most cervical cancers and other potentially malignant lesions. It also affects other areas, producing benign tumors on the skin. Plantar warts are a common problem found in clinical practice and share signs and symptoms with other dermatological conditions. Diagnosis of HPV infection remains a hot topic in research.

METHOD

The present work systematically reviews the literature on the diagnostic techniques available in the clinical setting for any type of lesion produced by the virus and compares the techniques identified to those found in use for foot lesions.

RESULTS

Results showed a variety of diagnostic methods, including molecular techniques, which exhibit more sensitivity than other methods but are less frequently applied to plantar lesions, where visual inspection is the most frequent method but can lead to errors.

CONCLUSION

The techniques identified need to be applied to plantar lesions to improve differential diagnosis in clinical practice.

EXPERT OPINION

Research will continue to grow and a proper diagnostic technique for plantar lesions will be available in the near future.

HPV Vaccination Status and Resolution of Warts in Pediatric Patients

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.

A case of resistant multiple plantar warts cured with combined autologous platelet-rich plasma injection and topical salicylic acid 30

BACKGROUND

Plantar warts are common benign cutaneous lesions affecting the plantar aspects of the feet; they are caused by infection of the keratinocytes by the human papillomavirus (HPV). The effective treatment of plantar warts is still a therapeutic challenge.

AIM

This study aimed to assess the possible clinical efficacy and safety of the combined intralesional autologous platelet-rich plasma (PRP) injection with local application of salicylic acid 30% solution in the treatment of multiple resistant plantar warts.

METHOD

In the present case, a 54-year-old immunocompetent male patient presented with multiple, bilateral resistant plantar warts.

RESULTS

A complete clearance of the plantar warts was observed after three sessions of intralesional autologous PRP injections with one-month interval, combined with twice-daily local application of salicylic acid 30% solution between sessions. No recurrence was recorded after a nine-month follow-up from the last session. There were no reported side effects during or after the sessions.

CONCLUSION

The combined intralesional autologous PRP injection with topical salicylic acid is an effective, economic, and safe modality of treatment for multiple resistant plantar warts.

A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts

Background:

Warts are benign proliferations of keratinocytes caused by Human Papilloma Virus (HPV). Plantar warts are caused by HPV types 1, 2, 4, 27 and 57. It is challenging to treat them due to frequent recurrences.

Aim:

To compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with needling versus 30% Trichloroacetic acid (TCA) with needling in the treatment of plantar warts.

Materials and Methods:

Sixty consecutive patients of plantar warts were randomly allocated into two groups of 30 each and treated with either 30% TCA with needling or 5% 5-FU with needling once in four weeks, until complete clearance of warts or for a maximum of three sessions. Baseline clinical photographs were taken and subjective response at the end of treatment was recorded. Objective assessment at 4, 8, and 12 weeks was carried out and outcome was evaluated by reduction in number and size of warts. Adverse effects of each group were noted and compared. Follow-up of patients was done at 6 months for clinical assessment of results and to study recurrence.

Results:

Out of 30 patients in 30% TCA group, 28 patients (93.33%) had complete response and 02 patients (6.66%) had partial response at the end of 12 weeks. In 5-FU group, 26 patients (86.66%) showed complete response, 02 patients (6.66%) had partial response, and 02 patients (6.66%) had no response to treatment. The mean reduction in size and number of warts was better in the TCA group and was significant at 4^th week of follow up while at the end of 8^th week and 12^th week, the response was identical. There was no recurrence of warts in the complete responders at the end of 6 months. The main adverse effect seen in both groups was pain at the needling site.

Conclusion:

Needling with both topical 5% 5-FU and 30% TCA are highly effective in clearing plantar warts. However, 30% TCA has the advantage of early action and complete clearance of plantar warts with fewer adverse effects.

