Treatment Of Recalcitrant Warts Research Articles

Therapeutic Effects of Intralesional Injection of Vitamin D3 in Treatment of Recalcitrant Warts: An Evaluator-Blinded Clinical Trial

Background: Viral warts are a prevalent infection that affects people all over the world. Unfortunately, there is no proven antiviral treatment for them. Recalcitrant warts are also difficult to resolve and deciding on a strategy for their treatment is challenging. Recently immunotherapy modalities have led to desired treatment outcomes in patients. This study investigated the efficacy of vitamin D injection (as an immunotherapeutic agent) in the treatment of recalcitrant warts. Methods: In this clinical trial study, 40 patients were divided into two groups: the first group (intervention group) received cryotherapy with an intralesional injection of vitamin D3 (0.1 cc of vitamin D3 (300000 IU/1mL) per lesion and a maximum of 0.5 cc per session), and the second group (control group) received just cryotherapy. In each treatment session, patients were evaluated for treatment responses and any side effects. Each patient received four treatment sessions at 2-week intervals. Results: After 4 treatment sessions, the rate of response in the intervention group and the group that received just cryotherapy was 95.33%±5.87 and 76.67%±25.14, respectively, and this difference was significant (P<0.01). Furthermore, 57% (26 out of 45) of the lesions in the intervention group were completely resolved after 4 sessions, and the rest showed a moderate response to this treatment. Moreover, the minimum response rate was 80% in the intervention group and 30% in the control group. Conclusion: In recalcitrant skin warts, intralesional injection of vitamin D3 combined with cryotherapy significantly increased the treatment response and reduced the financial burden imposed on patients. The limitation of this trial was the small sample size of patients without a follow-up plan after completing the treatment sessions. Trial registration: The Iranian Registry of Clinical Trials registered this study (identifier: IRCT20200513047434N1).

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 Purified Protein Derivative of Tuberculin Versus Intralesional Mycobacterium W Vaccine in Treatment of Recalcitrant Extragenital Warts: A Randomized, Single-Blinded, Comparative Study.

Introduction:Of late, immunotherapy has emerged as a promising therapeutic modality for the treatment of recalcitrant and difficult to treat warts. Purified protein derivative of tuberculin (PDD) and mycobacterium w (Mw) vaccine hold promising prospects for the treatment of verruca, especially in a country like ours where a majority of the population is already sensitized to mycobacterium tuberculosis both due to disease endemicity and Bacillus Calmette-Guérin (BCG) vaccination.Aims and Objectives:We aimed at evaluating the treatment outcome of intralesional PPD tuberculin and Mw vaccine in the treatment of recalcitrant extragenital warts in immunocompetent subjects.Materials and Methods:The patients included immunocompetent subjects between the ages of 16 and 65 years with two or more extragenital warts. The patients were randomized into two groups, namely A (PPD Tuberculin) and B (Mw vaccine). In both groups, 0.1 mL of active intralesional immunogen was injected at the base of the largest wart. The doses were repeated at 4 weeks' intervals for a maximum of 5 injections. Additionally, the improvement in quality of life was measured using the Hindi-validated version of the Dermatology Quality of Life Index (DLQI) questionnaire.Results:Ninety-seven patients completed the study, with 46 in group A and 51 in group B. In group A, 24 (52.17%) patients had complete clearance in all warts, and in group B, 32 (62.75%) (P = 0.38). The most common adverse event in patients of group A was transient injection site erythema and swelling, whereas that in group B was mild transient fever. None of the patients showed any signs of recurrence in the ensuing follow-up period. There was a statistically significant improvement in the mean DLQI scores after treatment in both groups (P < 0.0001).Conclusion:Both PPD Tuberculin and Mw vaccine are effective in the treatment of recalcitrant warts with minimal recurrence rate. The safety profile of PPD is superior to Mw vaccine. We suggest both to be used as first-line therapy in the treatment of difficult to treat warts.

