Warts Research Articles

MmuPV1 infection of Tmc6/Ever1 or Tmc8/Ever2 deficient FVB mice as a model of βHPV in typical epidermodysplasia verruciformis

Typical epidermodysplasia verruciformis (EV) is a rare, autosomal recessive disorder characterized by an unusual susceptibility to infection with specific skin-trophic types of human papillomavirus, principally betapapillomaviruses, and a propensity for developing malignant skin tumors in sun exposed regions. Its etiology reflects biallelic loss-of-function mutations in TMC6 (EVER1), TMC8 (EVER2) or CIB1. A TMC6-TMC8-CIB1 protein complex in the endoplasmic reticulum is hypothesized to be a restriction factor in keratinocytes for βHPV infection. However, the complex is also present in lymphocytes and its loss may compromise cellular immune control of βHPV infection. Indeed, certain primary immunodeficiencies, iatrogenic immunosuppression and AIDS are associated with the atypical form of EV. While well controlled in immunocompetent mice, murine papillomavirus MmuPV1 was first isolated from immunodeficient mice with florid skin warts, modeling atypical EV. To examine their potential as a model of typical EV, Tmc6-/-, Tmc8-/- or wildtype FVB mice were challenged with MmuPV1. At day 16 post vaginal challenge with MmuPV1, the levels of viral transcripts were similar in Tmc6-/- and Tmc8-/- mice and wildtype FVB mice, arguing against Tmc6/8 acting as intracellular restriction factors. Thereafter, greater clearance of MmuPV1 by the wildtype that the Tmc6-/- and Tmc8-/- FVB mice was evident, supporting the hypothesis that typical EV reflects a subtle cellular immune deficit. Indeed, Tmc6-/- or Tmc8-/- mice exhibit partial CD8 T cell deficits and elevated Treg. While interferon-γ production and surface CD25 were similarly elevated in CD8 T cells upon in vitro stimulation with anti-CD3/CD28, the fraction of Tmc6-/- or Tmc8-/- CD8 T cells that were dividing was lower compared to wildtype. Typical EV patients exhibit normal control of most viral infections; Tmc6-/-, Tmc8-/- and wildtype FVB mice similarly controlled vaccinia virus after skin challenge and induced neutralizing antibodies.

Microwave therapy for the treatment of resistant plantar warts: a randomized, placebo-controlled clinical trial.

Plantar warts, or verrucae plantares, are skin lesions on the soles of the feet caused by human papillomavirus (HPV). These warts are prevalent and affect up to 33% of children and 3.5% of adults. While they may regress spontaneously, plantar warts often persist and resist conventional treatments such as excision, cryotherapy, and laser procedures.This study investigated microwave-induced hyperthermia as a treatment for recalcitrant plantar warts. The study was conducted at a dermatology practice in Lübeck, Germany. Thirty-two adult patients with long-lasting, treatment-resistant plantar warts were randomly assigned to either a treatment or placebo group. The treatment group received microwave therapy (Swift®, Emblation Medical Ltd., UK), while the placebo group underwent sham treatment with a ruby laser (Sinon®, Alma Lasers Ltd., Israel). Treatments were administered every four weeks, for a total of 3 treatments, with a follow-up period of 3months after the third session. The primary outcome was complete wart clearance.Of the 32 participants, 6 dropped out, leaving 28 for analysis. Complete clearance was achieved in 27.3% of the treatment group (3/11) compared to 0% of the placebo group (p = 0.032). Six patients in the treatment group achieved a partial response ranging from 41.1 to 88.4% of the total wart area, with a partial clearance rate of 54.5% versus 13.3% in the placebo group. The average pain score for the microwave treatment group was 5.44.Microwave therapy has proven to be superior to placebo treatment. The clearance rate in this study was lower than that reported in previous uncontrolled studies, potentially due to differences in treatment protocols. The pain level and cost of consumables present challenges. However, further studies are needed to optimize the protocol and assess its efficacy in larger populations and for different wart types.

Atypical HPV Typing: Detection of Genital-Associated HPV Type 6 in Verruca Vulgaris of the Hands and Feet in an HIV-Positive Patient

Atypical HPV Typing: Detection of Genital-Associated HPV Type 6 in Verruca Vulgaris of the Hands and Feet in an HIV-Positive Patient

Efficacy of CO2 laser with computerized scanner in the treatment of recalcitrant plantar warts: A retrospective case series

Efficacy of CO2 laser with computerized scanner in the treatment of recalcitrant plantar warts: A retrospective case series

Investigation of Effectiveness of Nowarta110 Against Murine Malignant Melanoma in an Implanted Animal Model.

