Warts Research Articles

BI30 Remission of a large plantar verruca vulgaris in an immunocompromised patient postincisional punch biopsy

Abstract We report the case of a 41-year-old renal transplant recipient who has been attending dermatology for skin surveillance following a cadaveric renal transplant. His immunosuppressive treatment consists of tacrolimus, mycophenolate mofetil and prednisolone 5 mg once daily. His primary dermatological complaint was that of a large wart on the plantar aspect of his right foot. Given the location of this lesion, there was significant associated pain, which also resulted in a functional impediment, impacting on his ability to exercise or work. On examination, he had a large, hyperkeratotic, papillomatous nodule measuring 3.5 × 3 cm on the plantar aspect of his right foot, clinically in keeping with verruca vulgaris. This had been recalcitrant to extensive treatment, including topical salicylic acid, 5-fluorouracil, cantharidin and numerous courses of cryotherapy and paring over the previous 6 years. Following administration of xylocaine 1% with adrenaline as the local anaesthetic, we performed three incisional 4-mm punch biopsies through the centre of the wart to the depth of the dermis. We ensured visualization of haemorrhage at the base of each punch incision. The biopsy cores were left in situ and the wound was dressed with petroleum jelly, Kaltostat® and Opsite. At his 6-week follow-up review, the verruca vulgaris had completely resolved. No postprocedural complications were noted by the patient. Further skin surveillance was scheduled for 6 months later, at which time no recurrence of this verruca vulgaris had occurred. Verruca vulgaris is a benign papillomatous proliferation of epidermal cells driven by human papillomavirus (HPV) infection, commonly acquired in childhood. For many patients, verruca vulgaris will spontaneously regress. However, it can represent a therapeutic challenge when persistent, as it is recalcitrant to multiple treatment modalities, particularly in immunosuppressed patients. To our knowledge, our case is the first documented resolution of a giant plantar wart in an immunocompromised patient using such an approach. Renal transplant patients represent a unique cohort in relation to verruca vulgaris, whereby impaired cell-mediated immunity can increase their susceptibility to HPV, thereby reducing effective treatment options and meaning definitive clearance may never be achieved. Our case highlights that incisional punch biopsy may represent an accessible and cost-effective approach to the treatment of verruca vulgaris in immunosuppressed patients, where alternative treatment options would necessitate numerous hospital visits.

H17 Traditional medicine: a warts-and-all tale

Abstract A viral wart is a common benign lesion caused by infection with human papillomavirus. They typically present in children; however, they are also often seen in adults, particularly in immunosuppressed patients. Modern treatments for viral warts include cryotherapy, cantharone, cautery and curettage, and topical chemotherapeutic agents. However, historically, a variety of methods were employed to treat viral warts: animal-based, plant-based, mineral-based and magicoreligious. These can be further categorized based on the principles of chance and transference (Barron C, Soverino T. Snails, water in a stone, and Holy Wells: an examination of wart cures from the Irish Schools’ Folklore Collection, 1937–38. Folklore 2020; 131:386–412). One popular method that combined both the principles of chance and transference involved finding a snail by chance and then rubbing it on the warts, and skewering the snail to kill it. The concept behind this method was that the warts would be transferred to the snails and then the warts would subsequently decay with them. Another animal-based cure involved stealing a piece of meat, usually bacon, and rubbing the meat into the wart before burying the meat. In terms of mineral-based cures, there were many popular methods. The most commonly encountered treatments included holy water, forge water (often from a blacksmith), water from a stone or ‘wart rocks’. People would also attend ‘wart wells’ and make offerings of stones. The use of water was the most widespread mineral-based cure. Plant-based cures were also prevalent, with the milk of a dandelion, the juice of a potato, rushes and straw being just a few examples. Plant-based cures were often combined with aspects of religion. One cure involved cutting a potato in two, and rubbing the cut part to the wart in the name of the Father, Son and Holy Spirit. The potato was then put away in an old wall; when it shrivelled up, it was believed the wart would disappear. There were also ritualistic methods. Certain healers could perform prayers, and it was believed that when a funeral would pass, one should lift clay three times from under the right foot and rub it on the warts. They would then need to throw it away after the funeral. As the corpse wasted away, the warts would decay, too. While the natural trajectory was that these warts would have self-resolved irrespective of the cures used, our ancestors were proactive and employed many different methods to treat this common ailment.

