Treatment Of Periungual Warts Research Articles

Efficacy and Safety of Intralesional Vitamin D3 Injection in Recalcitrant Periungual Warts: A Randomized Controlled Trial

Introduction: Although the treatment of recalcitrant warts is often disappointing due to its high recurrence rates, the intralesional injections of Vitamin D3 (as an immunotherapeutic molecule) may regulate epidermal cell proliferation. Objective: To evaluate whether intralesional vitamin D3 immunotherapy is efficient and secure in treating the recalcitrant periungual warts. Materials and Methods: This randomized controlled therapeutic trial was performed in the Department of Dermatology and Venereology of Combined Military Hospital, Dhaka from July 2018 to December 2019. A total of 64 participants’ having different sizes and duration of recalcitrant periungual warts were included. Half of them were injected with about 0.2ml vitamin D3 solution (600,000 IU, 15 mg/ml) at the base of the wart (Group-A) and the remaining participants were subjected to cryotherapy (Group-B). A follow-up period of 6 months following the last session was performed to detect any recurrence. Results: The mean age of participants in Group A and B were 25.9±12.6 and 26.4±12.4 years, respectively (78.1% male in Group-A and 62.5% in Group B). The size and duration of warts between the two groups were not statistically significant (p>0.05). The treatment outcome in Group-A varied from excellent 19(59.4%) to significant 8(25.0%), moderate 3(9.4%), mild (3.1%), and no response 1(3.1%), whereas in Group-B, the results were as follows: excellent 13(40.6%), significant 3(9.4%), moderate 9(28.1%), mild 7(21.9%). The efficacy was significantly higher in Group-A when compared to Group-B (p <0.05). Furthermore, the burning sensation, blister, erythema, hypopigmentation, depigmentation and skin atrophy were significantly higher in Group-B compared to Group-A. The recurrence of warts were 12.5% and 34.4% in Group-A and B respectively. Conclusion: Vitamin D3 injection is more effective and secure than cryotherapy in the treatment of periungual warts. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 3-6

Intralesional Antigen Immunotherapy in the Treatment of Periungual Warts.

Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups. Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.

Early Treatment with Imiquimod 5% Cream of Periungual Warts in Vietnam: The Poorer, the Better.

AIM:To evaluate the efficacy of imiquimod 5% in periungual wart treatment.MATERIAL AND METHODS:A group of 40 patients were recruited to apply imiquimod 5 % cream once daily for 5 consecutive days per week in 8 weeks. They were classified into 3 levels: Mild (the total lesion area ≤ 25 mm2), moderate (25 mm2 <total lesion area ≤ 50 mm2), severe (total lesion area > 50 mm2). The outcome was evaluated at the 4th and the 8th week. The result was graded as excellent (complete clearance), good (≥ 50% clearance) and poor (< 50% clearance).RESULTS:The total area of the wart lesion got decreased significantly from the beginning to the 4th and the 8th week (36.7 mm2 vs 16.8 mm2, p = 0.0001 and 16.8 mm2 vs 8.8 mm2, p = 0.01). The complete clearance rate at the 4th week was lower than that at the 8th week significantly (22.5% vs 72.5%, p = 0.04). The clearance rate of patients suffering severe warts was lower significantly than that of mild/moderate patients (82.8% vs 45.5%, p = 0.03). The duration of the disease in people who responded completely to imiquimod was shorter than that of patients partially responded (10.2 ± 14.1 months vs 22.3 ± 14.3 months, p = 0.02). Adverse effects were not common, mild and local only. Recurrence rate after 6 months of follow up was 3.5%.CONCLUSION:In conclusion, Imiquimod 5% cream is a safe and effective drug in the treatment of periungual warts.

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.

Commentary: Successful Treatment of Periungual Warts with Highly Diluted Bleomycin Using a Translesional Multipuncture Technique: A Prospective Pilot Study

Commentary: Successful Treatment of Periungual Warts with Highly Diluted Bleomycin Using a Translesional Multipuncture Technique: A Prospective Pilot Study

Combination treatment of periungual warts

Periungual wart presents challenge for management in view of their frequent recurrence. The case report demonstrates the efficacy of a combination treatment of electrodessication and trichloroacetic acid application.

Cutaneous toxicity of intralesional bleomycin administration in the treatment of periungual warts

<h3>To the Editor.—</h3> The treatment of recalcitrant warts is a common problem, and there have been several reports claiming the efficacy of intralesional bleomycin sulfate in their management.^1-4 We describe herein a patient with periungual warts treated with intralesional administration of bleomycin sulfate, followed by fingernail loss in involved fingers. To our knowledge, only one case has been reported.⁵In our case, no radiotherapy was previously used and no fingernail regrowth was seen after six months. <h3>Report of a Case.—</h3> A 15-year-old girl was seen in March 1985, with a two-year history of periungual warts on the distal phalanx of second and third fingers of the right hand. She had been treated repeatedly with numerous topical keratolytic agents with no response. Within a 40-day interval, two intralesional bleomycin sulfate injections (0.15 U each) were administered. The patient only experienced mild local pain which was well tolerated. No fingernail

Cutaneous Toxicity of Intralesional Bleomycin Administration in the Treatment of Periungual Warts

<h3>To the Editor.—</h3> The treatment of recalcitrant warts is a common problem, and there have been several reports claiming the efficacy of intralesional bleomycin sulfate in their management.^1-4 We describe herein a patient with periungual warts treated with intralesional administration of bleomycin sulfate, followed by fingernail loss in involved fingers. To our knowledge, only one case has been reported.⁵In our case, no radiotherapy was previously used and no fingernail regrowth was seen after six months. <h3>Report of a Case.—</h3> A 15-year-old girl was seen in March 1985, with a two-year history of periungual warts on the distal phalanx of second and third fingers of the right hand. She had been treated repeatedly with numerous topical keratolytic agents with no response. Within a 40-day interval, two intralesional bleomycin sulfate injections (0.15 U each) were administered. The patient only experienced mild local pain which was well tolerated. No fingernail

ONYCHODYSTROPHY AFTER TOPICALLY APPLIED FLUOROURACIL FOR WARTS

To the Editor.— The only things harder to cure than warts are periungual Fluorouracil has been mentioned in both the scientific and the underground literature as a treatment for warts, periungual, 1 sub-ungual, 2 verrucae planae, 3 and viral warts. 4 Onychodystrophy due to fluorouracil in the treatment of periungual warts was reported several years ago. 5 Since this medication is now eminently available for topical use, it is time to report this problem again. Report of a Case.— A 15-year-old boy was seen on April 21, 1970, with several large, steadfast, periungual warts which had been present for about three years. He was advised to apply fluorouracil cream to each wart at bedtime, and then to cover the warts with adhesive tape overnight. He called five weeks later to report that the warts were smaller, but the tips on his fingers (not the warts) were tender. Treatment