Recalcitrant Plantar Warts Research Articles

Application of Photodynamic Therapy with 5-Aminolevulinic Acid and Fractional CO2 Laser for the Management of Recalcitrant Plantar Warts

SignificancePlantar warts, benign lesions on the soles of the feet, are caused by the human papillomavirus (HPV) infecting keratinocytes. Complete eradication of these warts is challenging, often leading to recurrences. This study evaluates the combined clinical efficacy of topical 5-aminolevulinic acid (5-ALA) photodynamic therapy (PDT) and fractional carbon dioxide (CO2) laser treatment for recalcitrant plantar warts. ApproachData from 10 patients with recalcitrant plantar warts were analyzed. Initially, thickened hyperkeratotic tissue was removed using a super-pulsed CO2 laser. This was followed by fractional laser application, after which a 20% 5-ALA cream was applied occlusively for 4 hours. Patients then received He-Ne laser irradiation for 30 minutes at an energy density of 100 mW/cm², with treatments spaced 4 weeks apart. ResultsThe study included 10 participants aged 24 to 53 years (mean age: 33.4 ± 8.09 years). In total, 40 lesions were treated across 1 to 9 PDT sessions, with an average of 5.2 ± 2.86 sessions per patient. Complete clearance was achieved in 3 patients (30%), 4 patients (40%) showed an excellent response (≥80% improvement), while 2 patients had a partial response. One patient (10%) showed <50% improvement. The overall clearance rate was 70% (28 out of 40 lesions). Aside from temporary pain during the procedure and mild erythema post-treatment, one patient developed localized proliferative scarring. After a one-year follow-up, only one patient experienced recurrence. ConclusionsThe combination of 5-ALA PDT and fractional CO2 laser therapy shows promise as an effective and safe alternative for treating persistent plantar warts.

Cantharidin (1%), podophyllin (5%), and salicylic acid (30%) formulation in recalcitrant plantar warts: Analysis of 48 patients.

A plantar wart is a benign hyperplasia that appears on the feet due to the human papillomavirus (HPV). One method used for the treatment of recalcitrant plantar warts, those lasting over 2 years or persisting after at least two treatment attempts, is the cantharidin (1%), podophyllin (5%), and salicylic acid (30%) formulation, also known as the CPS formulation. Although this method is in use, there are few studies on it. This study's objective was to ascertain its cure rate. For this retrospective observational study, we reviewed the medical records of patients treated with the CPS formulation at a podiatric clinic specializing in plantar wart treatment. Our sample size was 48 subjects. The CPS formulation had a cure rate of 62.5%. Out of the cured patients, 86.67% (26/30) required one or two applications. There was no observable correlation (p > 0.05) between wart resolution and virus biotype, evolution time, patient's morphological and clinical attributes, location, number of warts, or preceding treatments. The CPS formulation presents a relatively high efficacy rate for treating recalcitrant HPV plantar warts. Still, additional studies are necessary to evaluate its safety and efficiency.

Intralesional combined digoxin and furosemide versus intralesional 5-flurouracil for the treatment of recalcitrant plantar warts: a prospective, randomized study

There are many therapeutic modalities for plantar warts, however treating it remains challenging. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide were observed to be effective and safe, however no comparison study between them was done. Our study was conducted to evaluate the efficacy of both therapies in the treatment of plantar warts. 90 adult patients with multiple recalcitrant plantar warts were included in our study. They were randomly allocated to one of three groups; combined digoxin and furosemide, 5-fluorouarcil, or normal saline group. Fortnightly injections were done into all studied warts till complete clearance or up to 5 sessions. Warts were evaluated clinically and dermoscopically. Clinical response was reported in 24 patients (80%) of the combined digoxin and furosemide group with 40% complete response and in 24 patients (80%) of the 5-fluorouarcil group with 33.3% complete response. No statistically significant difference was observed between the two groups concerning efficacy and safety. Intralesional injection of 5-fluorouarcil and combined digoxin and furosemide are nearly equivalent in efficacy and safety for plantar wart treatment. Dermoscopy helps to take the truthful judgment about complete clearance of warts.