Melanoma is a prevalent and severe disease, making the development of new treatments essential. Nowata110 has demonstrated significant therapeutic efficacy in phase II clinical study against plantar warts. It has shown promising anti-cancer effects in both in vitro and in vivo studies using HPV-16 and HPV-18-induced cervical cancer models. This study evaluated the effectiveness of Nowarta110 in murine melanoma-implanted animals. Nowata110 is a novel compound composed of colloidal silver and fig extract. Male and female immunodeficient C(Cg)-Cd 79 atm 1 (cre) and immunocompetent BALB/c mice were used. Murine melanoma cancer cells (B16-F10) were implanted subcutaneously in experimental animals. Once the top cross-sectional area of tumors reached a minimum of 5 mm2 and approximately 4 mm depth, mice were anesthetized and treated with Nowarta110 intravenously or intratumorally. Control mice received no treatment. In non-treated immunodeficient mice, tumor growth progressed over five weeks, whereas Nowarta110-treated mice drastically reduced tumor volume until five weeks after treatment was initiated. Similarly, in untreated BALB/c mice, tumor growth persisted over five weeks. However, Nowarta110-treated mice exhibited a notable reduction in tumor size. Although intravenous administration of Nowarta110 did not result in complete tumor regression in immunodeficient mice, it did lead to reduced tumor growth. In BALB/c immunocompetent mice, intravenous treatment generally stalled tumor progression. Intratumoral and intravenous administration of Nowarta110 effectively treated murine melanoma in immunodeficient and immunocompetent mice. The Nowarta110 antitumoral efficacy was more pronounced in immunocompetent mice treated intravenously than immunodeficient mice. Clinical studies to examine the efficacy of Nowarta110 in human melanoma and skin cancers are warranted.

Unveiling the Mechanism of Retinoic Acid Therapy for Cutaneous Warts: Insights from Multi-Omics Integration.

Due to limited treatment options, cutaneous warts caused by human papillomavirus (HPV) remain a significant clinical challenge. Furthermore, the genetic susceptibility and molecular basis of viral warts are not yet fully understood. We utilized a multi-omics integration approach, encompassing genome-wide association study (GWAS) meta-analysis, summary data-based Mendelian randomization (SMR) analysis, and transcriptomic validation using the GSE136347 dataset. Differential gene expression (DEG) analysis was conducted to identify significant changes in gene expression between wart tissues and healthy skin. Our analyses revealed five genetic susceptibility genes associated with cutaneous warts, with RARA showing significant differential expression in wart tissues. Co-expression analysis indicated that RARA may regulate apoptosis through interactions with BAX, a pro-apoptotic gene. Additionally, functional annotation via Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses highlighted key biological processes and pathways involved in wart pathogenesis. This study identifies RARA as a pivotal regulator in the molecular pathology of cutaneous warts and a promising therapeutic target. RA-based therapies could offer effective and less invasive alternatives for wart treatment. Future investigations should refine the molecular role of RARA to optimize clinical interventions.

The emerging role of photodynamic therapy in the treatment of cutaneous infections.

Cutaneous infections pose ongoing challenges to standard treatments due to resistance and limited efficacy. Photodynamic therapy (PDT) emerges as a promising supplement or an alternative to address complicated cases. In this review, we comprehensively review PDT's safety and efficacy in treating cutaneous infections. A PubMed systematic review with search terms for PDT treatment, hair, skin, and nail infections. There were a total of 43 studies on the use of PDT in cutaneous infections which discussed the treatment of viral (N.=20), bacterial (N.=11), fungal (N.=9), and protozoal (N.=3) infections. There is evidence for using PDT, mostly 5-aminolevulinic acid (5-ALA) and methyl aminolevulinate (MAL), in the treatment of cutaneous infections. Most evidence for viral infections involved treatment with 5-ALA PDT in condyloma acuminatum (CoAc), verruca vulgaris, and molluscum contagiosum. In bacterial infections, 5-ALA and MB PDT have been used to achieve complete remission in refractory Pseudomonas and atypical mycobacteria infections without recurrence. In onychomycosis, MAL PDT achieved a 40.9% cure rate and MB PDT showed a 77.8-100% cure rate with no reports of recurrence. Parasitic infections, such as leishmaniasis have also been successfully treated with both 5-ALA and MAL PDT. PDT is a promising treatment option for cutaneous infections, with growing evidence for its utility in treating cutaneous bacterial, viral, fungal, and parasitic infections, particularly those that fail standard treatments. Side effects were mostly limited to localized pain with good outcomes and low recurrence rates.

