Recalcitrant Warts Research Articles

New Alternative Combination Therapy for Recalcitrant Common Warts: The Efficacy of Imiquimod 5% Cream and Duct Tape Combination Therapy

New Alternative Combination Therapy for Recalcitrant Common Warts: The Efficacy of Imiquimod 5% Cream and Duct Tape Combination Therapy

Treatment of Recalcitrant Viral Warts with Photodynamic Therapy with Mal and Red Light

Background: Photodynamic therapy (PDT) is a treatment for non-melanoma skin cancer. In recent years, its use has expanded to new indications. Viral warts (VW) are some of the most promising. Methods: A retrospective, descriptive, observational study was carried out. Patients who did not respond to cryotherapy were selected and were occluded with methyl aminolevulinate (MAL) for three hours and they were illuminated with red light. Tolerance to treatment was evaluated using a visual analog scale for pain (from 0 to 10). Results: A total of 15 patients with 134 VW were treated. A complete response was obtained in 13 of 15 patients (87%) and in 127 of 134 lesions (95%). The mean number of sessions was 3.1 (range 1 to 6) and the average pain score was 3.1 (range 0 to 8). Conclusions: PDT is a treatment that offers good results in the treatment of VW that are resistant to routine treatment. The treatment was well tolerated in our patient group.

Topical Immunotherapy with Diphenylcyclopropenone Is Effective and Preferred in the Treatment of Periungual Warts

BackgroundThere exists a treatment challenge with periungual warts. Topical immunotherapy with diphenylcyclopropenone (DPCP) has recently been reported to be an effective treatment for recalcitrant warts, including periungual types.ObjectiveWe aimed to evaluate the effectiveness and preference of topical immunotherapy with DPCP in treating periungual warts.MethodsTwenty-seven patients with periungual warts who were treated with DPCP immunotherapy (2007 through 2010; Dongguk University Ilsan Hospital, Goyang, Korea) were retrospectively recruited. Other treatment modalities were also used in some patients. Lesions were grouped into the types according to the following locations: proximal nail fold, lateral nail fold and hyponychium. Total and group clearance rates as well as treatment periods according to location and disease duration were evaluated. A patient questionnaire was performed to assess the satisfaction for the treatments in those who received multiple therapies.ResultsTotal success rates were 85% (by subjects) and 91% (by individual lesions). Success rate and treatment period for proximal nail fold type seemed more desirable than other locations. Success rate decreased and treatment period increased as disease duration increased. The questionnaire revealed a significantly higher satisfaction rate for DPCP immunotherapy than for cryotherapy and pulsed-dye laser.ConclusionTopical immunotherapy with DPCP is an effective and preferred method in the treatment of periungual warts.

Treatment of Plane Warts with a Low-Dose Oral Isotretinoin

Objective. To assess the efficacy of a low-dose oral isotretinoin in the treatment of plane warts. Patients and Methods. Thirty-one patients with recalcitrant facial plane warts were enrolled. A cumulative dose of 30 mg/kg for two months of treatment was calculated; this was equal to a mean of 0.5 mg/kg/day. Each patient was seen every two weeks during the treatment period. Response to treatment was either complete or no response. Patients with complete response were followed up monthly for four months to record the relapse rate. Results. Twenty-six patients completed the study; their ages range from 5 to 35 with a mean ± SD 15.28 ± 8.51 years. Fifteen (57.69%) patients were females and eleven (42.30%) were males. Nineteen (73.07%) patients showed complete response and seven (26.92%) patients showed no response at the end of two months of therapy. The difference was statistically significant; P value <0.0001. Fifteen (78.94%) out of nineteen patients, who had complete response, were still free from warts at the end of four-month followup. Conclusion. Oral isotretinoin is effective in the treatment of recalcitrant facial plane warts.