Topical treatment for plantar warts: A systematic review

There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the efficacy of different topical treatments on plantar warts. Systematic electronic searches (Pubmed, Cochrane Library, Embase, and Web of Science) were conducted in April 2020. Meta-analyses, systematic reviews, and retrospective or prospective clinical trials of the effects of topical and nonsurgical treatments of plantar warts were included. Two authors performed the study selection and data extraction. Any discrepancies between the two reviewers were discussed with a third reviewer. Forty-four studies were included. The average cure rates of the most frequent treatments were variable across the studies: cryotherapy (45.61%), salicylic acid (13.6%), cantharidin-podophyllin-salicylic acid formulation (97.82%), laser (79.36%), topical antivirals (72.45%), intralesional bleomycin (83.37%), and intralesional immunotherapy (68.14%). Twenty-two studies (50%) had a level of evidence 1b and grade of recommendation A, five studies (11.4%) had a level of evidence 2b and grade of recommendation B, two studies (4.5%) had a level of evidence 3b and grade of recommendation B, and 15 studies (34,1%) with a level of evidence 4 and grade of recommendation C. First-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts. Other treatments, such as CPA formulation, immunotherapy, and intralesional bleomycin, which have compassionate use, have higher cure rates. This review should stimulate future high-quality research to evaluate these specialized treatments.

The efficacy of microneedling alone vs its combination with 5-fluorouracil solution vs 5-fluorouracil intralesional injection in the treatment of plantar warts

Intralesional 5-fluorouracil (IL5-FU) has been used off-label for warts treatment; however, its use was limited by intense pain. Combination treatment can offer a robust therapeutic effect. Was to assess the therapeutic efficacy, safety and tolerability of microneedling vs its combination with 5-FU solution vs IL5-FU in the treatment of plantar warts. Ninety patients with plantar warts were divided randomly into three groups each containing 30 patients. Group A received (intralesional 5-FU), group B (microneedling) while group C (microneedling and 5-FU solution). All groups received treatment for a maximum of six sessions 2 weeks apart. Complete response was observed in 86.7% of the warts treated with 5-FU and microneedling (group C) vs to 76.7% and 70% in group A and B, respectively, with no statistically significant difference (P = .36). A significant increase in the number of sessions (P = .01) and pain score (P = .001) were found among group A compared to groups B and C. Patient's satisfaction was higher in group C (P = .05). No recurrence was reported in all groups. Microneedling can be used as alternative or adjuvant therapeutic modality for plantar warts treatment and significantly associated with less pain. Combination group was superior compared to the others.

Silver duct tape occlusion in treatment of plantar warts in adults: Is it effective?

Duct tape occlusive therapy may represent a convenient alternative to the standard wart therapies. The objective of the current study is to assess the therapeutic effect of duct tape occlusion in comparison to cryotherapy in treatment of plantar warts in adults, in a prospective comparative randomized non-inferiority design. A total of 100 patients presenting with plantar warts were divided into two equal groups. First group was treated with silver duct tape occlusion for up to 8 weeks or disappearance of warts, whichever occurred first. Second group was treated with cryotherapy every 2 to 3 weeks for a maximum of four sessions or disappearance of warts. There was a statistically significant lower rate of complete resolution in duct tape than cryotherapy group (20% vs 58%, P = .0001, respectively). Degree of response to treatment in the duct tape and cryotherapy groups was not correlated to patients' age (P = .361 and .334, respectively) or disease duration (P = .266 and .285, respectively), while there was a statistically significant inverse relationship between the number (P = .0032 and .001, respectively) and diameter of warts (P = .013 and .003, respectively) and the degree of response in the two studied groups. Cryotherapy has higher efficacy than duct tape in the treatment of plantar warts in adults; however, duct tape may represent a practical and convenient alternative to cryotherapy in certain circumstances.

Efficacy of intralesional methotrexate in the treatment of plantar warts

Warts are tumors or growths caused by infection with human papilloma virus (HPV). Currently, over 170 HPV types have been identified. This study aimed to evaluate the efficacy and safety of intralesional injection of methotrexate (MTX) for the treatment of plantar warts. Sixty patients presented with plantar warts were divided into two groups. Group A patients were injected with intralesional MTX (2 mg/ml). Group B patients were injected with intralesional saline as a placebo. The injections were repeated every week for a maximum of six sessions or until complete clearance, whichever was earlier. The patients were followed up for 6 months after the last injection. In the intralesional MTX group, 2 patients (6.7%) showed complete improvement, 8 patients (26.7%) showed partial improvement, and 20 patients (66.7%) showed no improvement. In the intralesional saline group, 3 patients (10%) showed complete improvement, 4 patients (13.3%) showed partial improvement, and 23 patients (76.7%) showed no improvement. Reported adverse events were local reactions in the form of swelling, pain, and infection in both groups. There was no statistically significant difference between the therapeutic responses to intralesional MTX injection and saline.