A critical review of the progress in prevention and treatment of radiation-induced skin damage.

Radiation therapy was initially used in dermatology to treat various skin diseases, including acne vulgaris, keloids, plantar warts, tinea capitis and hirsutism. Although it is no longer used in the treatment of many of these diseases, radiation therapy still plays a crucial role in the treatment of keloids, skin cancer and solid organ malignancies. In the past 20 years, the widespread use of intensity-modulated radiation therapy has significantly increased in the management of tumor growth in multiple cancer sites and reduced the incidence of complications in normal organs. However, the occurrence and severity of radiation-induced organ complications still significantly affects the quality of life of patients and remains a research hotspot. Skin tissue is the largest area in the human body, serving as both a barrier and a defender. In patients undergoing radiation therapy, skin is often the first tissue that gets damaged. Especially, when the tumor involves the skin or is close to the skin (i.e., skin cancer, head and neck cancer, breast cancer, vulvar cancer), the treatment targets the superficial tissues, and may have inherent adverse effects on the skin. With the increasing incidence of cancer and the widespread use of radiation therapy in cancer treatment, the radiation-induced skin damage has become a serious problem. In this pursuit, the present study provides a review of the progress in the prevention and treatment of radiation-induced skin damage, thereby providing a reference for the prevention and treatment of radiation-induced skin damage.

The Effectiveness of Topical Treatment for Plantar Warts: A Retrospective Cohort Study.

Background: Plantar warts, caused by human papillomavirus (HPV), are a common condition that can be painful and resistant to treatment. There are various therapeutic options for managing them, but it is not always clear which are the most effective and tolerated by patients. Among the most commonly used treatments are a zinc and nitric complex (nitrizinc complex), cantharidin, and bleomycin, each with different mechanisms of action and profiles in terms of pain and patient satisfaction. Objectives: We aimed to evaluate and compare the clinical efficacy, post-treatment pain, and patient satisfaction among three common treatments (zinc and nitric complex, cantharidin, and bleomycin) in subjects with plantar warts, as well as identify the most effective and best-tolerated treatment. Materials and Methods: This is a retrospective case series study analyzing 60 records of subjects aged 18 to 40 years diagnosed with plantar warts without systemic diseases or allergies and without any prior treatment. Complete records from 2020 to 2023 were selected. Subjects were divided into three groups according to the treatment received (zinc and nitric complex, cantharidin, bleomycin), and demographic variables, post-treatment pain (measured using the visual analog scale), the number of sessions required, and satisfaction after discharge (evaluated with the Likert scale) were analyzed. Results: Of the 60 subjects included, the group treated with bleomycin experienced higher levels of pain after the first session (mean of 7.1 points on the VAS) compared to the cantharidin group (2.7 points) and the zinc and nitric complex group (1.1 points). However, the bleomycin group required fewer sessions for complete healing (an average of 1.8 sessions), while the nitric acid group needed more (3.4 sessions), with cantharidin falling in between (2.5 sessions). Regarding post-discharge satisfaction, all groups showed comparable scores (between 7.9 and 8.5 points), although cantharidin demonstrated slightly higher satisfaction. A statistical analysis showed significant differences in the number of sessions and post-treatment pain between treatments (p < 0.05) but not in final satisfaction. Conclusions: Although bleomycin treatment is more painful, it is the most effective in terms of reducing the number of sessions required for complete healing. Cantharidin offers a good balance between efficacy and patient satisfaction, while a zinc and nitric complex, although less painful, requires more sessions for complete treatment. Each treatment has specific advantages, suggesting that therapeutic choices should be personalized according to the patient's needs and preferences.

