Recalcitrant Cutaneous Warts Research Articles

Intralesional human papillomavirus vaccine for the treatment of recalcitrant cutaneous warts.

Human papillomavirus (HPV) is ubiquitously distributed in the population worldwide and its most frequent clinical presentation is cutaneous warts. Despite various treatment options currently available, many patients experience persistent and refractory disease. We sought to evaluate the clinical effectiveness and safety profile of intralesional HPV 9-valent vaccine for the treatment of recalcitrant warts. A retrospective study was performed for all cases of cutaneous warts treated with intralesional 9-valent HPV vaccine between January 2017 and March 2021. Epidemiologic, clinical, and treatment data, including safety and effectiveness scores, were reviewed. Our cohort was composed of 20 patients: 13 adults and seven children. Twelve patients (60%) displayed a complete response whereas 8 patients (40%) showed a partial response. Older age was associated with a better response to treatment, while a history of laser therapy was associated with a worse prognosis. Adverse events were local, transient, and negligible. No systemic adverse effects were reported. Intralesional 9-valent HPV vaccine may be considered for the treatment of recalcitrant cutaneous warts. Controlled studies are required to confirm these results.

Warts in pediatric oncology patients: A single-institution retrospective study.

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. 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. 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. These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients.

640 Treatment of recalcitrant cutaneous warts with intralesional injection of HBV vaccine

640 Treatment of recalcitrant cutaneous warts with intralesional injection of HBV vaccine

Whole transcriptome-based skin virome profiling in typical epidermodysplasia verruciformis reveals α-, β-, and γ-HPV infections.

HPVs are DNA viruses include approximately 450 types that are classified into 5 genera (α-, β-, γ-, μ-, and ν-HPV). The γ- and β-HPVs are present in low copy numbers in healthy individuals; however, in patients with an inborn error of immunity, certain species of β-HPVs can cause epidermodysplasia verruciformis (EV), manifesting as recalcitrant cutaneous warts and skin cancer. EV presents as either typical or atypical. Manifestations of typical EV are limited to the skin and are caused by abnormal keratinocyte-intrinsic immunity to β-HPVs due to pathogenic sequence variants in TMC6, TMC8, or CIB1. We applied a transcriptome-based computational pipeline, VirPy, to RNA extracted from normal-appearing skin and wart samples of patients with typical EV to explore the viral and human genetic determinants. In 26 patients, 9 distinct biallelic mutations were detected in TMC6, TMC8, and CIB1, 7 of which are previously unreported to our knowledge. Additionally, 20 different HPV species, including 3 α-HPVs, 16 β-HPVs, and 1 γ-HPV, were detected, 8 of which are reported here for the first time to our knowledge in patients with EV (β-HPV-37, -47, -80, -151, and -159; α-HPV-2 and -57; and γ-HPV-128). This study expands the TMC6, TMC8, and CIB1 sequence variant spectrum and implicates new HPV subtypes in the pathogenesis of typical EV.

Successful Treatment of Recalcitrant Non-genital Warts (Verruca vulgaris) with a Topical Solution Containing Two Antivirals and a Low Concentration of Salicylic Acid

Aims: Commercial formulas for the treatment of warts use salicylic acid in concentrations above 100 mg/ml, which causes skin irritation, and the results are often unsatisfactory. To address this problem, we developed a new formula with a low concentration of salicylic acid (20 mg/ml) and with the addition of virucidal compounds (metallic iodine and benzoic acid) and compared it to a formula currently on the market (Verrux®) containing 165 mg salicylic acid (0.165 g) and 145.2 mg lactic acid (0.145 g) per ml collodion.
 Study Design: A randomized double-blind study was conducted.
 Location and Duration of Study: Department of Biotechnology, UNINCOR, Chácara das Rosas, Três Corações, MG, Brazil; School of Pharmacy, Universidade Federal do Amapá - Campus Universitário Marco Zero do Equador, Rod. Juscelino Kubitschek, KM-02, Jardim Marco Zero, Macapá, AP, Brazil and School of Medicine, Universidad Politécnica y Artística del Paraguay (UPAP), Km 10, Ciudad del Este, Paraguay, between December 2004 and October 2016.
 Methodology: 95 patients were treated with the formula with salicylic acid (20mg), benzoic acid (20mg) and metallic iodine (2.5mg) per ml (group A) and 95 received treatment with Verrux® (salicylic acid 165mg, lactic acid 145.2mg per ml collodion) (group B).
 Results: All patients in Group A (100%) reported complete resolution of signs and symptoms after 13 weeks of treatment. In contrast, 67 subjects (70.5%) in group B reported regression of symptoms during the same period.
 Conclusion: There was a statistically significant difference between the groups studied here (P< 0.05). This new formulation with a low level of salicylic acid and two virucidal agents promotes healing of recalcitrant cutaneous warts without significant side effects. The price of the two formulas is virtually the same (about $8 to $10 each bottle).