Effectiveness of topical application of 15℅ salicyclic acid and 0.1℅ diphencyprone combined in an ointment form for treatment of plantar warts

Objective: To determine the Effectiveness of topical application of 15℅ salicyclic acid and 0.1℅ Diphencyprone combined in an ointment form for treatment of plantar warts. Place and Duration: This Descriptive, case series was held in Dermatology outpatient department, Abbasi Shaheed Hospital Karachi. Method: A sample size of 80 patients with plantar warts were included as calculated by exact 95% confidence interval. Results: Total 80 patients of plantar warts were enrolled. 40 (50%) were females and 40 (50%) were males, with mean age of 31 yrs. 65 patients (81.25%) showed positive response to treatment with combined DPCP and salicyclic acid, while remaining 15 (18.75%) had some mild adverse reactions. Conclusion: As Plantar wart is a common problem in all populations therefore more randomized trials should be done on combined chemical treatments for better outcomes.

Epidemiological survey of warts in Chinese military recruits: A cross-sectional and follow-up study

BackgroundWarts are very common in military personnel, either at war or during peace times. However, little is known about the prevalence and natural course of warts in military recruits in China. ObjectiveTo investigate the prevalence and natural course of warts in Chinese military recruits. MethodsIn this cross-sectional study, the head, face, neck, hands, and feet of 3093 Chinese military recruits aged 16–25 years in Shanghai were examined for the presence of warts upon enlistment medical examinations. Questionnaires were distributed to collect the general information of the participants before the survey. All the patients were followed up by telephone interview for 11–20 months. ResultsThe prevalence rate of warts in Chinese military recruits was 2.49%. The diagnosis of most cases was common and plantar warts, which were usually less than 1 cm in diameter and with mild discomfort. Multivariate logistic regression analysis showed that smoking and sharing personal items with others were risk factors. Coming from southern China was a protective factor. Over 2/3 of patients recovered within 1 year and the type, number, and size of warts and treatment choice did not predict resolution.Study limitations and Conclusions This study demonstrated that warts had a relative lower morbidity and a higher spontaneous resolution rate in Chinese military recruits. The telephone interviews following the initial survey and the limitations of a cross-sectional study were the main drawbacks.

Remission of a Large Plantar Verruca Vulgaris in an Immunocompromised Patient After Incisional Punch Biopsy.

Beatty, Paula Mb, BCh, BAO, MRCPI*; Tobin, Anne-Marie PhD, FRCPI*; Hackett, Caitriona MB, BCh, NUI, MRCPI* Author Information

A peptide-based human papillomavirus therapeutic vaccine, PepCan, or Candida adjuvant alone in treatment of cervical intraepithelial neoplasia 2/3 (CIN2/3).