Long Pulsed Nd-YAG Lasers versus Q Switched Nd-YAG Lasers in the treatment of recalcitrant Plantar Warts - Comparative Randomized Study

Long Pulsed Nd-YAG Lasers versus Q Switched Nd-YAG Lasers in the treatment of recalcitrant Plantar Warts - Comparative Randomized Study

Gardasil 9 vaccine for the treatment of recalcitrant plantar warts in an immunocompromised patient

Plantar warts (verruca plantaris) are benign epithelial tumors caused by HPV 1 (myrmecia) and HPV 2, 27 or, 57 (mosaic). They may be difficult to treat with many failures or recurrences after multiple treatments, especially in immunosuppressed patients.

A Novel Percutaneous Delivery System — Needle-Free Injection and Its Clinical Applications in Dermatology

Needle-free injection is commonly used in the fields of inoculation and diabetes. Moreover, its potential as a powerful tool for percutaneous drug delivery is being fully realized in the field of dermatology. Compared with conventional subcutaneous needle injection, needle-free injection causes less pain, has a shorter recovery time, allows for easier control of the pressure and dosage, and is less reliant on the operational technique. Thus, we performed a systematic review of currently available literature to examine the applications of this novel percutaneous delivery system in dermatology. We identified more than 30 prospective and retrospective studies and case reports for inclusion. We found that needle-free injection can be used for both medical and non-medical aesthetic purposes, including treatment of scars, wrinkles, condylomata acuminata, cutaneous tumors, recalcitrant plantar warts, nail psoriasis, and hyperhidrosis. Needle-free injection is very efficient and safe overall, especially when performed with gas-powered injectors; however, close attention is needed when applying high-pressure injectors in areas of relatively thin skin.

Intralesional immunotherapy for multiple recalcitrant plantar warts: Candida antigen is superior to intralesional purified protein derivative.

Treatment of recalcitrant plantar warts represent a highly challenging issue for both patients and physicians. Candida antigen and purified protein derivative (PPD) have shown promising efficacy in the treatment of warts, however no previous studies have compared both antigens for recalcitrant plantar warts. To assess the efficacy and safety of intralesional Candida antigen versus intralesional PPD in the management of recalcitrant plantar warts. The study included 120 adult patients with multiple recalcitrant plantar warts. They were randomly assigned to one of three groups; Candida antigen, PPD, or normal saline. Injections into the largest wart were repeated every 2 weeks until clearance or for a maximum of five sessions. Complete wart clearance was reported in 33 patients (82.5%) of the Candida antigen group, in 22 patients (55.6%) of the PPD group, and in one patient (5%) of the control saline group. A statistically significant difference was found between the studied groups in favor of Candida antigen. Adverse effects were mild and insignificant in the three groups. Intralesional antigen immunotherapy by Candida antigen or PPD is a promising, safe, and cost-effective therapeutic option for multiple recalcitrant plantar warts, with statistically significant superiority of Candida antigen.

Successful Treatment of Recalcitrant Plantar Warts Using Combined Long-pulsed Nd:YAG and Alexandrite Lasers

Successful Treatment of Recalcitrant Plantar Warts Using Combined Long-pulsed Nd:YAG and Alexandrite Lasers

Rose Bengal-gold-polypyrrole nanoparticles as a photothermal/photodynamic dual treatment of recalcitrant plantar warts: Animal and clinical study

This paper studies the combined photodynamic and photothermal effects of Rose Bengal conjugated gold-polypyrrole nanoparticles (RB-AuPpy NPs), in vivo and clinically. RB-AuPpy NPs were prepared by in-situ incorporation of Rose Bengal (RB) into gold-polypyrrole (AuPpy) nanoparticles during synthesis and then comparatively characterized in parallel with free AuPpy for their morphologies, sizes, spectroscopic properties and zeta potentials. Free RB, free AuPpy and RB-AuPpy were formulated as topical pharmaceutical preparations and the three formulae were examined for their in vivo cytotoxicity and photocytotoxicity on albino mice skin as an in vivo model and then were clinically applied to evaluate their topical efficiency in the treatment of plantar warts. Results showed that RB-AuPpy NPs exhibited enhanced photocytotoxic effects in comparison to either free AuPpy or free RB under the same conditions in vivo; indicating the enhancing effect of RB on the photothermal action of AuPpy and the effect of AuPpy, as a delivery system, on the photodynamic action of RB. Clinical case study emphasized the superior photo-induced activity of RB-AuPpy.