EFFICACY OF INTRALESIONAL BCG IN RECALCITRANT WARTS – A STUDY AT TERTIARY CARE CENTRE

Background:Warts are benign cutaneous and mucosal epithelial proliferations caused by Human papilloma viruses (HPV).[1]Several therapeutic approaches have been used in treating warts like topical medication such as salicylic acid, trichloroacetic acid, podophyllin, podophyllotoxin, glutaraldehyde, formalin, imiquimod,5-uorouracil and ablative procedures and surgical excision. This study is designed to determine the efcacy of intralesional immunotherapeutic agent BCG vaccine in clearing warts. Materials and Methods: The study group comprised of 20 cases of multiple recalcitrant cutaneous warts. Ethical clearance was sought and informed consent was obtained from all patients.The wart with longer duration and largest size was selected for this procedure. 0.1ml of BCG vaccine was injected intralesionally into the wart and was repeated every 3 weeks till complete clearance of the warts or for a maximum of 9 weeks. Results: After completion of 3 sittings at an interval of 3 weeks we observed the complete response in common warts , palmar warts and plantar warts was 64.5% , 58% and 40% respectively. Conclusion: Our study showed that intralesional BCG injection was safe and efcacious in the treatment of multiple recalcitrant cutaneous warts.

491 Recalcitrant cutaneous warts in a family with inherited ICOS deficiency

Recalcitrant warts (RW), caused by human papillomaviruses (HPVs), can be a cutaneous manifestation of inborn error of immunity. This study investigated the clinical manifestations, immunodeficiency, single-gene susceptibility, and HPV repertoire in a consanguineous family with severe sinopulmonary infections and RWs. Clinical and immunological evaluations, including fluorescence-activated cell-sorting and lymphocyte-transformation test, provided evidence for immunodeficiency. Combined whole-exome sequencing and genome-wide homozygosity mapping was utilized to disclose candidate sequence variants.

Skin needling with 100% trichloroacetic acid vs. needling with bleomycin in the treatment of recalcitrant cutaneous warts.

The treatment of warts has always been a challenging prospect for dermatologists. In some cases, these warts can become resistant or recalcitrant to treatment. Although a plethora of therapeutic and destructive options is available for wart management, to date no treatment has been found to be completely effective because none of the agents induce specific antiviral immunity. We conducted a study to evaluate the efficacy and safety of skin needling with topical 100% trichloroacetic acid (TCA) against the same type of skin needling with bleomycin in patients with recalcitrant cutaneous warts. In total, 33 (63.5%) patients in the TCA group and 35 (81.4%) in the bleomycin group had complete clearance of all the warts, which was not statistically significant (P = 0.13). There was also no statistically significant difference between the treated and untreated warts in the bleomycin group, whereas in the TCA group there was a significantly higher response rate in the treated warts. The most common adverse event (AE) in both groups was transient procedure site pain. We found that the use of needling plus TCA leads to a faster resolution of warts compared with needling plus bleomycin, with a comparable safety profile. Additionally, we found that TCA is superior to bleomycin for management of multiple warts. However, needling with either TCA or bleomycin has excellent and fairly comparable efficacy, and these methods should be used for the management of multiple or recalcitrant warts, as they have minimal AEs and recurrence rates.

