Flat Warts Research Articles

LCC: Towards efficient label completion and correction for supervised medical image learning in smart diagnosis

Smart technology brings convenience to our lives, and smart medical diagnosis plays a particularly important role in smart cities and the smart world. In smart diagnosis, high-quality image labels are essential for supervised medical image learning. The correctness of labels has a substantial influence on smart disease diagnosis. However, the labelling of disease images by professional doctors is a time-consuming and labour-intensive project; therefore, obtaining correct and high-quality labels is a difficult task. This paper proposes a deep convolutional neural network (CNN)-based label completion and correction method (LCC) for supervised medical image learning in smart diagnosis. We use a small number of labelled images in a dataset to train a model, and design a strategy to complement most of the unlabelled data and correct noise label data, and then use the results of completion and correction to continually modify the model to achieve better results. We take the diagnosis of Seborrheic Keratosis (SK) and Flat Wart (FW) as examples; the experimental results show that this strategy can use limited labelled data to complete the labels for most of the unlabelled data and correct some noise labels in the dataset, which improves the accuracy rate of the model to identify diseases.

Histological and immunohistochemical characterization of the integument and parotoids glands Rhinella bergi (Anura: Bufsonidae): Development and differentiation

A detailed description of the tegument and parotoid glands of pre-metamorphic, post-metamorphic, juvenile and adult individuals of Rhinella bergi is presented to provide an exhaustive analysis of the integumentary characteristics of this species. Fragments of the tegument were fixed in Bouin solution and preserved in buffered Formol 10%. Subsequently, scanning electron microscopy (SEM) was performed to characterize the macroscopic structure of these regions. Microscopic observations were made from histological sections stained with Hematoxylin and Eosin, Alcian Blue (pH 2,5), PAS-H, Coomassie Blue, Oil Red, and Bielschowsky Impregnation.. There were three types of protuberance: warts, tubers, and thorns. These structures became evident from post-metamorphic stages. The ventral surface shows elevations similar to flat warts; however, tubers and spines are absent. Histologically, each structure consists of a spongy dermis of lax connective tissue and dense and compact dermis, associated with granular glands and a keratinized epidermis. The latter, in the dorsal region, forms projections called thorns. The granular glands accumulate, and their alveoli increase in size progressively. This work provides a morphological and histological description of the integument and the parotoid glands during the larval and post-metamorphic stage of the genus Rhinella, with aspects described for the first time in the genus.

Observation of the effect of 5-aminolevulinic acid-photodynamic therapy combined with liquid nitrogen cryotherapy in the treatment of patients with facial stubborn flat warts

目的 观察5-氨基酮戊酸光动力疗法联合液氮冷冻治疗颜面部顽固性扁平疣的临床疗效。 方法 选择运城市中心医院2016年1月至2017年6月收治的符合入组标准的面部顽固性扁平疣患者70例为研究对象，采用随机数字表法分为对照组35例和观察组35例，对照组采用单纯液氮冷冻治疗；观察组先给予5-氨基酮戊酸光动力疗法治疗，随后再进行液氮冷冻治疗。治疗结束后10 d、20 d、30 d进行扁平疣综合临床疗效评估及瘢痕愈合质量评估，记录治疗期间不良反应发生情况，统计随访6个月的复发情况。 结果 观察组治疗后10 d、20 d、30 d的总有效率分别为68.57%、82.86%、91.43%，对照组分别为34.29%、48.57%、65.71%，观察组有效率均明显高于对照组(χ2＝9.010、9.353、8.173，均P<0.05)。观察组治疗后10 d、20 d、30 d瘢痕愈合质量均明显优于对照组(χ2＝58.209、91.369、59.917，均P<0.05)。随访6个月，观察组复发率为5.71%(2/35)，明显低于对照组的22.86%(8/35)，两组差异有统计学意义(χ2＝4.200，P<0.05)。 结论 5-氨基酮戊酸光动力疗法联合液氮冷冻治疗颜面部顽固性扁平疣能够有效提高综合临床疗效及瘢痕愈合质量，降低复发率。

Treatment of Warts by Immunotherapy Using Purified Protein Derivative

Introduction: Spontaneous clearance of warts has been reported with the development of cell mediated immunity. Various antigens and vaccines have been used for the non specific stimulation of cell mediated immunity and purified protein derivative (PPD) is one of them.Objective: To assess the effectiveness of intralesional PPD injection for the clearance of cutaneous warts.Methodology: This is an open labeled study and non-probability sampling method was used for enrolling the cases. Patients with cutaneous warts were injected with PPD intralesionally (2.5 TU) at an interval of 2 weeks for a total of five sessions and they were followed for 6 months after they received the last session therapy.Results: A total of 52 patients,29 males and 23 females, were enrolled in the study and among them 28 patients had verruca vulgaris,12 patients had verruca plantaris, 9 patients had periungual wart and 3 patients had verruca plana. Total clearance of warts was seen in 78.8%(41) of patients, however 21.2% (11) patient did not respond to the therapy. Most of the patients tolerated the therapy well and few of them had mild side effects like erythema, pain and oedema at the site of injection.Conclusion: Immunotherapy with intralesional injection of PPD is a safe and effective way to treat cutaneous warts with good response rate. BJHS 2018;3(2)6: 463-467.