Nonavalent Human Papillomavirus Vaccine as a Treatment for Recalcitrant Warts in an Adult with HIV

To the Editor: Cutaneous warts are seen in as many as a quarter of immunosuppressed patients. 1 Cell-mediated immunodeficiency, as seen in HIV, is correlated with increased rates of palmoplantar warts. 2 These warts often cause discomfort, and can progress to verrucous carcinoma. As they can be resistant to traditional treatments like cryotherapy, patients must resort to more aggressive and invasive measures like intralesional bleomycin. In this case report, we present an immunocompromised patient with HIV successfully treated for his palmoplantar human papilloma virus (HPV) warts using the nonavalent HPV vaccine (Gardasil 9TM, Merck Inc, Kenilworth, NJ, USA) after only marginal improvement with six treatments of bleomycin.

Comparison of Purified Protein Derivative and Vitamin D in the Treatment of Recalcitrant Warts

Background: Viral warts are caused by human papillomavirus. There are various treatment modalities which cause destruction of the warts. Not all of them are very effective on difficult-to-treat warts. For the treatment of difficult-to-treat warts, new and effective treatment includes intralesional immunotherapy. Objectives: The aim was to evaluate and compare the efficacy of intralesional Vitamin D and tuberculin purified protein derivative (PPD) as immunotherapy in difficult-to-treat warts. Materials and Methods: A total of 100 patients with difficult-to-treat viral warts were enrolled in this randomized controlled study. Group A patients were injected intralesionally with 2.5 TU of tuberculin PPD (0.1 ml) and Group B patients were injected with 0.1 ml of Vitamin D3 per lesion to a maximum of ten lesions. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and after the completion of the treatment every 2 weeks for a total of four sessions. Unpaired t-test was used to compare both the treatment modalities. Results: In Group A, a total of 38 (76%) patients showed complete clearance and 12 (24%) showed partial response, while in Group B, a total of 42 (84%) patients showed complete clearance, while 8 (16%) showed partial response. There was no statistically significant difference between both the modalities. Conclusions: Intralesional Vitamin D3 injection and intralesional PPD may be a treatment option for difficult-to-treat warts that are unresponsive to conventional treatments. Both are equally effective with minimal side effects.

Efficacy of intralesional Candida antigen immunotherapy in treatment of recalcitrant warts.

Efficacy of intralesional Candida antigen immunotherapy in treatment of recalcitrant warts.

Curettage + microneedling + topical ALA-PDT for the treatment of acral resistant warts: Our experience.

Cutaneous warts are an extremely common problem, whose eradication can be challenging. Topical PDT involves applying a porphyrin precursor, 5-aminolevulinic acid (ALA) or methyl aminolevulinate (MAL) to the affected area. ALA-PDT has been well documented to be successful in the treatment of recalcitrant warts. PDT has a limited role in the treatment of thicker lesions because the photosensitizer does not penetrate keratotic lesions well, though this is vehicle dependent. The aim of this study was to evaluate the efficacy and safety of curettage + microneedling + ALA-PDT for the treatment of resistant acral warts. We hypothesized that microneedling may increase the efficacy of PDT, providing a channel to deliver the ALA to deeper areas of warts. Our study was carried out between November 2017 and July 2018. Eligible participants had one or more resistant plantar or palmar warts. Thirteen patients were recruited. They underwent a thorough curettage, followed by the application of 5-ALA 10% cream on the wart, and by microneedling. Later, the pricked skin was covered for three hours by an occlusive polyurethane dressing, and finally irradiated with a red-light source. Patients performed one session every three weeks for a total of three cycles. After 3 treatments of curettage + microneedling + ALA-PDT, 11 patients (84.6%) showed complete remission (defined as complete disappearance of their warts). One patient (7.7%) showed partial remission (defined as greater than 50% decrease in the wart area) after 3 sessions; this patient needed other 2 sessions to achieve complete remission. The mean follow-up period after healing was 4.3 months. Adverse effects were recorded. We have demonstrated, for the first time to our knowledge, that the combination of curettage + microneedling + topical ALA-PDT may offer an effective and safe alternative for the treatment of acral resistant warts, even when PDT alone has already been insufficient.