Intralesional cidofovir for the treatment of multiple and recalcitrant cutaneous viral warts

Cidofovir is a nucleoside analog of deoxycytidine with a strong activity against a broad spectrum of DNA viruses, including human papillomavirus. The first objective was to evaluate efficacy of cidofovir for the treatment of cutaneous viral warts, recalcitrant after conventional therapies or where the surgery approach is difficult for their location or extension. Second, the present authors propose to point out possible local and systemic side effects consequent to treatment. Two-hundred eighty patients affected by recalcitrant cutaneous viral warts, were treated with intralesional cidofovir 15 mg/mL once a month. The present authors stated that candidates were those who had made before at least two other treatments reported in the guideline for management of cutaneous viral warts. In 276 cases, warts completely cleared: 158 of those have a follow-up period longer than 12 months and 118 have a follow-up of 6 months. On the average, 3,2 injections were enough to solve the problem. Local side effects consisted of pain and burning sensation during the injections; itching, erythema, and post-inflammatory hyperpigmentation were observed. No cases of systemic side effects were noted. The treatment was well tolerated, and the warts were completely cleared without relapses. Intralesional cidofovir is emerging as an effective therapeutic alternative for warts that are unresponsive to conventional treatments.

Recalcitrant plantar warts treated with recombinant quadrivalent human papillomavirus vaccine

To the Editor: A 59-year-old healthy woman presented in October 2009 with a 5-year history of recalcitrant plantar warts. Four large warts were present on her feet; the largest measured 4.6 cm in diameter. She had previously been treated with numerous therapies, including liquid nitrogen cryotherapy, topical imiquimod 5%, 40% salicylic acid, pulsed dye laser, and oral cimetidine without improvement. A shave biopsy was performed and findings confirmed the diagnosis. On the basis of the classic clinical and histopathologic findings, human papillomavirus (HPV) typing was not performed initially.

Photodynamic Therapy Can Improve Warts’ Discomfort in Renal Transplant Patients Prospective Multicenter Study

Many studies have been conducted showing that aminolevulinic acid (ALA)-photodynamic therapy (PDT) can be an alternative treatment for recalcitrant warts. Recently, we performed a study evaluating methyl-aminolevulinic acid (MAL)-PDT for the treatment of hand warts in a population of renal transplant patients. Two symmetrical targets were selected on each hand and randomly assigned to chemical keratolytic treatment followed by three cycles of ALA-PDT (75 J cm(-2) red light). Patients were evaluated after 3 months and a second run of PDT was performed if the total area and number of warts decreased less than 50%, with evaluation every 3 months for 1 year. Twenty patients were included and 16 were evaluable (9 M, 7 F). After 6 months the reduction of warts' area was 48.4% on the treated side versus 18.4% in the control area (P = 0.021). The decrease in the total number of warts was 41%versus 19.4% (P = NS). The global tolerance of the treatment was good with acceptable pain during irradiation. These results suggest that ALA-PDT is a safe and efficient treatment for transplanted patient warts. The improvement between treated and control zone is 20% due to the decrease in untreated warts' area and number.

Topical vitamin A treatment of recalcitrant common warts

BackgroundCommon warts (verruca vulgaris) are benign epithelial proliferations associated with human papillomavirus (HPV) infection. Salicylic acid and cryotherapy are the most frequent treatments for common warts, but can be painful and cause scarring, and have high failure and recrudescence rates. Topical vitamin A has been shown to be a successful treatment of common warts in prior informal studies.CaseThe subject is a healthy, physically-active 30 old female with a 9 year history of common warts on the back of the right hand. The warts resisted treatment with salicylic acid, apple cider vinegar and an over-the-counter blend of essential oils marketed for the treatment of warts. Daily topical application of natural vitamin A derived from fish liver oil (25,000 IU) led to replacement of all the warts with normal skin. Most of the smaller warts had been replaced by 70 days. A large wart on the middle knuckle required 6 months of vitamin A treatment to resolve completely.ConclusionRetinoids should be further investigated in controlled studies to determine their effectiveness in treating common warts and the broad range of other benign and cancerous lesions induced by HPVs.