Successful treatment of plantar warts using topical Zijinding, a traditional Chinese medicine preparation: A case series

Introduction

Plantar warts are associated with high transmissibility and morbidity. Among the available therapeutic options, none is uniformly effective or virucidal. Salicylic acid is the first‐line therapy but approximately one‐third of lesions could not resolve and become recalcitrant despite repeated treatment. Cryotherapy is widely accessible with low cost but may be complicated by pain, blister formation, hemorrhage, infection, excessive granulation tissue formation, and hyper‐/hypo‐pigmentation. Hence, alternative treatment modalities are essential.

Methods

Three patients with debilitating plantar warts refractory or intolerant to cryotherapy were treated with a course of Zijinding (a traditional Chinese medicine preparation) paste prepared with white vinegar.

Results

All three patients showed excellent clinical response with Zijinding application with evolution of lesions to scabs and subsequently healthy skin within 1.5 to 5 months of treatment. Treatment was well tolerated and had no significant side effects with excellent compliance recorded for all three patients. There was no relapse for at least 10 months after stopping the treatment.

Conclusion

Topical Zijinding could be a promising alternative modality for the treatment of plantar warts. Further clinical trials on the comparison of Zijinding and other treatment modalities of plantar warts are warranted. Further studies are required to investigate the mechanism of action of Zijinding and to isolate the active ingredient.

Cryotherapy versus CO2 laser in the treatment of plantar warts: a randomized controlled trial

Background

Warts are one of the most common infections in humans. Plantar warts are a subtype of non-genital warts, and several procedures and topical treatments have been used in its treatment. Cryotherapy is one of the most popular modalities, but it is time-consuming and remission rates vary in different studies. CO₂ laser was the first laser used for treating warts. To date, no clinical trial has been done to compare CO₂ laser with cryotherapy in the treatment of plantar warts.

Patients and Methods

This randomized controlled trial was performed in order to compare the efficacy and number of sessions needed to treat plantar warts in 60 patients who had received no previous treatment in the previous 3 months. They were randomly allocated to the cryotherapy or CO₂ laser group. The number of sessions needed for response and the recurrence rate after a 3-month follow-up was compared in the 2 groups.

Results

Sixty patients with plantar warts were randomly allocated to either the CO₂ laser or cryotherapy groups. Median age was 25 (range=18–53) and 27 (range= 18–75) years in the cryotherapy group and CO₂ laser groups, respectively. Both groups were matched for age and sex (56% male and 44% female in the cryotherapy group and 34% male and 66% female in the CO₂ laser group). The median number of sessions needed for complete resolution of the warts in the CO₂ laser and cryotherapy groups were 1 (range=1–2) and 3 (range=1–12), respectively. The difference in the number of sessions was statistically significant between the 2 groups (P-value≤0.001). Recurrence rates after a 3-month follow-up was not statistically significant (P-value= 0.069).

Conclusion

The number of sessions needed to treat plantar warts was less using CO₂ laser than cryotherapy; therefore, this modality can be a good addition to the already existing anti-wart armamentarium.

Three Hundred Patients Treated with Ultrapulsed 980 nm Diode Laser for Skin Disorders

The use of lasers in skin diseases is quite common. In contrast to other laser types, medical literature about 980 nm ultrapulsed diode laser is sparse in dermatology. Herein, we report the use of ultrapulsed diode 980 nm laser in 300 patients with vascular lesions, cysts and pseudocysts, infectious disease, and malignant tumors. This laser is a versatile tool with excellent safety and efficacy in the hands of the experienced user.

EVerT2-needling versus non-surgical debridement for the treatment of verrucae: study protocol for a single-centre randomised controlled trial

INTRODUCTION

Verrucae are extremely common, and are experienced by most people at some time during their lives. Although most verrucae will spontaneously disappear without treatment, many patients seek treatment, often because they have persisted for many years, are unsightly or painful or prevent them from doing sports or other activities. There are many different treatments available; including the Falknor's needling procedure. To date, there has only been one small trial evaluating the clinical effectiveness of this treatment and no health economic analysis has been undertaken. The Effective Verruca Treatments (EVerT2) trial aims to evaluate the clinical and cost-effectiveness of the needling procedure for the treatment of verrucae.

