Warts Research Articles

An Individualized Homoeopathic Approach in a Case of Palmar Wart- A Case Report

Background: Palmar warts are benign skin and mucous membrane lesions, caused by human papilloma virus (HPV) infection. In this case a 32 years old woman visited our outpatient department for the complaint of outgrowths over the front and back of both hands which was clinically diagnosed to be palmar warts along with headache. Methods: After detailed case taking and repertorization, at first individualized homoeopathic medicine, Natrum-muriaticum 200c was given and thereafter other drugs as per the indication were given. Within about one and half year of homoeopathic treatment, the patient started improving and continues to be free from her complains at the time of last followup visit in OPD and leaving a clear smooth skin demonstrating a positive role of individualised homoeopathic treatment in a case of verruca vulgaris. Results: Modified Naranjo Criteria for Homoeopathy tool was used to assess the causal relationship between homoeopathic intervention and clinical outcome. The MONARCH score(+9) suggested that the clinical improvement was likely attributable to the homoeopathic treatment, which is also evident from photographic images. Conclusions: This case study shows the utility of individual homoeopathic treatment in case of palmar wart. More studies and evidenced based clinical verification is required to establish the efficacy of homoeopathy in such cases.

The novel treatment of children with viral warts using microwave technology.

Microwave therapy is emerging as an effective, well-tolerated and safe treatment modality for cutaneous warts but there is limited data in paediatric patients. In our cohort of 35 paediatric patients with recalcitrant warts, 68.6% (24/35) demonstrated complete resolution after an average of three microwave treatment sessions. There were no reports of ulceration or blistering but 22.9% (8/35) of patients reported pain that required discontinuation of microwave therapy. This study provides evidence that microwave therapy can be used for the treatment of warts in paediatric patients.

Successful Remission of Refractory Plantar Warts with Cantharidin Plus in an Immunosuppressed Patient

Organ transplant patients on immunosuppressive therapies are susceptible to developing refractory human papillomavirus (HPV) infections including cutaneous warts. These warts are known to respond to conservative treatment modalities in the immunocompetent but are often refractory to multiple treatments in the immunosuppressed. Here we report a case of an immunosuppressed adult with plantar warts recalcitrant to numerous therapies that was ultimately treated successfully with cantharidin-podophyllotoxin-salicylic acid (CPS) monotherapy. After 19 treatment sessions over a 16-month time period, complete resolution was achieved. CPS may be a promising treatment modality in cases of severe, refractory verruca plantaris such as those seen in our immunosuppressed patient.

HPV Vaccination in Immunosuppressed Patients with Established Skin Warts and Non-Melanoma Skin Cancer: A Single-Institutional Cohort Study.

cSCC (cutaneous squamous cell carcinoma) and its precursors are a major cause of morbidity, especially in immunosuppressed patients, and are frequently associated with human papillomavirus (HPV) infections. The purpose of this study is to investigate the therapeutic potential of alpha-HPV vaccination for immunosuppressed patients with established cSCC and its precursors. In this retrospective study, all patients who received Gardasil-9®, a nonavalent HPV vaccine, as secondary prophylaxis were examined. Dermatologic interventions in both the pre- and post-vaccination periods were analyzed with zero-inflated Poisson regression and a proportional intensity model for repeated events with consideration of the clinically relevant cofactors. The hazard ratio for major dermatologic interventions was 0.27 (CI 0.14-0.51, p < 0.001) between pre- and post-Gardasil-9® intervention. Gardasil-9® vaccination showed good efficacy in reducing major dermatologic interventions even after correction of relevant cofactors and national COVID-19 caseloads during the observational period. Alpha-HPV vaccination may potentially cause a significant decrease in dermatologic interventions and overall mortality as well as healthcare costs in immunosuppressed patients with high skin tumor burden.

Treatment of therapy-resistant verruca plantaris with laser-assisted photodynamic therapy (PDT) with methyl aminolevulinate (MAL)

Mosaic warts are atype of verruca vulgaris that occur almost exclusively on the soles of the feet. They are particularly known for their treatment resistance and high recurrence rate. Laser-assisted drug delivery (LADD) photodynamic therapy (PDT) with methyl aminolevulinate (MAL) offers alow pain treatment option with hardly any side effects in therapy-resistant cases of verruca plantaris. Pretreatment with anablative fractional laser is especially important to obtain penetration of MAL through the human papillomavirus (HPV)-infected skin layer.