Predictive dermoscopic features of cryotherapy treatment response in cutaneous warts

The utility of dermoscopy for the diagnosis of cutaneous warts is well known. However, its role in predicting the outcome of cryotherapy for cutaneous warts remains unexplored. To identify dermoscopic features predicting treatment responses in cryotherapy for cutaneous warts. We conducted a retrospective analysis of 119 warts in 103 patients. Responses were categorized as complete, partial, or none after three sessions of cryotherapy within 4 months. The evaluated features included vascularity, papillary patterns, and margin characteristics. Marked surface scales and well-defined margins were common in complete responses. Minimal surface scales and smooth patterns were observed in less responsive cases. In the group with a complete response, marked surface scales were observed 6.59 times more frequently, well-defined margins were 4.1 times more common, and dots were 4.07 times more common compared to the group with no response. Common warts responded well when showing vascularity and marked surface scales, whereas plantar warts responded positively when showing background erythema. Dermoscopic features, such as dots, marked surface scales, and well-defined margins, predict a favorable cryotherapy response in cutaneous warts. Plantar warts respond positively in the presence of perilesional erythema, whereas common warts exhibit vascularity and marked surface scales for a better response to cryotherapy.

Prevalence of Plantar Warts, Genital Warts, and Herpetic Infections in Greek Competitive Swimmers.

Viral outbreaks are common in the sport community. Data regarding the prevalence of plantar warts, genital warts, herpes simplex type 1 (herpes labialis), herpes zoster, and genital herpes in competitive swimmers are lacking in the literature. The purpose of this study was to determine the prevalence of those viral infections among young competitive swimmers participating in Greek swimming clubs. Swimmers' parents and adult swimmers were asked to complete an anonymous questionnaire. In total, 1047 swimmers enrolled in this study. The measured parameters included gender, age, times of infections, and seasons when athletes may be more susceptible to infections. Practicing information such as type of swimming facility, number of training years, average hours of daily training, behaviors in swimming practice, and sunlight exposure was also recorded. All infections showed a significant difference in relation to "age" and "years of training". The gender significance was observed in herpes labialis (p = 0.016) and plantar warts (p = 0.05). The prevalence of all infections in swimmers who use outdoor facilities was higher. Certain behaviors such as walking barefoot on a pool deck and sharing swimming equipment correlate with herpes simplex and plantar warts. Virus infections can affect swimmers of all ages. In our study, plantar warts and herpes labialis are more common in swimmers. Herpes zoster and sexually transmitted viruses are rarer and affect adult swimmers. The impact of cutaneous infections on swimmers can affect performance and well-being. Effective prevention and management are essential to avoid complications. Proper hygiene, medical guidance, and treatment reduce swimmers' exposure to skin viruses.

Local Hyperthermia for Warts Treatment.

Warts, benign epidermal proliferations, are a direct result of human papillomavirus (HPV) infection, specifically targeting the keratinocytes within the stratum corneum of the skin. The development of warts is the most common clinical manifestation of HPV, with plantar warts, condylomata acuminata, and common warts being the most frequently observed types. These growths can be unsightly and sometimes painful, affecting the quality of life for those afflicted. Although various treatments are available, ranging from topical medications to surgical procedures, the quest for a treatment that is both safe and effective while minimizing invasiveness continues. This is particularly crucial for populations with heightened risk factors, such as immuno-compromised individuals. In the clinical need for minimally invasive treatments, local hyperthermia has emerged as a promising therapeutic strategy for wart management. As demonstrated in various studies, local hyperthermia is effective as a standalone treatment, offering a valuable alternative for patients seeking less intrusive therapeutic options.

Pediatric genital warts successfully treated with photodynamic therapy

Genital warts (GWs) are the most common sexually transmitted infections worldwide, caused by the human papillomavirus (HPV). In adults, the primary mode of transmission is through sexual contact, whereas in children it can occur through skin-to-skin or skin-to-mucosa contact and be sexual or non-sexual. The increasing prevalence of GWs in children has renewed the interest in therapeutic management which still presents a unique challenge, being influenced by many variables including size, quantity, and location of warts, as well as the presence of comorbidities. Photodynamic therapy (PDT) has already shown encouraging results in treating viral warts in adult patients, but its use is still not standardized in the pediatric population. On this topic, we report the case of an otherwise healthy 5-year-old child affected by GWs, successfully treated with three sessions of PDT with 10% 5-aminolaevulinic acid (ALA), at one-month intervals. Our case is paradigmatic of the potentiality of PDT to treat difficult lesions in a pediatric setting.

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.

Knowledge and Awareness of Dental Students Regarding Human Papillomavirus and Oral Cancer in Saudi Arabia.