Combined acitretin and Candida antigen versus either agent alone in the treatment of recalcitrant warts

Combined acitretin and Candida antigen versus either agent alone in the treatment of recalcitrant warts

Wart Immunotherapies: A Short Review

Objective: To review the efficacy and costs of various contact immunotherapies, contact allergens, intralesional immunotherapies, and intralesional cytotoxic agents for the treatment of recalcitrant warts. Background: Cutaneous warts are common viral skin lesions caused by human papillomavirus that can be challenging to treat and frustrating for physicians and patients. Although several treatment options exist, there is no single treatment that can ensure a complete response with lack of lesion recurrence. Immunotherapies for recalcitrant warts present as a cost-effective, efficient therapy option for patients. Intralesional approaches have the added benefit of affecting warts at locations distant to the target location by inducing a systemic T-cell mediated response in the body. Results: Various contact immunotherapies, contact allergens, intralesional immunotherapies, and intralesional cytotoxic agents have shown to be effective in treating warts. The costs of each treatment varies drastically from around $10 US to over $1000 US to achieve a complete response. Several antigens were found to be both efficacious and cost effective. Conclusion: Although efficacy of several antigens has been confirmed by randomized studies, more randomized comparative studies will need to be performed in order to determine the best antigen and correct standardized doses for the treatment of warts in individual patients. It is important to note that individual response to antigen type and dose may vary among patients. Therefore, further studies may play an important role in the use of immunotherapies in a clinical setting.

A Study on the Efficacy of Immunotherapy with Purified Protein Derivative for the Treatment of Recalcitrant Warts

Introduction: There are many treatment modalities of warts, but most of them are destructive therapies which have propensity to cause scarring. Many antigens especially purified protein derivative (PPD) of tuberculin bacilli are being used for the regression of warts.Aims: To study the efficacy of purified protein derivative of tuberculin bacilli in the treatment of warts.Methods A randomized controlled trial was done in which 25 patients of recalcitrant warts were taken up for the study. In all the patients, 2.5 units of PPD was injected in each wart and upto maximum of 25 units PPD was given and the injections were given every 3 weeks for a total of 3 sessions.Results: Commonest type of wart seen in our study was verruca vulgaris in 15(60%) patients, verruca plana in 5(20%) patients, palmoplantar warts in 3 (12%) patients and genital warts in 2 (8%) patients. Regarding the number of warts 15 (60%) patients had more than 20 warts, 5 (20%) patients had number of lesions between 11 – 20 and another 5(20%) patients had lesions between 1 – 10. Complete clearance of lesions after 3 sessions was seen in 18 (72%) patients, partial clearance of lesions was seen in 4 (16%) patients and no response was seen in 3 (12%) patients.Conclusion: Immunotherapy with PPD causes boosting up of the cell mediated immunity of the patients which causes spontaneous regression of the warts.

A comparative study of pulsed dye laser versus long pulsed Nd:YAG laser treatment in recalcitrant viral warts

Background: Viral warts are common infectious skin disease induced by human papillomavirus (HPV). But the treatment of recalcitrant warts is still challenging.Objective: In this study, we compared the effectiveness of pulsed dye laser (PDL) and long pulsed Nd:YAG (LPNY) laser in the treatment of recalcitrant viral warts.Methods: We retrospectively analyzed the medical records of patients with recalcitrant warts treated with laser therapy between January 2013 and February 2016.Results: Seventy-two patients with recalcitrant warts were evaluated. Thirty-nine patients were treated with pulsed dye laser and thirty-three patients were treated with LPNY laser. The following parameters were used: PDL (spot size, 7 mm; pulse duration, 1.5 ms; and fluence, 10–14 J/cm2) and LPNY (spot size, 5 mm; pulse duration, 20 ms; and fluence, 240–300 J/cm2). Complete clearance of two patients (5.1%) in PDL group, and three patients (9.1%) in LPNY group were observed without significant side effects. The patients who achieved at least 50% improvement from baseline were 20 (51.3%) in PDL and 22 (66.7%) in LPNY, respectively.Conclusion: This research is meaningful because we compared the effectiveness of the PDL and LPNY in the recalcitrant warts. Both PDL and LPNY laser could be used as a safe and alternative treatment for recalcitrant warts.