Treatment of recalcitrant warts with the carbon dioxide laser using an excision technique

Recalcitrant warts remain a challenging problem to treat, with considerable morbidity for patients. Our technique uses the carbon dioxide (CO2) laser as a bloodless scalpel to excise and treat recalcitrant warts. This paper reviews the results of patients with recalcitrant warts treated by the senior author using this technique. Methods. A retrospective case note review and questionnaire-based survey of patients treated by this technique. Results. Seventy-one recalcitrant warts treated in 22 patients, all as day case procedures. A total of 54.5% of patients had complete remission after one treatment and the average length of follow-up was 71.5 months. Recurrence occurred on average 5.29 months following treatment. Of those patients, 90% were successfully retreated, giving an overall rate of 95.5%. In total, 46.7% of patients were left with scarring, but all felt this was acceptable given the benefits of the treatment, and 80.0% of patients would have the procedure again. Four patients had spontaneous regression of warts at other body sites not treated with the CO2 laser. Conclusion. This study illustrates the efficacy of our technique with a favourable outcome comparable to published studies. Recurrence occurred within 12 months; therefore, we would recommend this as a minimum follow-up period. In addition, the disappearance of warts at distant sites suggests that the effects of the CO2 laser therapy modulate the immune system, thereby extending it beyond simple excision or ablation.

Intravenous cidofovir for resistant cutaneous warts in a patient with psoriasis treated with monoclonal antibodies

Human papilloma virus is a common and often distressing cutaneous disease. It can be therapeutically challenging, especially in immunocompromised patients. We report a case of recalcitrant cutaneous warts that resolved with intravenous cidofovir treatment. The patient was immunocompromised secondary to monoclonal antibody therapy for psoriasis.

Recalcitrant subungual verruca of a child successfully treated with combination use of traditional Japanese herbal medicines, shokenchuto and makyoyokukanto

Recalcitrant subungual verruca of a child successfully treated with combination use of traditional Japanese herbal medicines, shokenchuto and makyoyokukanto

Effective treatment of extensive and recalcitrant plantar warts associated with human papillomavirus-52 by oral acitretin

Effective treatment of extensive and recalcitrant plantar warts associated with human papillomavirus-52 by oral acitretin

Generalized molluscum contagiosum in an HIV patient treated with diphencyprone

Diphencyprone is a universal contact immunotherapy. The mechanism of action is based on an induction of the delayed-type hypersensitivity. Diphencyprone has been used in various forms for treatments of recalcitrant and facial warts, and alopecia areata. However, this treatment modality has not been generally used in immunocompromised patients. The present report demonstrated the efficacy of diphencyprone immunotherapy on the treatment of generalized molluscum contagiosum in a human immunodeficiency virus (HIV)-infected patient. Minimal and transient side effects including pruritus, postinflammatory hyperpigmentation and irritation were noted. Diphencyprone contact immunotherapy appears to be a possible alternative treatment of widespread molluscum contagiosum in immunocompromised patients.

Rapid response to acitretin, combined with cryotherapy, for extensive and recalcitrant verruca vulgaris on the scalp

Rapid response to acitretin, combined with cryotherapy, for extensive and recalcitrant verruca vulgaris on the scalp

Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women

Immunotherapy for treatment of recalcitrant warts was used through different modalities including intralesional injection of purified protein derivative (PPD), which is an extract of Mycobacterium tuberculosis, used for testing exposure to tuberculin protein, either from a previous vaccination or from the environment. This method is used to evaluate the efficacy of a new approach of intradermal injection of PPD in the treatment of anogenital warts in pregnant women. A total of 40 pregnant women, aged 20-35 years, and presented with anogenital warts were enrolled in this study. Human papillomavirus (HPV) typing was done using the GP5+/GP6+ PCR assay. The patients were treated with weekly injections of PPD given intradermally in the forearms, and evaluated for the response regularly. HPV type-6 was the predominant genotype (67.5%). Overall, the improvement in this study was 85% and was related to the extent of tuberculin reactivity. Nineteen (47.5%) patients demonstrated complete clearance, 15 (37.5%) had partial response, and three (7.5%) had minimal response. Three (7.5%) cases did not respond to treatment. Side effects were minimal and insignificant. Treatment of anogenital warts in pregnant women with intradermal injection of PPD was found to be a unique, safe, and effective modality of immunotherapy.