Clinical evidence of 595nm pulse dye laser treatment for viral warts on hands and feet.

Viral warts, induced by infection by different HPV genotypes, are highly frequent in the general population, particularly during infancy and among adolescents. The effectiveness of the 595nm Pulse dye-laser in treating viral warts on the hands and feet in both adults and children was investigated in this study. A selection of 203 patients with multiple viral warts was made. All patients underwent 4-5 treatment sessions with a 595nm pulse Dye Laser (PDL). Treatment outcome was assessed by a quartile scale: 1 indicates no or low results (0%-25% of the lesion area cleared), 2 indicates slight clearance (25%-50% of the lesion area cleared), 3 indicates moderate-good clearance (50%-75%), and 4 indicates excellent clearance (75%-100%). Patients were asked for a subjective evaluation of the perceived overall results by means of the following score: unsatisfied (1), not very satisfied (2), satisfied (3), and very satisfied (4). Possible side effects were monitored. Results obtained were judged with a photographic evaluation, immediately and at the control visit (6 months after the last laser session). All patients observed global improvements. Most of the lesions were completely removed after laser therapy. A total of 95% of patients achieved excellent clearance and they were very satisfied following the laser treatment. Relevant side effects were absent in all patients. PDL treatment with the study device using a wavelength of 595nm has proven to be a tolerable and safe therapy for viral warts management.

Painless and non-invasive treatment of plantar warts utilizing traditional Chinese medicine soaking: A case report

BackgroundWarts result from an infection with the human papilloma virus (HPV). Plantar warts, also known as Verruca plantaris, can be notably painful for the patient and possess contagious qualities, thus necessitating assertive treatment. Despite several available approaches for addressing plantar warts, efficacy remains elusive. Case presentationOne 22-year-old firefighter suffered from numerous plantar warts. After 26 days of traditional Chinese medicine soaking, the rashes completely disappeared. The treatment was without complications or discomfort, and a three-month follow-up showed no recurrence. ConclusionOur case investigation highlighted the efficacy of herbal soaking as a safe, painless, and non-invasive therapeutic option, positioning it as a potential avenue for managing multiple plantar warts.

Quality of life in children with skin disease: A Spanish sample

IntroductionThe impact of skin diseases on quality of life varies widely, and some can have an impact similar to that of asthma or cystic fibrosis. Material and methodsWe conducted a cross-sectional, observational and descriptive study with the aim of describing the degree to which quality of life was affected in paediatric patients managed in a dermatology clinic by means of the Children’s Dermatology Life Quality Index (CDLQI). ResultsIn our study, the skin disease with the greatest impact on quality of life was atopic dermatitis, chiefly on account of symptoms like pruritus and insomnia. It was followed by acne, mainly due to the associated negative feelings (shame, sadness, etc.). Quality of life in patients with viral warts and molluscum contagiosum was mostly affected by the treatment, chiefly based on cryotherapy. Most patients with nevi or café-au-lait spots did not have a decreased quality of life, although up to one third of them had negative feelings in relation to their skin disease. DiscussionAtopic dermatitis was the common skin disease that caused the greatest impairment in quality of life in our sample, although other diseases also had an impact on different dimensions of quality of life. We ought to underscore the recommendation to use less painful treatments than cryotherapy for viral warts and molluscum contagiosum, as the impairment in quality of life in paediatric patients with these conditions was mainly due to the treatment.

Skin surface material for detecting human papillomavirus infection of skin warts.