DDA: A deep neural network-based cognitive system for IoT-aided dermatosis discrimination

The rapid development of the Internet of Things (IoT) and cognitive cyber-physical systems (CPS) has made people's daily lives more intelligent. Additionally, emerging technologies, such as wearable devices and machine learning, have demonstrated the potential for acquiring and processing large amounts of data from the physical world. In the medical field, effectively utilizing the collected medical data and providing more intelligent systems for doctors and patients to assist in diagnoses have also become important research topics. This paper presents a deep neural network-based cognitive system named DDA (dermatosis discrimination assistant) for classifying the dermatosis images generated by confocal laser scanning microscopes. Considering the lack of labels, we increase the labeled data automatically using an incremental model based on a small amount of labeled data and propose a disease discrimination model to distinguish and diagnose the categories of the disease images. In this system, the diagnoses of seborrheic keratosis (SK) and flat wart (FW) are used as examples, and experiments are conducted using the proposed models. Experimental results show that this system performs almost as well as individual dermatologists and can identify and diagnose other common dermatoses.

A novel cosmetic and clinically practicable laser immunotherapy for facial verruca plana: Intense pulsed light combined with BCG-PSN.

There is no standard method to remove facial verruca plana and achieve better cosmetic effects. The present study is the first study to use intense pulsed light (IPL) as photothermal therapy (PTT) combined with intra-gluteal injection of bacillus calmette-guerin polysaccharide nucleic acid (BCG-PSN), which function as immunotherapy, contracting a new type of clinically available laser immunotherapy (LIT) for the treatment of facial verruca plana. The aim of this study was to evaluate the efficacy, cosmetic outcome, and adverse reactions of IPL combined with BCG-PSN for facial verruca plana. Twenty-three patients with facial verruca plana were treated with IPL (560-nm filter, 15-17 J/cm2) and all patients were given intra-gluteal injections of BCG-PSN twice a week for 8 weeks combined with IPL once a month in two times. The clinical responses, recurrences, adverse reactions, and rejuvenation outcomes were evaluated. A complete and excellent response was noted in 17 patients (74%). Of the 676 treated warts, 548 were eradicated and the overall clearance rate was 81%. No patient relapsed during the 20-week follow-up. No obvious adverse reactions was observed. Almost all patients showed an improvement in skin texture after IPL treatment CONCLUSION: We conclude that a novel LIT based on BCG-PSN and IPL for the treatment of facial verruca plana proved to be a well-tolerated and effective treatment modality. This novel LIT can clear skin lesions and achieve a very good cosmetic effect.

Combined ablative fractional Er∶YAG laser and 10% ALA-PDT in treatment of refractory verruca plana

Objective To evaluate the efficacy of combined therapies of ablative fractional Er∶YAG laser (2, 940 nm) and ALA-PDT on refractory verruca plana. Methods 120 cases of refractory verruca plana patients were randomly divided into two groups: 60 cases in the control group and 60 cases in the experimental group. The control group used 10% ALA-PDT with LED irradiation of a power density 70 of mW/cm2 at a distance of 20 cm, which lasted for 20 min each time. The experimental group was treated with ablative fractional Er∶YAG laser (2, 940 nm) first with the fluence of 500P/cm2 and short pulse duration, and then treated 10% ALA-PDT as mentioned before. Every patient was treated twice at two-week intervals. Three independent investigators evaluated subject outcomes at 3 months post-treatment including efficacy and side-effects. Results The effective rate of the experimental group was 86.44% at 3 months post-treatment after one to two times. Meanwhile, the control group was 59.65%. The clinical outcome of experimental group was better than the control group. There was significant difference between the two groups (P<0.05). The recurrent rate of experimental group was 3.39% and 12.30% in control group. There was significant difference between the two groups (P<0.05). There were no obvious side-effects in both groups. Conclusions Ablative fractional laser with low fluence promotes the transdermal absorption of ALA and enhances the efficacy of PDT. Key words: Fractional ablative laser; Photodynamic therapy; Verruca plana; Aminolevulinic acid

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.