This study aimed to evaluate the knowledge and awareness of dental students and interns in Saudi Arabia regarding human papillomavirus and oral cancer using a cross-sectional web-based survey. A cross-sectional survey was undertaken to assess the knowledge of dental students and dental interns regarding oral cancer and awareness of human papillomavirus (HPV) in public and private dental schools in Saudi Arabia. The survey included 18 questions grouped into three sections. The responses were analyzed for variations between dental students and interns, among males and females, and those attending private or public colleges. The Chai-square test assessed the correlation between participants' demographic data and their knowledge/awareness of oral cancer and HPV. A total of 451 dental students and dental interns responded. The results show that dental students at private and public dental schools in Saudi Arabia are generally knowledgeable regarding knowledge of oral cancer and awareness of human papillomavirus. The dental interns exhibited significantly superior knowledge compared to the undergraduate dental students (p<0.05), particularly in the areas of identifying the most common location of oral cancer and recognizing the signs and symptoms of oral cancer (76.5% versus 65.1% correct answers). The dental interns showed a significant difference and better awareness (p<0.05) than dental students regarding HPV having a relationship with AIDS and HPV causing common warts. Dental students and interns in this study presented a good but less than optimal knowledge and awareness regarding HPV and its prevention. Improving education courses and training for dental students in Saudi Arabia is crucial for improving their knowledge and awareness regarding oral cancer and HPV infection.

Pinto Bean Pressure Wraps: A Novel Approach to Treating Digital Warts.

Identifying an optimal treatment method for verruca vulgaris can be a frustrating challenge for clinicians. We describe the use of a pinto bean pressure wrap to induce ischemic change in digital warts. This novel technique provides a low-cost, low-risk, and nearly pain-free home-based treatment option with response rates similar to those of other commonly employed methods.

Investigation of the Efficacy of Nowarta110 in the Treatment of HPV-16 and HPV-18 Oncogenically-transformed Human Cells and Cancer-implanted Animal Models.

Cervical cancer is the third leading cause of cancer-related death in women worldwide. Nearly all cases of cervical cancer are due to infection with human papillomavirus (HPV). Nowata110 has shown breakthrough therapeutic efficacy in phase II clinical study against plantar warts, with no reported side effects. This study evaluated the effectiveness of Nowarta110 in killing cultured HPV-transformed cancer cells and its anti-cancer effects in mice, using both vaginally engrafted and subcutaneously implanted animal cancer models. Nowata110 is a novel compound composed of colloidal silver and fig extract. The cytotoxic properties of Nowarta110 were evaluated on HPV-16 and HPV-18-transformed human cancer cells (ARPE-19/HPV-16 and HeLa cells, respectively). The therapeutic potential of Nowarta110 in vivo was evaluated following the engraftment of ME-180 epidermoid carcinoma cells in the mouse vagina or their subcutaneous implantation. Nowarta110 treatment was initiated when the tumor reached an approximate volume of 65 mm3 Results: Our data showed that HPV16-expressing human retinal pigmented epithelial cells are susceptible to Nowarta110-induced cell death, with a reduction in cell viability observed at 1% Nowarta110 and a complete absence of viable cells at 5% Nowarta110. In HPV18-expressing HeLa cells, Nowarta110 caused significant and rapid cell death at a dose of 5%, whereas lower doses of 1% did not produce the same effects. The results from animal studies indicated that Nowarta110 effectively induced tumor regression in both the intravaginal and subcutaneous tumor models. Nowarta110 effectively induced cell death in HPV-16 and HPV-18-transformed human cancer cells. It also effectively induced tumor regression in mouse models with intravaginally engrafted or subcutaneously implanted cancer cells. Considering the high prevalence of HPV-induced cervical dysplasia and cancer and the lack of treatment, clinical studies to promote the implementation of Nowarta110 are warranted.

