Measuring the serum level of retinol-binding protein can enhance the treatment of recalcitrant warts.

Abstract

Warts are common benign (60%-65%) self-limited tumors of the epidermis caused by human papillomaviruses (HPVs). However, some warts fail to resolve despite of different treatments and become recalcitrant. Vitamin A has antiproliferative and antikeratinizing properties by which the disruption of HPV replication can be occurred. Concentrations of retinol-binding protein (RBP) and retinol in the circulation highly correlate with each others. To assess the serum level of RBP in patients with resistant warts to evaluate the possible role of retinol in the disease pathogenesis. This case-control study included 30 patients with resistant cutaneous warts (defined as failure of cure after conventional treatment as 12weeks of salicylic acid application, 4 or more cycles of cryotherapy or electrocautery and/or other physical treatment modalities) and 30 age- and sex-matched healthy controls. RBP level in the serum was measured by ELISA. There was a significant difference between cases and controls regarding the level of serum RBP (P=.001). However, serum RBP level did not differ significantly regarding sociodemographic or clinical data (P>.05 each). RBP is a good biomarker for significant early detection and discrimination between cases and controls (P=.001) at a cutoff point<563.3mg/l with sensitivity (93%) and specificity (80%). Low serum RBP level in our studied patients may suggest an important role of retinol in the resistant warts pathogenesis. Thus measuring serum RBP will help to identify patients who are going to have resistant warts in the future.