Recalcitrant Cutaneous Warts in a Family with Inherited ICOS Deficiency

Recalcitrant warts, caused by human papillomaviruses (HPVs), can be a cutaneous manifestation of inborn error of immunity. This study investigated the clinical manifestations, immunodeficiency, single-gene susceptibility, and HPV repertoire in a consanguineous family with severe sinopulmonary infections and recalcitrant warts. Clinical and immunologic evaluations, including FACS and lymphocyte transformation test, provided evidence for immunodeficiency. Combined whole-exome sequencing and genome-wide homozygosity mapping were utilized to disclose candidate sequence variants. Whole-transcriptome sequencing was used to concomitantly investigate the HPV genotypes and the consequences of detected sequence variants in the host. The proband, a male aged 41 years, was found to be homozygous for the c.6delG, p.Lys2Asnfs∗17 variant in ICOS, encoding the inducible T-cell costimulator. This variant was located inside the 5 megabase of runs of homozygosity on 2q33.2. RNA sequencing confirmed the deleteriousness of the ICOS variant in three skin biopsies revealing significant downregulation of ICOS and its ligand, ICOSLG. Reads unaligned to the human genome were applied to 926 different viruses, and α-HPV57, β-HPV107, β-HPV14, and β-HPV17 were detected. Collectively, we describe a previously unrecognized inborn error of T-cell immunity to HPVs, indicating that autosomal recessive ICOS deficiency can underlie recalcitrant warts, emphasizing the immunologic underpinnings of recalcitrant warts at the nexus of human and viral genomic variation.

Predictors of the Therapeutic Response to Intralesional Bivalent HPV Vaccine in Wart Immunotherapy.

Variable intralesional immunotherapies have recently been proposed as a means of achieving a successful eradication of recurrent and recalcitrant human papillomavirus (HPV)-induced cutaneous and anogenital warts. The bivalent HPV vaccine is one of the newly proposed immunotherapeutic agents. We investigated the role of interleukin-4 (IL-4) and interferon-gamma (IFN-γ) as ex vivo immunologic predictors to estimate the response to the bivalent HPV vaccine as a potential immunotherapy for cutaneous and anogenital warts. Heparinized blood samples were withdrawn from forty patients with multiple recurrent recalcitrant cutaneous and anogenital warts and forty matched healthy control subjects. Whole blood cultures were prepared with and without bivalent HPV vaccine stimulation. Culture supernatants were harvested and stored for IL-4 and IFN-γ measurements using an enzyme-linked immunosorbent assay. A comparative analysis of IL-4 and IFN-γ levels in culture supernatants revealed a non-significant change between the patient and control groups. The bivalent HPV vaccine stimulated cultures exhibited a non-significant reduction in IL-4 levels within both groups. IFN-γ was markedly induced in both groups in response to bivalent HPV vaccine stimulation. The bivalent HPV vaccine can give a sensitive IFN-γ immune response ex vivo, superior to IL-4 and sufficient to predict both the successful eradication of HPV infection and the ultimate clearance of cutaneous and anogenital warts when the bivalent HPV vaccine immunotherapy is applied.

A Combination of Herbal Medicine and Moxibustion Treatment is Effective for a Recalcitrant Cutaneous Warts in a Pediatric Patient: A Case Report

Although warts are a common skin condition/disease that recurs in childhood, treatment completion is difficult owing to the pain associated with conventional therapies. In this case, Korean herbal medicine, Guijakjihwang-Tang, and indirect moxibustion was used to treat a recalcitrant cutaneous wart without pain and recurrence. A 7-year-old boy presented with recurrent cutaneous warts on his right hand and received cryotherapy 3 times in the previous year. The wart recurred during the course of cryotherapy treatment, and the patient did not want to suffer any more pain from the previous treatment. Therefore, parents sought an efficient and painless therapy. The patient was treated for 2 months using Guijakjihwang-Tang combined with indirect moxibustion. The prominent lesion separated in the 2nd month of treatment and completely recovered without adverse events in the 3rd month. There was no recurrence over 12 months of follow-up. This report provides meaningful insights into the use of Korean medicine as a safe, painless and efficient treatment for warts in pediatric patients.

Comparative efficacy of intralesional Candida antigen, intralesional bivalent human papilloma virus vaccine, and cryotherapy in the treatment of common warts

Comparative efficacy of intralesional Candida antigen, intralesional bivalent human papilloma virus vaccine, and cryotherapy in the treatment of common warts

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.

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.

Clearance of recalcitrant warts in a pediatric patient following administration of the nine‐valent human papillomavirus vaccine

Verruca vulgaris is a common, benign infection of the skin and mucous membranes caused by human papillomavirus (HPV). Although many therapeutic options for warts exist, they have limited efficacy and there is no definitive cure for warts. We report the case of a 10-year-old girl with recalcitrant cutaneous warts persisting more than two years which resolved completely following vaccination with the nine-valent HPV vaccine.