Overview of the human papilloma virus: types and its treatment

The human papillomavirus (HPV) is the most prevalent sexually transmitted disease in the United States and one of the most common causes of sexually transmitted infections (STDs) globally. Warts are cutaneous and occasionally mucous lesions brought on by HPV, with 2-20% of elementary school students getting them. There are three types of warts: non-genital warts, flat warts, and plantar warts. Non-genital warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly associated with HPV-1, 2, 4, 27, or 57. Flat warts appear as flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts, also known as verrucae plantaris, are cutaneous lesions on the plantar aspect of the foot that result from a human papillomavirus infection of keratinocytes (HPV).Genital warts are transmitted through sexual contact, while autoinoculation and vertical transfer do occasionally happen. After engaging in sexual activity with an infected partner, about 70% of people experience anogenital warts. Treatment for HPV includes imiquimod cream formulations, photodynamic treatment (PDT), green tea, chemical cautery, fluorouracil cream, cryotherapy, and surgical treatment. Common warts are hyperkeratotic, exophytic, dome-shaped papules or plaques commonly found in fingers, dorsal surfaces of hands, knees, or elbows. Flat warts are flesh-coloured, erythematous to brown, or hyperpigmented smooth papules with a flat top and a diameter of 2 to 5 mm. Plantar warts are unique in their location and appearance, primarily affecting high-pressure locations on the palms and soles and are uniquely linked to HPV type 1.

Effects of the COVID-19 pandemic on inpatient dermatosurgery in Germany : Retrospective evaluation of the surgical cases from nine dermatology clinics

Currently, only little data is available on the impact of the COVID-19 pandemic on inpatient dermatosurgical care in German dermatological clinics. Aretrospective analysis of all dermatosurgical cases that were treated in inpatient setting in nine German dermatological clinics in four federal states in 2019, 2020 and 2021 was performed. The diagnoses were recorded using the ICD-10codes. In addition, demographic data such as age, gender and the length of inpatient stay were analysed. In 2019, 2020 and 2021, a total of 10,739, 9185 and 9828 dermatosurgical inpatients were treated respectively. Thus, the reduction of inpatient dermatosurgical cases was 14.5% in 2020 and 8.5% in 2021 compared to 2019. Inpatient surgical treatment of melanoma decreased by 10.1% of cases in 2020. This decrease was only 1.4% in 2021 compared to 2019. The number of inpatient surgeries performed for benign lesions such as melanocytic nevi or viral warts reduced sharply in both pandemic years. Our data show for the first time how inpatient care for the entire spectrum of dermatosurgical diseases developed during the COVID-19 pandemic in Germany. After the initial marked decline in inpatient dermatosurgical cases in 2020, there was less difference in 2021 compared to 2019. This trend can be interpreted as an indication that there is still astrong need for inpatient dermatosurgical care that cannot yet be met on an outpatient basis.

Conventional versus daylight photodynamic therapy for recalcitrant hand warts: Efficacy, safety and recurrence

BackgroundAcral warts appear as skin-colored, verrucous, hyperkeratotic papules most located on the dorsal hands, distal fingers, subungual skin, and feet. Conventional photodynamic therapy (C-PDT) has shown a good efficacy and safety profile in patients with viral warts, in both adults and children, with a good cure rate and excellent cosmetic results in front of few and light side effects. The efficacy of daylight photodynamic therapy (DL-PDT) has not yet been evaluated. Objectivesto investigate and assess the short- and long-term efficacy of PDT using 10 % aminolevulinic acid (ALA) in the treatment of multiple verrucae vulgaris of the hands. The second endpoint was to compare the efficacy and safety of C-PDT versus DL-PDT. Materials and methods68 patients (38 males and 30 females) aged between 6 and 80 years, affected by hand warts, were divided into two arms: group A was treated with C-PDT, and group B was treated with DL-PDT. Patients underwent treatments three times at 1-month intervals. The response was assessed 3 months after the last session (W24) and 1 year after the last session (W52) and scored as excellent (75–100 % reduction of total wart count), partial (74−25 % reduction), and none (< 25 % reduction or no response). Any adverse events occurring during or after ALA application or irradiation as well as pain intensity were recorded at each visit. Results48 patients (70.6 %) achieved excellent response at W24, while 6 patients (8.8 %) had a partial response and 14 (20.6 %) were resistant to treatment. Patients treated with DL-PDT were less likely to have an excellent response (66.7 %) than patients treated with C-PDT (73.7 %), although not statistically significant. Among patients with excellent or partial response (n=54), 37 % (n=20) had warts relapse at W52. Both treatment modalities were well tolerated, with transient pain as the main side effects. ConclusionPDT is effective in the treatment of verrucae vulgaris of the hands. An overall response rate of 70.6 % of excellent response was achieved. While C-PDT showed a trend towards better outcomes, DL-PDT offered a more patient-friendly approach, particularly in terms of comfort and compliance.