Effectiveness of Pulsed Dye Laser in the Treatment of Recalcitrant Warts in Children

Effectiveness of Pulsed Dye Laser in the Treatment of Recalcitrant Warts in Children

Huge Recalcitrant Warts Treated with Pulse Dye Laser after Conventional Therapies and Others Destructive Physical Modalities Failed

Cutaneous infections with the human papilloma virus, despite being almost always asymptomatic, can induce slow-growing lesions knowed as warts that can remain subclinical for long periods of time. There are several therapeutical options namely keratolytics, retinoids, imiquimod, cryotherapy, electrosurgery, lasers and classic surgery, but none has antiviral effects. We describe the case of a patient with large warts located on the dorsal surface of the right hand, treated with cryotherapy, CO2 laser and topical imiquimod having either no clinical response or quick relapse. Treatment with PDL was started and after 13 sessions, the patient was without lesions, with a good cosmetic result and so far without relapse. This case report is relevant to us and deserves to be published because of the size of the lesions and the great response to PDL despite all the failures with the other treatments.

Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine

Despite numerous therapeutic modalities reported in the literature, treatment of common warts remains a continuing challenge and there is no universal consensus about optimal treatment. Recently, intralesional immunotherapy by different antigens has proved efficacy in the treatment of different types of warts. To evaluate the efficacy and safety of intralesional mumps, measles and rubella (MMR) vaccine in the treatment of common warts. The study included 135 patients with single or multiple recalcitrant or non-recalcitrant common warts. They were randomly assigned to two groups; the first group (85 patients) received intralesional MMR vaccine, and the second group (50 patients) received intralesional saline as a control group. Both treatments were injected into single lesions or largest wart in case of multiple lesions at 2-week intervals until complete clearance or for a maximum of five treatments. Follow-up was made every 2 months for 6 months to detect any recurrence. A highly significant difference was found between the therapeutic response of common warts to MMR vaccine and saline control group (P < 0.001). In the MMR group, complete response was achieved in 80% and 84.6% of patients presenting with recalcitrant and multiple warts respectively. No recurrence was observed in the MMR group and side effects included pain during injection and flu-like symptoms. Intralesional immunotherapy by MMR vaccine is a promising effective and safe treatment modality for common warts, particularly the multiple ones.

A novel mutation of the WAS gene in a patient with Wiskott-Aldrich syndrome presenting with recalcitrant viral warts

Wiskott-Aldrich syndrome (WAS) is a rare X-linked immunodeficiency disorder characterized by a combination of immunodeficiency, microthrombocytopenia, recalcitrant eczema, and high susceptibility to cancers and autoimmune diseases [1]. WAS has a broad range of clinical phenotypes associated with different mutations in the gene encoding the WAS protein (WASP), which is involved in cell signaling, cell locomotion, and immune synapse formation [2,3].

Treatment of recalcitrant viral warts with pulsed dye laser MAL-PDT

Background: Photodynamic therapy (PDT) has been explored for the treatment of recalcitrant viral warts (VW) with good results in recent publications. Methods: We carried out a descriptive and observational study in 19 patients with recalcitrant VW. Methyl aminolaevulinic acid (MAL) was occluded for 3 hours and pulsed dye laser (PDL) was used as the light source. VW were treated weekly until they were clear or for a maximum of six sessions. Results: A total of 53% of the VW cleared, and 26% of the patients demonstrated complete clearance of all their VW. The treatment was well tolerated and no adverse events were recorded. Conclusions: PDL-PDT is an effective and well-tolerated treatment option for patients with recalcitrant VW. Though only half of patients show any improvement, responders are likely to show complete clearance of their warts.