5538 Background: A non-surgical alternative for treating CIN2/3 would be desirable for women of childbearing age due to a risk of cervical incompetency in subsequent pregnancies following surgical treatments. PepCan consists of four current good manufacturing-grade HPV 16 E6 peptides and a Candida skin testing reagent (Candin, Nielsen Biosciences), because of Candida’s ability to regress common warts in humans, and to promote T cell proliferation and interleukin-12 secretion in vitro. Methods: In this single-center, randomized, double-blind Phase II study (NCT02481414), women with biopsy-confirmed CIN2/3 were treated with PepCan or Candida (1:1). Four intradermal injections were given 3 weeks apart which were followed with two visits 6 months apart. Histological responses (primary endpoint) were assessed using quadrant biopsies, and those whose lesions regressed to no CIN were considered to be responders. Regression rate of each treatment group was compared to that of a historical placebo group following the same treatment schedule. A sample size of 35 per arm had 93% power to test the null hypothesis that π = 0.29 (historical control placebo rate) and detect a difference of 0.31 with a two-sided type I error of 5%. Adverse events (AEs) were assessed using Common Terminology Criteria for Adverse Events Version 4. Results: Of 99 subjects screened, 81 (81.8%) qualified for vaccination, and 80 received at least one vaccination. No dose-limiting toxicity was observed. With the intention-to-treat analysis, PepCan showed 30.8% efficacy (12 of 39, p=0.16) while Candida demonstrated 47.6% efficacy (20 of 42, p=0.0004). Likewise, with the per-protocol analysis, PepCan showed 45.8% efficacy (11 of 24, p=0.06) and Candida showed 62.1% efficacy (18 of 29, p=0.0002). There was no difference between efficacy of PepCan and Candida. Conclusions: PepCan and Candida treatments are safe. Only Candida was effective in inducing histological regression in the intention-to-treat and per-protocol analyses. Candida could become a new treatment for CIN2/3 by eliciting general immune stimulation similar to checkpoint inhibitors. Clinical trial information: NCT02481414 . [Table: see text]

Warts in pediatric oncology patients: A single-institution retrospective study.

Pediatric oncology patients undergoing cancer treatment can often have numerous and recalcitrant cutaneous warts due to their underlying immunosuppression. There are little published data on the optimal management of warts in pediatric oncology patients undergoing active cancer treatment compared to patients having completed treatment. Our objective was to analyze the clinical course of warts treated within this patient population at Boston Children's Hospital over a 10-year period. This was a single-institution retrospective study of 72 pediatric oncology patients from 1 September 2011 to 1 September 2021 who were treated for warts at Boston Children's Hospital. All patients had a diagnosis of cutaneous warts with at least one follow-up visit and were receiving active treatment for cancer either during or after concurrent treatment of their warts. We examined the modality and effectiveness of wart treatments while both on and offactive treatment of their cancer. The median age was 12 years (range 4-18). Fifty-four percent of patients were documented to have plantar warts. Sixty percent of patients with a documented number of warts had more than five warts at presentation. For cases in which outcomes were specified, treatment resulted in complete resolution of warts in only 24.0% of patients undergoing active cancer treatment compared to 63.3% of patients not on active treatment. Warts persisted or worsened in 56.0% of patients undergoing active cancer treatment compared to only 13.4% of patients not on active treatment. These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients.

How to differentially detect potentially risky human papilloma virus strains in the human population?

The human papillomavirus (HPV) represents one of the most common sexually transmitted infections, knowing more than 100 viral types that, in relation to their oncological pathogenesis, are classified into types of high and low oncological risk. Cervical cancer is the second leading cause of death from malignant neoplasms in women. HPV can often cause warts. Most types of this virus are harmless, but a percentage of them are associated with an increased risk of cancer. These types are born from the genitals and are acquired through sexual contact with an engaged partner. Cervical cancer is the second leading cause of death from malignant neoplasms in women. HPV infection is responsible for various lesions in different areas of the body. Common warts are the most frequent. They consist of whitish papillomatous lesions that can be in any area, oral mucosa, genital mucosa, etc. Most people infected with the genital human papillomavirus are only carriers. It usually has no symptoms and goes away on its own, without causing serious health problems. There is no cure for HPV, but there are treatments for the health problems that some types of HPV can cause, such as genital warts and cervical cancer. Thanks to cytology and histopathology, it can be detected and treated promptly, reducing the impact of this disease. In addition, there are vaccines that promise to reduce this cancer, especially in countries with the highest number of cases. The virus can remain in the body, even after receiving treatment for genital warts. This means that HPV can still be transmitted to sexual partners, despite not having physical manifestations of it. This work will present the bases for the differential detection between the riskiest HPV strains: HPV-18 and HPV-16 through their detection using the amazing idea of ​​Kary Mullis: Polymerase Chain Reaction.