Warts, caused by human papillomavirus (HPV) infection, have various clinical presentations, making them difficult to differentiate from clavus, callus, and sometimes, squamous cell carcinoma. Although skin biopsies are the gold standard, a less-invasive method of examining these lesions is desired. Ninety patients with warts and related diseases, such as clavus and callus, were recruited to explore new differentiation methods using the surface of the warts. DNA was extracted from three types of specimens in each case: surface swab, shaved hyperkeratotic scale, and post-shaved surface swab. Total DNA was successfully extracted from these three specimens and was sufficient for subsequent HPV DNA detection. We analyzed samples for the HPV type and HPV viral load using polymerase chain reaction (PCR). Fifty-five cases were PCR-positive, and HPV1a, 2a, 4, 27, 57, and 65 were detected. The amount of HPV1a DNA produced was significantly greater than that of other HPV types. Regarding the correlation between the clinical diagnosis and HPV detection, the positive agreement rate was 90.9%, the negative agreement rate was 40.0%, and the overall agreement rate was 71.1%. Ten of the 21 cases clinically diagnosed as plantar warts were PCR-negative, especially in elderly patients. This suggests that it is difficult to distinguish plantar warts from clavus and callus in clinical practice. Although the amount of HPV DNA in the removed keratinization scale was highest for all HPV types, HPV detection by swabbing before and after shaving is also useful for follow-up as well as for differential diagnosis.

Evaluation of Allograft Injection (Heterologous Verruca Vulgaris Lesion Extract) in the Treatment of Verruca Vulgaris

Abstract Background Warts are a common viral infection in different age groups with more than 200 types. Its pathogen is the human papillomavirus (HPV), which causes cutaneous and mucosal warts Aim of the Work This study aims to evaluate the efficacy of local allograft injection (heterologous VV lesion extract) as a treatment of verruca vulgaris. Patients and Methods This study included 30 patients with VV recruited from Ain Shams University hospital outpatient dermatology clinic in the period from November 2018 till November 2019. They were 16 females and 14 males divided into 2 groups where 15 patients; got the treatment heterologous VV lesion extract repeated every 2 weeks till resolution or reaching maximum of 4 injections. The other 15 patients (controls) received saline injection. Follow up was performed with digital photography. Results After 4 sessions of intralesional injection and through 6 months follow-up, 11 patients out of the 15 cases group underwent complete resolution of all warts, while 2 patients had mild improvement, the last 2 patients had no improvement at all. while in controls group only one patient had a spontaneous resolution, one with mild improvement, and the rest 13 subjects with no improvement at all. Some of the patients suffered side effects during treatment course, where 3 patients (20% of cases group) suffered mild erythema, 1 patient (6.7% of total cases) suffered erythema and tenderness, 2 patients (13.3% of total cases) had minor ulcers. And 9 patients (60% of total cases) had no side effects. No recurrence in cases with complete resolution occurred in 6 months follow-up to the patients. Conclusion Heterologous verruca vulgaris extract when used as a line of immunotherapy treatment in multiple verruca lesions, shows promising results in both outcome of the treatment with total complete resolution 73.3% with no recurrence in cases in a 6-months follow-up.

Effect of ayurvedic multimodal therapies on Plantar warts - a case report

Deep plantar warts are the most common cutaneous lesions of the plantar aspect of the foot caused by Human papilloma Virus (HPV), mostly occur in children and adolescents. Most of the HPV infections are controlled by the humoral or cellular immune responses. But in few of the population groups these are manifested very frequently compared with other group of population. The virus sheds from the lesions and may infect the other sites of the plantar aspect or affect other parts of the body. Here we present a case of plantar warts which was successfully treated with multiple ayurvedic treatment modalities. This paper describes the case of a thirteen-year-old boy who presented to our hospital’s outdoor department with plantar warts since seven days. The patient was treated holistically with ayurvedic treatment modalities including soaking feet in lukewarm triphala decoction, topical application of garlic paste with 777 oil and an ayurvedic oral medication, pancha tikta ghrita guggulu, and the patient was cured completely in 20 days with 100% clearance and even after four years of follow up there was no sign of recurrence. The holistic approach of these ayurvedic treatment modalities have proven as effective and safe in treating the plantar warts.