Oral zinc sulfate in the treatment of recalcitrant warts

Background Cutaneous warts are benign papillomas of the skin caused by infection with human papillomavirus. The primary treatment methods of warts are physical destruction. However, these treatments are not suitable for patients with multiple lesions or with fear of pain and scarring. Therefore, immune-modifying agents might be a useful therapeutic alternative because they can be painlessly and easily administrated. Zinc is a trace element that is essential for the functioning of the immune system. It could counteract viral infections. Zinc sulfate is a promising therapy for the management of multiple warts. Aim The aim of this study was to determine the association of low serum zinc levels with persistent viral warts and to assess whether oral zinc sulfate was effective in treating persistent viral warts. Patients and methods This randomized case–control clinical trial was conducted on 40 patients. Eligible patients had five or more warts of at least 6-month duration resistant to one or more lines of treatment. Blood samples of all patients were taken to determine basic serum zinc level using spectrophotometry. Patients were randomly divided into two groups; each group consisted of 20 patients. Group I received oral zinc supplementation 10 mg/kg up to 600 mg maximum daily dose for 1 month. Group II did not receive any treatment. All of the patients were instructed not to take any other treatment during the trial. At the end of the study, the patients were assessed and the serum zinc level was remeasured. The percent of improvement of the warts was classified as follows: excellent, greater than 75%; moderate, 75–50%; mild, less than 50%; and no change. Results At the beginning of the study, the mean serum zinc level in group I was 85.95 μg/dl and that in group II was 81.30 μg/dl. However, at the end of the study, the mean serum zinc level in group I was 115.61±19.69 μg/dl and that in group II was 81.90±36.04 μg/dl. Serum zinc level significantly increased after treatment compared with that before treatment in group I (P=0.013); moreover, it became significantly higher than that in group II (P=0.006). The significant increase in serum zinc level in group I was associated with more clinical improvement in the warts. Shorter duration of the disease was associated with better response. Patients with excellent improvement had significantly higher serum zinc level than those with no improvement. Conclusion Our findings suggest that oral zinc supplementation should be considered as a therapeutic option in the treatment of recalcitrant multiple warts. Zinc deficiency is relatively common in our population. Oral zinc supplementation was associated with elevation of serum zinc level, which was associated with clinical improvement in the warts.

Efficacy of squaric acid dibutyl ester in treatment of recalcitrant warts in children.

Dermatologic TherapyVolume 28, Issue 5 p. 330-330 Journal Highlights Efficacy of squaric acid dibutyl ester in treatment of recalcitrant warts in children Nooshin Bagherani, Corresponding Author Nooshin Bagherani Dr. Nooshin Bagheran's Office, Taha Physicians’ Building, Khoramshahr, Khuzestan Province, IranAddress correspondence and reprint requests to: Nooshin Bagherani, MD, Dermatologist at Dr. Nooshin Bagheran's office, Taha Physicians' building, P.O.Box: 6414715878, Khoramshahr, Khuzestan Province, Iran, or email: [email protected].Search for more papers by this author Nooshin Bagherani, Corresponding Author Nooshin Bagherani Dr. Nooshin Bagheran's Office, Taha Physicians’ Building, Khoramshahr, Khuzestan Province, IranAddress correspondence and reprint requests to: Nooshin Bagherani, MD, Dermatologist at Dr. Nooshin Bagheran's office, Taha Physicians' building, P.O.Box: 6414715878, Khoramshahr, Khuzestan Province, Iran, or email: [email protected].Search for more papers by this author First published: 26 March 2015 https://doi.org/10.1111/dth.12234Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume28, Issue5September/October 2015Pages 330-330 RelatedInformation

Treatment of recalcitrant warts with Bacillus Calmette-Guérin: a promising new approach

Recalcitrant warts represent a therapeutic challenge for both patients and physicians. Recently, intralesional immunotherapy by different antigens has been proved effective in the treatment of different types of warts. We describe a case of a 48-year-old male who presented with troublesome huge common wart on the left little toe of 5 years duration and not responding to many lines of therapy. Nearby and distant common and plantar warts have also been observed. Intralesional Bacillus Calmette-Guérin (BCG) vaccine was injected into the huge wart of the little toe at 2-week intervals for five sessions. Follow-up was made every month for 6 months. A gradual decrease in the size of the injected wart was observed until reaching complete clearance by the end of the fifth session. Untreated nearby common and distant warts disappeared completely by the end of the third session. BCG injection was associated with erythema and edema with or without pustules, at the site of injection. A flu-like illness that rapidly subsided within 3 days was also observed with each injection. No recurrence was observed after the 6-month follow-up period. Intralesional immunotherapy with BCG vaccine seems to be a promising effective and safe treatment modality for recalcitrant warts.