Analysis of dermoscopy and reflectance confocal microscopy features of verruca plana

Objective To evaluate imaging features of verruca plana by dermoscopy and reflectance confocal microscopy (RCM) . Methods Totally, 88 untreated patients with verruca plana were enrolled into this study. One typical skin lesion was chosen from each patient and subjected to dermoscopy and RCM separately, and imaging features were recorded and analyzed. Results Dermoscopy revealed a light red background in 48 cases (54.55%) , a light yellow background in 40 cases (45.45%) , and a various number of punctate hemorrhages in 84 cases (95.45%) . RCM showed concentric onion-skin-like structures in 48 patients (54.55%) . Among 57 patients with disease duration > 1 year, 44 (77.19%) had the concentric onion-skin-like pattern, while only 4 (12.90%) patients had similar structures among 31 patients with disease duration 1 year and those with disease duration < 1 year (χ2= 33.47, P < 0.05) . Of 88 patients, 86 (97.73%) had hyperpigmentation in the basal layer at the dermo-epidermal junction, intact dermal papillary rings, vasodilatation, hyperemia and 1-2 dilated capillaries in the dermal papillae. Eight patients were treated for 2 weeks, and the above features disappeared after the treatment under dermoscopy and RCM. Conclusion Based on clinical manifestations, dermoscopy and RCM features may be helpful for the diagnosis of verruca plana. Key words: Warts; Dermoscopy; Microscopy, confocal; Verruca planae

Case Report: Lupoid cutaneous leishmaniasis mimicking verruca plana.

Cutaneous leishmaniasis (CL) is an infectious disease caused by various species of leishmania protozoan parasites. Lupoid CL is a rare form of CL that has a stunning similarity to other granulomatous cutaneous conditions of infectious or inflammatory origin. Verruca plana, also known as a "flat wart", is a benign proliferation of the skin resulting from infection with human papilloma virus (HPV). Herein, we presented a case of lupoid CL mimicking verruca plana on the face.

A randomized study of combination of ablative fractional laser and ALA-PDT for treatment of refractory verruca plana

A randomized study of combination of ablative fractional laser and ALA-PDT for treatment of refractory verruca plana

편평 사마귀의 한약치료에 대한 임상 연구 동향 - 중의학논문을 중심으로

Objective The purpose of this study is to investigate recent clinical studies on the effect of herbal medicine in flat warts in China, and to seek better methods to treat and study for flat warts in Korea. Methods The clinical studies from the CAJ (China Academic Journal) of CNKI (China National Kno...

Reflectance confocal microscopy features of several common diseases manifesting as papules in children

Objective To evaluate the clinical application value of reflectance confocal microscopy (RCM) in the diagnosis of several common diseases manifesting as papules in children, including lichen nitidus, verruca planae, lichen striatus, milium, molluscum contagiosum and lichen pilaris. Methods A total of 579 children clinically characterized by papules were recruited into this study. RCM was used to observe lesions and perilesional normal skin. The RCM features of 6 diseases manifesting as papules were analyzed and compared. Results Based on RCM images, 236 patients were diagnosed with lichen nitidus, 70 with verruca planae, 123 with lichen striatus, 40 with milium, 53 with molluscum contagiosum and 57 with lichen pilaris. All the 6 diseases had typical RCM features. Concretely speaking, RCM images of lichen nitidus lesions showed infiltration of dense inflammatory cells and melanophages in enlarged dermal papillae. In RCM images of verruca planae lesions, cells in the granular and spinous layers were arranged in concentric circles, giving a rose cluster-like appearance. RCM images of lichen striatus lesions revealed focal swelling of stratum spinosum, absent or local liquifaction degeneration of basal cells, and clustering of a moderate number of inflammatory cells in the superficial dermis. In RCM images of milium lesions, well-circumscribed round or oval structures containing highly but nonuniformly refractive materials could be seen in the dermis. RCM images of molluscum contagiosum lesions showed intact cystoid structures containing highly refractive molluscum bodies. Lowly to moderately refractive cutin-like materials were observed along with the dilation of hair follicle infundibula in RCM images of lichen pilaris lesions. In RCM images, the 6 diseases were distinguished mainly based on structural features (patterns and refractivity) of skin lesions shown by continuous vertical scanning. Conclusion RCM is of great value to the diagnosis of diseases manifesting as papules in children. Key words: Microscopy, confocal; Skin diseases, papulosquamous; Child; Diagnosis, differential