Estudio de la calidad de vida en Dermatología Pediátrica: un ejemplo de la población española

IntroductionThe impact of skin diseases on quality of life varies widely, and some can have an impact similar to that of asthma or cystic fibrosis. Material and methodsWe conducted a cross-sectional, observational and descriptive study with the aim of describing the degree to which quality of life was affected in paediatric patients managed in a dermatology clinic by means of the Children's Dermatology Life Quality Index (CDLQI). ResultsIn our study, the skin disease with the greatest impact on quality of life was atopic dermatitis, chiefly on account of symptoms like pruritus and insomnia. It was followed by acne, mainly due to the associated negative feelings (shame, sadness, etc.). Quality of life in patients with viral warts and molluscum contagiosum was mostly affected by the treatment, chiefly based on cryotherapy. Most patients with nevi or café-au-lait spots did not have a decreased quality of life, although up to one third of them had negative feelings in relation to their skin disease. DiscussionAtopic dermatitis was the common skin disease that caused the greatest impairment in quality of life in our sample, although other diseases also had an impact on different dimensions of quality of life. We ought to underscore the recommendation to use less painful treatments than cryotherapy for viral warts and molluscum contagiosum, as the impairment in quality of life in paediatric patients with these conditions was mainly due to the treatment.

Towards Formulation of Highly Acidic Active Ingredients: Development of Clinically Effective Concentrated Trichloroacetic Acid Gel for Wart Management.

Common warts are benign skin lesions caused by the human papillomavirus. Although they are usually not harmful, they can cause pain, depending on their location. While many modalities are available for treatment of warts, none is a gold standard, and many are not affordable and/or have suboptimal outcomes. Trichloroacetic acid (TCA) is a chemical tissue-destroying agent used as a highly concentrated solution for wart management. While available and efficient, it is difficult to handle as the solution spreads to tissue surrounding the wart causing pain and burning. Hence, we developed a new polymer-based gel of high TCA content (100% w/v). Gels were formed successfully as hydroxyethyl cellulose (HEC) and chitosan were used to impart viscosity and bioadhesion. Formulae of different concentrations were tested for their physical properties, and the optimal formulation was selected for clinical evaluation. A combination of 3% HEC and 2% chitosan provided optimal viscosity and limited water content and have acceptable stability. The efficacy and safety of the biweekly application of TCA gel were evaluated in 30 patients. The clinical study revealed gel's efficacy and tolerability; half of the patients showed a complete cure, and 90% showed improvement within 6weeks. Only 10-12% of the patients reported side effects. In summary, transforming TCA solution into a gel enabled its application and handling in a practical manner by physicians and patients alike, while maintaining its efficacy as a tissue-destroying agent. Moreover, it is economic and easy to apply, rendering it a promising formulation for similar conditions requiring controlled tissue ablation.

Effectiveness of light-oxygen therapy in plantar warts (clinical observation)

Purpose: to describe a clinical case of successful application of light-oxygen therapy (LOT) in a patient with plantar warts.Material and methods. The publication presents a clinical case of the successful outcome after light-oxygen therapy in the absorption spectrum of endogenous oxygen with its transfer to the singlet state in a patient with plantar warts. Russian-made diode laser «Super Seb», manufactured by LLC New Surgical Technologies (Moscow, Russia) with wavelength near 1265 nm, laser power 0–3 W was used as a source of laser light. Radiation power was from 2.1 to 2.7 W. Power density – from 0.86 to 1.86 W/cm2. Exposure dose – from 258 to 558 J/cm2. No anesthesia was required. The maximal surface heating temperature during the procedure was 41 °C. Temperature was controlled with non–contact infrared thermometer ELARI SmartCare model YC-E13 (manufactured by Zhengyang Yuncheng Medical Technology Co. Ltd., China) to eliminate thermal damage. Laser sessions were twice a week with 3–4 day intervals.Results. Complete clinical remission was achieved after 14 LOT sessions.Conclusions. Light-oxygen therapy is an effective and safe procedure for patients with plantar warts.