Efficacy of Intralesional Vitamin D3 Injection in Cutaneous Warts

Background: Cutaneous warts are common dermatological viral infection caused condition which causes cosmetic problems besides it primary morbidity like pain and discomfort. Intralesional vitamin D3 derivatives therapy is recent and effective modality for treatment of cutaneous warts. Objective: To determine the efficacy of intralesional vitamin D3 injection in cutaneous warts in local patients. Methods and patients: A descriptive case series study conducted from June to December 24, 2019 at Dermatology OPD, SMBBMU- Larkana.A sample of 65 patients with cutaneous warts, either gender, age 20-50 years, 3 months to 6 months history were included after taking a valid informed/ written consent. Pregnant and lactating women, patients on immunosuppersive therapy, signs of any systemic or local inflammation or infection, history of pasthma allergic skin disorders meningitis or convulsions, history of hypersensitivity to Vitamin D3 were excluded. The injections of vitamin D3 (vials containing 6,00,000 IU of cholecalciferol in 1 ml = 15 mg)were given at 2 weekly intervals for a maximum of four injections.A standard questionnaire was used to collect demographic and study related data. Data analysis was performed through SPSS Version-21. Descriptive and inferential statistics were calculated. Stratification was done and post stratification chi square test was applied. P-value ≤0.05 was considered as significant. Results: The mean age of patients was 27.9±5.1 with C.I (26.63-29.16) years. The Mean ± SD of duration was 4.4±1.9 with C.I (3.92-4.87) months. The Mean ± SD of number of warts was 14.3±4.2 with C.I (13.25-15.34). Out of 65 patients, 35 (53.8%) were malewhile 25 (38.5%) patients were belong to urban areas. Primary outcome of this study i-e; the efficacy was n=54 (83.1%). Stratified analysis revealed that younger age (20 – 30 years), male gender, urban residence, 3-5 mm size, 2-3 months duration (p value = 0.009) were associated with more efficacy of intralesional vitamin D3 injection in cutaneous warts. Conclusion:This study clearly demonstrates that recalcitrant plantar warts can be treated successfully with intralesional vitamin D3 injection. The immunotherapy of injection vitamin D3 has better patient compliance, good therapeutic response without cosmetic disfigurement and capable of preventing recurrences. Keywords: Efficacy, Intralesional Vitamin D3, Cutaneous Warts, Treatment,Immunotherapy

Nanovesicular Photodynamic Clinical Treatment of Resistant Plantar Warts.

Photodynamic therapy which involves the use of photosensitizer molecule activated by a light source was proven very promising for the treatment of dermatological diseases, especially the resistant ones such as recalcitrant Plantar Warts (PW). However, its efficacy is hindered by the poor permeation of the photosensitizer molecule required to initiate skin photo-induced effects. In this manuscript, the efficiency of the nano-vesicular system (transfersomes) as a potential topical drug delivery system for the photosensitizer methylene blue (MB) was investigated following clinical Photodynamic Therapy (PDT) in patients suffering from PW. Results revealed that MB transfersomal gel displayed a higher complete healing percentage for the lesions compared to the free MB gel (86.67% versus 53.57%) achieved at a lower number of treatment sessions (2.2 versus 4.14). Patients reported no signs of pain or inflammation, with no recurrence of the lesions during the follow up period of 8 months. PDT using transfersomal MB is an effective and safe therapeutic modality for the treatment of PW.