Intralesional vitamin D3 vs purified protein derivative in treatment of recalcitrant cutaneous and venereal warts

Introduction Human papilloma virus (HPV) can produce a significant amount of anxiety and stress in patients. Many therapeutic options are available for treating warts. More recent and effective treatment, including intralesional immunotherapy, have been tried in the recent times with variable success rates. Aim The aim was to compare the efficacy, safety, and the clinical response of intralesional vitamin D3 (Vit D3) vs purified protein derivative (PPD) in the treatment of recalcitrant cutaneous and venereal warts. Patients and methods This study was carried out on 30 patients with cutaneous and venereal recalcitrant warts. Fifteen patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of Vit D3 in one up to three warty lesions in every patient; the other 15 patients (11 patients with recalcitrant cutaneous warts and four patients with recalcitrant venereal warts) were subjected to intralesional injection of PPD in one up to 15 warty lesions in every patient. Assessment of the results was done by clinical evaluation, patient satisfaction, and multiple digital photographs. Results We found that the total response rate to immune therapy was 83.3% in both groups of patients collectively. In the Vit D3-treated group, complete response was achieved in 73.3% of patients and partial response in 26.6%. However, in the PPD-treated group, complete response was achieved in 46.6% of patients, partial response in 20%, and 33.3% of the patients showed no response. The overall clinical response in Vit D3-treated group was significantly higher than in the PPD-treated group (100 vs 66.67%, respectively). We also found that the longer the duration of HPV infection, the poorer the response rate to treatment and the need for more sessions. Conclusion Clinical efficacy and safety of intralesional injection of Vit D3 vs PPD for treatment of HPV, the high response rate, the absence of adverse effects, low cost, and the affordability of the Vit D-treated group makes it a very useful tool in the treatment of HPV and is more superior than the PPD.

Serum retinol-binding protein: a novel biomarker for recalcitrant cutaneous warts.

Cutaneous viral warts are benign epidermal proliferations caused by human papillomaviruses (HPVs). Despite treatment, a significant proportion of warts fail to resolve, becoming recalcitrant. Vitamin A (retinol) may disrupt the interplay of HPV replication and epithelial cell differentiation, allowing normal tissue to replace warts. Circulating retinol-binding protein (RBP) concentrations highly correlate with retinol levels. We aimed at evaluation of serum RBP level in patients with recalcitrant cutaneous warts in order to assess its correlation with disease pathogenesis. Serum RBP level was measured by an ELISA technique in 50 patients with recalcitrant cutaneous warts and 30 apparently healthy controls. Serum RBP level was significantly lower in patients with recalcitrant warts than the control group (P < 0.001). However, it did not differ regarding different clinical parameters in studied patients (P > 0.05 each). RBP is a reliable biomarker for significant early detection and discrimination between patients and healthy controls (P < 0.001) at a cutoff value ≤1034.6 μg/ml, with sensitivity and specificity (100% each). Our results revealed that low serum RBP as a relatively cheap biomarker with high specificity and sensitivity is a reliable indicator of vitamin A (retinol) deficiency that may play a role in the pathogenesis of recalcitrant cutaneous warts among our studied patients.

HPV Vaccine for Treatment of Recalcitrant Cutaneous Warts in Adults

Waldman, Abigail MD; Whiting, Dennis PA-C; Rani, Monica MD; Alam, Murad MD, MSCI, MBA Author Information

Common variable immunodeficiency and natural killer cell lymphopenia caused by Ets-binding site mutation in the IL-2 receptor γ (IL2RG) gene promoter

Common variable immunodeficiency and natural killer cell lymphopenia caused by Ets-binding site mutation in the IL-2 receptor γ (IL2RG) gene promoter

Intralesional Candida Antigen Immunotherapy for the Treatment of Recalcitrant and Multiple Warts in Children.

Intralesional injection of Candida antigen appears to be an effective alternative for the treatment of warts. To determine the efficacy and safety of this treatment. We retrospectively reviewed records of all children who received intralesional injection of Candida antigen at our center from January 2008 to July 2013. From a total of 220 patients, 156 (70.9%) had a complete response, 37 (16.8%) had a partial response, and 27 (12.2%) had no improvement. An average of 2.73 treatments was needed. Forty-seven of the patients with more than one wart (21.3%) also noted at least partial resolution of untreated warts at distant sites. Twenty-seven of the 47 patients (57.4%) had complete resolution. All treated patients experienced some discomfort at the time of the injection, but no serious side effects were reported. We report our results using this approach in a large group of children. Intralesional injection of Candida antigen is an effective and safe therapy for children with multiple and recalcitrant cutaneous warts.

Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.

Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.