Evaluation of skin disease patterns in a tertiary dermatology outpatient clinic in Türkiye

Skin diseases are among the reasons for frequent hospital admissions and bring a significant burden. The aim of this study is to determine the pattern of skin diseases in our dermatology outpatient clinic in a tertiary care hospital in Türkiye. Pediatric and adult patients evaluated in our dermatology outpatient clinics for the first time were included in this cross-sectional observational designed study between January and March 2023. The characteristics of the patients, including age, gender, duration of disease, anatomic localization of the disease, and complaint counts, were recorded in the data collection form. Diagnoses were grouped according to gender, age, and complaint counts. A total of 1381 patients with 1772 skin problems were included in the study. 62.3% of the patients were female (n=860), and 37.7% (n=521) were male. The age range was between 0 and 98 years. The most common diseases were acne (18%), dermatophytosis (8.1%), viral warts (6.5%), seborrheic dermatitis (4.8%), other dermatitis (4.8%), follicular disorders (4.6%), pruritus (3.7%), scabies (3%), benign neoplasms (3%), and urticaria (3%), respectively. 23.4% of the patients (n=324) had at least two complaints. The maximum number of complaints at one visit was 5. The probability of reporting more than one complaint was higher in women and those whose first complaint was on the scalp. In this analysis to determine the patterns of skin diseases, acne, dermatophytosis, and viral warts were found to be important problems. The number of complaints at one visit may vary according to gender and localization.

Plantar warts successfully treated with bee venom: A case report

BackgroundPlantar warts, or verruca plantaris, are common cutaneous lesions of the plantar surface caused by the human papilloma virus (HPV) infection. Current treatments include salicylic acid, cryotherapy, bleomycin, and immunotherapy; however, they have limitations of low-cure rates or side effects. Plantar warts treated with bee venom (BV) have not been reported. Here we present a case of a patient who showed complete remission of multiple plantar warts after BV treatment. Case presentationA 13-year-old boy experienced total of 16 plantar warts and visited department of dermatology of Korean Medicine. BV was injected into wart sites. Warts were completely removed at the end of the 8-week treatment with no adverse event recorded. There was improvement during the follow-up after 4 weeks. ConclusionThis is the first case of plantar warts that improved with BV injection. This study suggests that BV may be a therapeutic option for individuals who cannot receive cryotherapy due to pain during and after treatment or who have refractory or relapsed warts.

Intralesional immunotherapy with Bacille Calmette- Guerin (BCG) vaccine for the treatment of cutaneous warts

Myriad of therapeutic modalities for warts are available but none promises complete response. Despite adequate treatment, the virus may persist in the surrounding tissues leading to recurrence. Immunotherapy is considered better than destructive options where there are multiple lesions, extensive involvement and is best suitable for paediatric patients. The aim of the study was to evaluate the efficacy and safety of intralesional BCG vaccine in the management of cutaneous warts (common warts, plantar and periungual warts). Patients of age 12 years and above clinically diagnosed with cutaneous warts and presenting consecutively in the outdoor clinic of Dermatology, Venereology &amp; Leprosy Department of Dr. R.P. Govt. Medical College, Kangra at Tanda, Himachal Pradesh between June 2021 to May 2022 were enrolled. BCG vaccine was administered into the largest wart intralesionally and the injection was repeated every 3 weeks for a maximum of four injections or till the complete clearance of warts, whichever was earlier. The efficacy was assessed every 3 weeks and patients were followed up at 3 and 6 months. Majority of patients were in the age group of 14-53 years. The study showed therapeutic response in 35.08% (20/57) patients and partial response in 63.15% (36/57) patients while there was no response in 1.75% (1/57) patients at the end of 12 weeks with a very low recurrence rate (5.2%). Plantar warts have responded excellently showing complete clearance in 91.5% and partial response in 9.5% of the patients followed by palmar warts achieving complete response in 60% and partial response in 40% of the patients. The reconstituted BCG immunotherapy is a cheap, effective and easily available therapeutic option which can easily be practised routinely. However, due its considerable adverse effects as compared to other immunotherapeutic agents, we do not recommend it to be the first line agent.

Quantitative super-resolution microscopy reveals the differences in the nanoscale distribution of nuclear phosphatidylinositol 4,5-bisphosphate in human healthy skin and skin warts.