The Prevalence of Secondhand Smoke Exposure in Hidradenitis Suppurativa: A Cross-Sectional Survey Study

Introduction Hidradenitis Suppurativa (HS) is a chronic inflammatory disease of the skin highly associated with firsthand smoking. Secondhand smoke, defined as the inhalation of smoke from burning a tobacco product or smoke that is exhaled by smokers, and its relationship to HS has not been assessed. This study aims to determine the prevalence of secondhand smoke exposure in the HS population. Methods In this cross-sectional study (N=136), surveys were both administered in a dermatology clinic and emailed to patients with HS, verruca vulgaris (VV), and atopic dermatitis (AD). Control groups were selected based on secondhand smoke associations: AD has a known association, whereas VV does not. Results The survey response rate was 67.3% (N=136). We found that more than half of HS patients (58.73%) were exposed to secondhand smoke within the last 12 months, whereas 38.30% and 30.77% in the AD and VV groups were exposed, respectively (p=0.0209). Additionally, our data did not identify a significant correlation between secondhand smoke and HS disease severity. Conclusion Our study is the first to assess the prevalence of secondhand smoke exposure in the HS population. However, due to the limitations of the study design and significant differences between study groups, we were unable to assess the true association between HS and secondhand smoke exposure. While our study did not identify an increased prevalence of secondhand smoke exposure in the HS population, it highlights an area for further investigation evaluating the relationship between passive tobacco exposure and inflammatory skin disease.

Histopathological Analysis of Tongue Lesions and Distribution by Age Groups

Aim: To retrospectively evaluate the histopathological characteristics of biopsies taken from tongue lesions and compare the results with current literature. Material and Methods: Histopathological results of biopsies taken from 163 patients with suspected tongue lesions between January 2017 and January 2022 were retrospectively reviewed. The results were evaluated in different age groups. Results: Seventy-two (44.2%) of the patients were male and 91 (55.8%) were female. The mean age of the patients was 47.76±17.33 years. The lesion was benign in 135 (82.8%) patients, precancerous in 4 (2.5%), and malignant in 24 (14.7%). Of the 135 patients with benign findings, squamous papilloma was detected in 33 (24.4%) patients and irritation fibroma in 19 (14.1%). Ulcer/inflammatory granulation tissue was detected in 18 (13.3%) patients, parakeratosis/acanthosis in 14 (10.4%), fibroepithelial polyp in 14 (10.4%), and pseudoepitheliomatous hyperplasia in 9 (6.7%). Less frequently, lymphoid hyperplasia, neurofibroma, mucocele, and verruca vulgaris were detected in 1 (0.7%) patient each. Squamous cell carcinoma was detected in all patients with malignancy. When evaluated according to age groups, it was found that the patients were most commonly in the 50–59 (27.6%) age group, followed by the 40–49 (19.6%) age group. Conclusion: The results show that most tongue lesions are benign. It should be noted that not every mass in the tongue is cancerous, but leukoplakic and ulcerated areas can be malignant. Due to the rapid metastasis of tongue lesions, early diagnosis and treatment may contribute significantly to the prognosis of patients.

Combined therapy of local recombinant human interferon α1b injection and acupuncture on verruca vulgaris: a retrospective study.

Verruca vulgaris is always stubborn to treat. We applied a new combined therapy of local recombinanthuman interferonalpha 1b (rhIFNα1b) injection plus acupuncture on verruca vulgaris recently to evaluate the efficacy and safety of the combined therapy. The retrospective study was conducted in The First Hospital of China Medical University from 2018 to 2020. Patients with verruca vulgaris were included. Combined therapy with local rhIFNα1b injection plus acupuncture was set as treatment group, rhIFNα1b injection and carbon dioxide (CO2) laser were set as control groups. A total of 2415 patients were included in the study. The cure rates were 81.85%, 85.93%, and 100% in combined group, rhIFNα1b group, and CO2 laser group, separately. All lesions cured in combined group were located on hands or feet, while majority of lesions cured in other groups were located on other sites. For patients with medium/big single lesion or 6-9 lesions, less treatment times were needed in combined group than rhIFNα1b group. For patients with small single, two to five or more than ten lesions, the treatment times of combined group and rhIFNα1b group were comparable. All patients complained of pain in varying degrees when local injection or laser irradiation. Compared with CO2 laser group, more fever, less swelling or scar was reported in combined group. In conclusion, combined therapy of local rhIFNα1b plus acupuncture was beneficial for verruca vulgaris with limited adverse effects. The therapy was more acceptable by younger female patients with verruca vulgaris.