METHODS AND ANALYSIS

This single-centre randomised controlled trial will recruit 58 participants (aged 18 years and over with a plantar verruca) from Salford Podiatry Clinic patient lists and the surrounding area. If the participant presents with multiple verrucae, an 'index' verruca (largest and thickest lesion) will be identified and patients will be randomised 1:1 to the intervention group to receive the needling treatment or the control group to have the callus overlying the verruca debrided. The primary outcome is complete clearance of the index verruca at 12 weeks after randomisation. Secondary outcomes include clearance and recurrence of the treated verruca, clearance of all verrucae, number of verrucae remaining, change in size of the index verruca, pain, and participant satisfaction. A cost-effectiveness analysis of the needling versus callus debridement will be carried out from the perspective of health services over a time horizon of 12 weeks.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the University of Salford, Department of Health Sciences Ethical Approval Committee (HSCR15/24) and the University of York, Department of Health Sciences Research Governance Committee (HSRGC/2014/98/B). Findings will be disseminated through publication and conference presentations.

TRIAL REGISTRATION NUMBER

ISRCTN16429440.

Recalcitrant plantar warts during azathioprine therapy for Crohn's disease

Dermatological complications of long-term immunosuppressive therapy in inflammatory bowel disease (IBD) are rarely reported. We present the case of a 29-year-old man with worsening of plantar warts while on azathioprine therapy for Crohn's disease. This case underlines the need to perform thorough skin examination of IBD patients before and during immunosuppressive therapy.

Plantar warts treated with topical adapalene

Background:

Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful.

Purpose:

The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts.

Materials and Methods:

A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts.

Findings:

Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene.

Conclusion:

Adapalene clears the plantar warts faster compared to other modalities available.

Limitation:

Need trial with large number of patients.

The immune reconstitution inflammatory syndrome

A paradoxical clinical worsening of a known condition or the appearance of a new condition after initiating antiretroviral therapy in HIV-infected patients is defined as immune reconstitution inflammatory syndrome (IRIS). Because of wide variation in clinical presentation and the still increasing spectrum of symptoms and etiologies reported, diagnosis remains problematic. Furthermore, no test is currently available to establish an IRIS diagnosis. Until a greater understanding of the syndrome is achieved in different regions of the world, clinicians need to remain vigilant when initiating ART and individualize therapy according to known treatment options for the specific infectious agent.

[Risk factors linked to the transmission of papilloma virus in the school environment. Alicante, 1999]

OBJECTIVE

The aim of this study is to describe an outbreak of plantar warts and to analyse the risk factors wich determining the transmission.

DESIGN

Cross-sectional survey.

SETTING

A school of Alicante.

PARTICIPANTS

1,620 students.

MEASUREMENTS AND MAIN RESULTS

Description and analysis of the outbreak. We studied the magnitude and the association between risk factors (sports activities and hygiene habits) and disease by logistic regression model. We estimated the crudes and adjusted odds ratio (OR) and the confidence intervals (CI) of 95%. We carry out environmental study and active search of cases. The global rate of answer to the cross-secctional survey was 70.86%. Reported cases were 221, the global attack rate was 19.25%. The outbreak occurred over 16 months. We did not find statistical significal difference either by sex (P=.138) or age (P=.233). The hygiene conditions of the swimming pool and the changing room were adapted. The risk of disease increased with the number of activities taking place (P=.001). The OR adjusted for hygiene habits was: use of changing room 0.95 (95% CI, 0.38%-2.41%), use of shower rooms 1.06 (95% CI, 0.70%-1.62%), walking barefoot in the changing room 1.97 (95% CI, 1.39%-2.79%) and showering barefoot 0.97 (95% CI, 0.58%-1.64%).

CONCLUSIONS

Outbreak of person to person transmission, the floor of the changing rooms was the prime cause of transmission. We did not find any association between the use of public swimming pool and the disease