Introduction: Imaging of human clinical formalin-fixed paraffin-embedded (FFPE) tissue sections provides insights into healthy and diseased states and therefore represents a valuable resource for basic research, as well as for diagnostic and clinical purposes. However, conventional light microscopy does not allow to observe the molecular details of tissue and cell architecture due to the diffraction limit of light. Super-resolution microscopy overcomes this limitation and provides access to the nanoscale details of tissue and cell organization. Methods: Here, we used quantitative multicolor stimulated emission depletion (STED) nanoscopy to study the nanoscale distribution of the nuclear phosphatidylinositol 4,5-bisphosphate (nPI(4,5)P2) with respect to the nuclear speckles (NS) marker SON. Results: Increased nPI(4,5)P2 signals were previously linked to human papillomavirus (HPV)-mediated carcinogenesis, while NS-associated PI(4,5)P2 represents the largest pool of nPI(4,5)P2 visualized by staining and microscopy. The implementation of multicolor STED nanoscopy in human clinical FFPE skin and wart sections allowed us to provide here the quantitative evidence for higher levels of NS-associated PI(4,5)P2 in HPV-induced warts compared to control skin. Discussion: These data expand the previous reports of HPV-induced increase of nPI(4,5)P2 levels and reveal for the first time the functional, tissue-specific localization of nPI(4,5)P2 within NS in clinically relevant samples. Moreover, our approach is widely applicable to other human clinical FFPE tissues as an informative addition to the classical histochemistry.

Efficacy of Intralesional Immunotherapy with Vitamin D3 Injection in Cutaneous Warts: A Clinical Observational Study

Background: Skin warts are benign tumors caused by infection of keratinocytes with human papillomavirus (HPV), visible as well-defined hyperkeratotic protrusions. Recently, immunotherapy is emerging as a new modality in the treatment of viral warts. Immunotherapy using Vitamin D3 is being tried widely for the treatment of warts. It is based on enhancing the immune system to achieve an HPV-targeted immune reaction. Objective: The objective of this study was to evaluate the safety and efficacy of intralesional Vitamin D3 for the treatment of viral warts. Materials and Methods: This was a hospital-based longitudinal study of 55 patients with viral warts. 0.5 ml Vitamin D3 solution (600,000 IU, 15 mg/ml) was injected in the base of the wart. A maximum of four warts per session were injected at 2-week intervals until resolution or for a maximum of four treatment sessions. The clinical assessment was done by pre- and posttreatment photographic comparison at baseline, before each treatment session, and after the completion of treatment. Results: Thirty-five patients (63.63%) showed complete clearance, 15 patients (27.27%) showed partial clearance, and 5 patients (9.09%) patients showed no improvement. No significant side effects were observed except for pain and mild swelling at the site of injection. Conclusion: Intralesional Vitamin D3 immunotherapy seemed to be an effective, safe, inexpensive treatment with minimal side effects.

Intralesional Measles, Mumps and Rubella Vaccine versus Formic Acid Puncture in the Treatment of Common Warts: A Prospective Randomised Study.

Many therapeutic modalities have been reported for the treatment of warts: a common bothersome condition; however, no single treatment is completely effective. This study aimed to evaluate the efficacy and safety of intralesional injection of measles, mumps and rubella (MMR) vaccine and to compare its efficacy with 85% formic acid puncture for common warts. This was a prospective comparative study. A total of 60 patients, divided into two groups, were included in the study. Group A received an intralesional MMR vaccine of 0.3 ml per lesion, and group B received 85% formic acid puncture into each lesion with a maximum of 10 warts treated in each case. Five sessions were conducted every 2 weeks in each case with a follow-up period of 3 months to check for recurrence. The Chi-square test, Fisher's test and t-test were used for statistical analysis. A P-value <0.05 was considered statistically significant. In group A, the complete response was observed in 62.5%, partial response in 8% and no response in 4.1% of patients. In group B, the complete response was observed in 31.8%, partial response in 63.6% and no response in 4.5% of patients. The difference in cure rates was found to be statistically significant with a P value of 0.031. No recurrence was observed in both groups in the follow-up period. Immunotherapy by intralesional MMR vaccine is a simple, well-tolerated, effective and cost-benefit modality for the treatment of warts and showed a statistically significant cure rate than formic acid therapy.