Use of Er:YAG for the treatment of recalcitrant facial verruca plana

Background: Recalcitrant facial verruca plana (FVP) may persist for years and full remission is not always achieved with conventional therapies. The clinical success rates reported for different lasers are highly variable and only one study evaluated the Er:YAG laser for the treatment of FVP.Objective: To determine whether Er:YAG is safe and effective for the treatment of recalcitrant FVP.Methods: Forty-six patients with recalcitrant FVP were treated by Er:YAG at four-week intervals. The patients’ clinical response, adverse effects such as scarring and pigment change, recurrence and patient satisfaction were assessed. Patients were clinically evaluated after each session over a six-month follow-up.Results: A total of 550 lesions of 46 participants were treated with 1–3 passes. The patients received 1–4 laser sessions with one session on average. Thirty-two patients (62.5%) achieved a complete response with 458 lesions (83.3%) being completely and 30 (5.5%) being partially healed. The post-treatment side effects were post-inflammatory hyperpigmentation and mild scar formation. FVP recurred in 12 patients (26.0%). Twenty-six patients (56.5%) were completely satisfied and nine (19.5%) were mostly satisfied with the treatment.Conclusions: Er:YAG laser is a good treatment option in patients with recalcitrant FVP, particularly for cosmetically sensitive areas.

Epidermodysplasia verruciformis as a manifestation of ARTEMIS deficiency in a young adult

Abstract This study is the first to report epidermodysplasia verruciformis (EV) associated with ARTEMIS deficiency in a young adult. This broadens the clinical scope of ARTEMIS deficiency, and provides a new genetic etiology for susceptibility to EV.

Laser and light therapy for facial warts: a systematic review.

Facial verruca plana, or flat warts, are benign skin papillomas caused by human papillomavirus infections. A large portion of cases are refractory to treatment and can cause psychosocial distress in patients. Laser and light modalities offer an alternative therapeutic approach that has not been extensively explored. We systematically reviewed PubMed for studies describing treatment of facial verruca plana using lasers, photodynamic therapy and infrared coagulation. Final inclusion and review of eighteen studies suggests laser and light therapies to have considerable potential in the treatment of this recalcitrant condition. In particular, yttrium aluminium garnet lasers, infrared coagulation and photodynamic therapies have been reported to demonstrate efficacy. Further studies with larger power are required to determine which method should be established as the alternative treatment of choice for recalcitrant facial verrucae.

Facial flat warts in a young patient with a previous trauma: an example of isotraumatopic response

Facial flat warts in a young patient with a previous trauma: an example of isotraumatopic response

Off-label photodynamic therapy for recalcitrant facial flat warts using topical 5-aminolevulinic acid.

The facial flat wart (verruca plana) is one of the most common reasons for dermatology and primary care visits. Although there are many therapeutic modalities, no single therapy has been proven to be completely curative. Case reports and uncontrolled studies suggested that photodynamic therapy (PDT) with topical 5-aminolevulinic acid (ALA) can effectively treat recalcitrant facial flat warts. A total of 12 patients with recalcitrant facial flat warts were enrolled in the study. ALA gel (10%) was applied topically to lesions and incubated for 3h. The lesions were irradiated by an LED light of 630 ± 10nm at dose levels of 60-100mW/cm. Clinical assessment was conducted before and after every treatment for up to 24weeks. Among the ten patients completing three sessions of ALA-PDT, five had complete lesions clearance, and the other five patients were significantly improved. At the 24-week follow-up, the average effective rate was 88.8%, with no recurrences. No significant side effects were reported. A low-dose topical ALA-PDT regimen using 10% ALA, 3h incubation, and a red light source for three treatment sessions are suggested as the optimal scheme for the treatment of recalcitrant flat warts on the face in Chinese patients. Superior efficacy is found in elevated or active period lesions with mild side effects.

When Acne is Not Acne.

Acne vulgaris (AV) is considered a straightforward diagnosis made clinically without specific diagnostic testing. However, certain disorders may simulate AV, such as multiple small epidermal cysts or deep milia, multiple osteoma cutis, multiple small adnexal neoplasms, and follicular and/or infections characterized by multiple small papules and/or pustules such as gram-positive folliculitis, gram-negative folliculitis, Malassezia folliculitis, keratosis pilaris, and flat warts. This can lead to an erroneous diagnosis and improper management. Acneiform eruptions, often associated with ingestion of certain drugs and chemicals, can confound the clinician regarding AV diagnosis. We present herein an interesting case that was originally misdiagnosed as AV.

Tretinoin in microsphere technology increases the sphere of efficacy in verruca plana

Tretinoin in microsphere technology increases the sphere of efficacy in verruca plana