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.

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.

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

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

To determine the efficacy and safety of the 585-nm pulsed dye laser (PDL) in the treatment of recalcitrant warts in children. Retrospective survey of the medical records of children with recalcitrant warts who were treated with PDL between March 1995 through January 1999 at the Children's Memorial Hospital outpatient subspecialty center, Chicago, Illinois. Sixty-one children with recalcitrant warts were treated with PDL; 75% of them had total clearance of warts after an average of 3.1 treatment sessions. Overall success rates were 100% for both perineal and perianal and face-only warts, 93% for hands, 69% for plantar warts, 67% when both face and extremities were involved, and 60% when multiple extremities were involved. Pain and other side effects were minimal. Mild scarring occurred in 2% of patients; 75% of patients remained free of warts after a follow-up period of 24 months or longer. PDL therapy is an effective, safe alternative therapy for treatment of recalcitrant warts in children, with few side effects and a low long-term recurrence rate.

Pulsed Dye Laser Treatment is Effective in the Treatment of Recalcitrant Viral Warts

BACKGROUND Verrucae vulgaris can be removed in a variety of ways but a specific therapy of choice has not yet been developed. Doctors are faced with a challenge, especially in the treatment of recalcitrant warts. It has been suggested that the success of pulsed dye laser treatment lies in the fact that warts contain an increased number of dilated blood vessels. METHODS Seventy-three patients (42 female, 31 male) with verrucae vulgaris on their hands or feet (1:1.5) were given a maximum of 12 treatments with a flashlamp-pumped pulsed dye laser every 2 weeks over a period of 24 weeks until complete clearance had been achieved. A laser energy density of 8 to 12 J/cm2 with a spot size of 5 mm and a pulse duration of 450 μsec were used. The minimum follow-up period was 6 months. RESULTS A total of 15.1% patients achieved complete clearance after 1 session and 47.9% after 2 to 5 sessions, resulting in a remission of 63.0% patients after a maximum of 5 treatment sessions. A remission of 23.3% patients was seen after 6 to 9 treatments and a total of 89.0% of patients showed remission after a maximum of 10 sessions. Only three patients (4.1%) failed and five patients (6.9%) stopped the treatment on account of pain/noncompliance. Only one patient, from a group of patients treated between January 2003 and April 2004, has relapsed. CONCLUSION Pulsed dye laser treatment is effective and safe in the treatment of recalcitrant viral warts.

Pulsed Dye Laser Treatment is Effective in the Treatment of Recalcitrant Viral Warts

Verrucae vulgaris can be removed in a variety of ways but a specific therapy of choice has not yet been developed. Doctors are faced with a challenge, especially in the treatment of recalcitrant warts. It has been suggested that the success of pulsed dye laser treatment lies in the fact that warts contain an increased number of dilated blood vessels. Seventy-three patients (42 female, 31 male) with verrucae vulgaris on their hands or feet (1:1.5) were given a maximum of 12 treatments with a flashlamp-pumped pulsed dye laser every 2 weeks over a period of 24 weeks until complete clearance had been achieved. A laser energy density of 8 to 12 J/cm2 with a spot size of 5 mm and a pulse duration of 450 microsec were used. The minimum follow-up period was 6 months. A total of 15.1% patients achieved complete clearance after 1 session and 47.9% after 2 to 5 sessions, resulting in a remission of 63.0% patients after a maximum of 5 treatment sessions. A remission of 23.3% patients was seen after 6 to 9 treatments and a total of 89.0% of patients showed remission after a maximum of 10 sessions. Only three patients (4.1%) failed and five patients (6.9%) stopped the treatment on account of pain/noncompliance. Only one patient, from a group of patients treated between January 2003 and April 2004, has relapsed. Pulsed dye laser treatment is effective and safe in the treatment of recalcitrant viral warts.