Immunotherapeutic modalities for the treatment of recalcitrant plantar warts: a comparative study

Background Plantar warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy has been used as a promising alternative therapeutic option in such recalcitrant cases. Aim To evaluate and compare the efficacy and safety of the intralesional injection of vitamin D3, zinc sulfate 2%, and Candida antigen in the treatment of recalcitrant plantar warts. Patients and methods The study included 152 adult patients with single or multiple recalcitrant plantar warts. They were equally subdivided into four groups (38 patients in each): 2% zinc sulfate, vitamin D3, Candida antigen, and normal saline respectively. Injections were done at 3-week intervals until complete resolution or for a maximum of 4 sessions. Results Complete response was achieved in 20 patients (52.7%) of the zinc sulfate group, 34 patients (89.5%) of the intralesional vitamin D3 group, 25 patients (65.7%) of the intralesional Candida antigen group and 8 patients (21.2%) of the saline group. The difference between the groups was statistically significant in favor of vitamin D3 (p = .037). Conclusions Recalcitrant plantar warts were best treated with vitamin D3 that also has the advantages of better response on distant warts, minimal side effects, and low rate of wart recurrence.

Intralesional cryotherapy versus cryotherapy spray for the treatment of recalcitrant plantar warts: a prospective, randomized study

Background Recalcitrant plantar warts are representing a therapeutic challenge. Intralesional cryotherapy (ILC) has emerged as a promising therapeutic option in recalcitrant plantar warts treatment. Objective To compare the clinical efficacy, safety and tolerability of (ILC) versus Cryotherapy spray (Cryo-sp) for treatment of recalcitrant plantar warts. Methods One hundred-thirty patients with recalcitrant plantar warts were assigned equally to two groups. Group A received ILC and group B treated with Cryo-SP. Both groups received one session at 2 weeks intervals until complete clearance or for a maximum of 5 sessions. The main outcome was complete clearance of warts guided by dermoscopy. Follow-up was carried out for 6 months after the treatment. Results Complete clearance occurred in 80.3% in group A compared to 50.8% in group B with a highly significant difference between both groups (p < .001). The clearance rate was faster in group A (1.5 ± 0.40) than group B (4 ± 1.3) (p < .001). The adverse effects were mild in group A than group B (p < .001). The recurrence rate was 2% in group A versus 23.3% in group B (p < .007).patients satisfaction was higher in ILC (p < .001). Conclusion Intralesional cryotherapy is more effective, requiring few sessions with a low recurrence rate than cryo-sp.

Successful treatment of recalcitrant plantar warts: Pretreatment with superficial shaving is vital before photodynamic therapy

• Pretreatment with superficial shaving combined with photodynamic therapy is an effective therapy for recalcitrant plantar warts . • Superficial shaving effectively promoted the penetration depth of 5-ALA, thereby enhancing the treatment efficacy. • For plantar warts, the combined therapy is suitable, convenient, low cost and worth promoting.

Combined therapy of plantar warts with topical bleomycin and microneedling: a comparative controlled study‏

Background: The aim of this study was to assess the efficacy of combination between microneedling with dermapen and topical bleomycin in the treatment of plantar warts in comparison with intralesional bleomycin and intralesional saline (placebo).Methods: Fifty-four patients were assigned into three groups, each containing 18 patients. The first group treated by micro-needling phenotype with topical bleomycin at 2 weeks interval, the second group received intralesional bleomycin at 3 weeks interval and the control group was intralesional saline for a maximum of four weeks.Results: Complete clearance of warts in 16 patients in the micro-needling group (88.9%) versus 15 patients (83.3%) in the intralesional bleomycin group versus one patient (5.6%) in the control group‏.Conclusions: Microneedling assisted topical bleomycin spraying seems to be a promising effective and noninvasive therapeutic modality for recalcitrant plantar warts that facilitates delivery and absorption of bleomycin into the lesion‏.

Safety and effectiveness of cantharidin-podophylotoxin-salicylic acid in the treatment of recalcitrant plantar warts.

The aim of our study was to evaluate the efficacy and safety of topical cantharidin-podophylotoxin-salicylic acid (CPS) treatment of recalcitrant plantar warts (RPW). This study was carried out in a health center in the city of A Coruña (Spain) between January and December 2013. A total of 75 patients completed all the stages of the research process. Information related to treatment with CPS and adverse effects was abstracted from medical records. Of 93 potential patients identified, 75 had at least one follow-up visit or telephone call after treatment and were included in this study. Patients experienced an average of 5.4 visits until complete resolution of their plantar wart occurred, although CPS was not applied at every visit. Fifty-four patients required one application to eliminate the wart and 21 patients required two applications/patient. Seventy-seven percent of patients experienced blistering - an expected therapeutic side effect. All patients experienced some form of an adverse event, the most common being pain (81.3%) and significant blistering (15%). Other side effects were rare (18.7%) and included pruritus, possible mild infection, significant irritation, and bleeding. All patients reported treatment, supporting our results that CPS is a safe and efficacious treatment modality for RPW and should be considered when symptomatic infection necessitates treatment.

A case of recalcitrant plantar warts associated with statin use.

Background. Plantar warts are a common presenting skin complaint caused by the human papillomavirus. 1st line therapies include cryotherapy and topical salicylic acid. Where there is resistance to these treatments, consideration is made for 2nd line therapies, including intralesional bleomycin, imiquimod, 5-fluorouracil, and photodynamic therapy. We present a case of bilateral persistent plantar warts, resistant to treatment with repeated cryotherapy and topical salicylic acid over a 6-year period. Following a patient initiated decision to discontinue their statin medication, we observed rapid clearance of plantar warts without change to standard therapy or their environment. This case correlates with emerging literature demonstrating a link between statin medication and proliferation of HPV through increased levels of FOXP3+ regulatory T cells.

Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study

Plantar warts are common viral infection that are usually challenging in treatment. Conventional treatment methods are usually invasive, have low efficacy, and need long recovery periods. In this study, we compared pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) lasers in the treatment of recalcitrant plantar warts. The study included 46 patients with multiple plantar warts. In each patient, lesions were divided into two groups: one treated with Nd:YAG (spot size, 7 mm; energy, 100 J/cm(2); and pulse duration, 20 ms) and the other with PDL (spot size, 7 mm; energy, 8 J/cm(2); and pulse duration, 0.5 ms). Laser sessions were applied every 2 weeks with maximum of six sessions. The study included 63% males and 37% females with a mean age of 29.6 ± 7.34 years. The cure rate was 73.9% with PDL with no significant difference (p = 0.87) from Nd:YAG (78.3%). The number of sessions required was more in PDL (mean, 5.05 ± 0.2) compared with Nd:YAG (mean, 4.65 ± 0.5) but without significant difference. Complications were significantly higher with Nd:YAG (43.5%) compared with PDL (8.7%). Hematoma was the most common complication recorded by Nd:YAG (28.3 %), and it was significantly higher (p = 0.002) than PDL (2.2%). Relapse was recorded in 8.7% with Nd:YAG compared with 13% in PDL with no significant difference (p = 0.74). Our results suggested that PDL and Nd:YAG lasers are effective in the treatment of resistant plantar warts. PDL is safer and less painful but needs more sessions, while Nd:YAG is more painful and shows more complications.

Topical cidofovir for plantar warts

Plantar warts are a common reason for dermatological consultations and their treatment can occasionally be a challenge. Plantar warts are benign lesions produced by the human papillomavirus (HPV) that often fail to respond to habitual treatment. Cidofovir is a potent antiviral drug that acts competitively, inhibiting viral DNA polymerase. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral plantar warts. We undertook a retrospective observational study of patients with plantar warts who received treatment with topical cidofovir between July 2008 and July 2011 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data about the rate of treatment response, the adverse effects, and recurrences, as well as the characteristics of the patient cohort, were recorded. We identified 35 patients who had received some previous treatment. The usual concentration was 3% (in 33 of 35 cases), applied twice a day (in 31 of 35 cases). A greater or lesser response was noted in 28 cases. There were two recurrences. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant plantar common warts that fail to respond to usual treatment.

Successful Treatment of Recalcitrant Warts with the Chinese Herb E. ebracteolata Hayata

Warts are benign proliferations of the skin and mucosa caused by an infection resulting from the human papilloma virus. Plantar warts (verruca plantaris) are known to be particularly difficult to treat and eradicate. We herein report a case of recalcitrant plantar warts that was successfully treated with the Chinese Herb E. ebracteolata Hayata.