Translated article] Nonvenereal Infections in Spanish Dermatology Clinics: Results of the DIADERM Study

Background and objectiveThe burden of nonvenereal infections in Spanish dermatology practice has not yet been evaluated. The aim of this study was to analyze the overall weight of these infections in outpatient dermatology caseloads. Material and methodsObservational cross-sectional study of diagnoses made by a random selection of dermatologists from the Spanish Association of Dermatology and Venereology (AEDV) working in outpatient dermatology clinics. The data were obtained through the anonymous DIADERM survey. Diagnoses of infectious diseases were selected using codes from the International Classification of Diseases, Tenth Revision. After excluding sexually transmitted infections, the diagnoses were classified into 22 groups. ResultsSpanish dermatologists diagnosed an estimated 16Y190 (95% CI, 9338–23Y042) nonvenereal infections on average per week, a figure that accounted for 9.33% of the dermatology caseload. The most common diagnostic groups were nonanogenital viral warts (7475 diagnoses, 46.17% of nonvenereal infections), dermatophytosis (3336, 20.61%), and other viral infections (1592, 9.84%), which included Molluscum contagiosum infections. Nonvenereal infections were more common than noninfectious dermatologic conditions in private clinics (P<.0020) and adults (P<.00001). Patients with these infections were also more likely to be discharged than those with other conditions in both public (P<.0004) and private (P<.0002) practices. ConclusionsNonvenereal infections are frequent in dermatology. They are the third most common reason for outpatient visits, behind actinic keratosis and nonmelanoma skin cancer. By enhancing the participation of dermatologists in the management of skin infections and encouraging interactions with other specialists, we will be able to carve out a niche in an area we have scarcely ventured into to date.

A Comparative Study of Intralesional Acyclovir vs Immunotherapy for Treatment of Viral Warts.

Viral warts are caused by human papillomavirus (HPV), are difficult to treat with conventional modalities, and are cosmetically disfiguring; hence, immunomodulators are being used. The viral origin of warts suggests the antiviral drug acyclovir as a potential therapeutic option. The current study compares the effect of intralesional acyclovir (nucleoside analogue) and intralesional purified protein derivative (PPD) (immunotherapy) in treating various viral warts. Prospective observational comparative study was conducted to determine the efficacy of acyclovir, and PPD administered via the intralesional route in patients with viral warts. The study population was categorized into two groups. One group received intralesional acyclovir, and the other received intralesional PPD. Patients were followed-up with for three months. Outcomes considered in our study were recovery (complete, partial, and no recovery) and side effects like pain, burning sensation, and desquamation. Statistical analysis was carried out by coguide software. In our study total of 40 participants, 20 in each group were included. 25 and 15 were of age <30, and ≥ 30, respectively, while 20 were males, and 20 females. Our study reported 60%, and 30% of complete recovery with intralesional acyclovir treatment and intralesional PPD treatment, respectively, in the twelfth week. However, p-value > 0.05 represented no significance between groups. 90% in the acyclovir-treated group presented with pain, and 100% presented with burning sensation, while in the case of PPD-treated group, 60% presented no side effects and the rest 40% showed pain. Intralesional acyclovir is more effective in treating viral warts than PPD. The focus is to be laid on anticipated side effects.

Atypical Cutaneous Viral Infections Reveal an Inborn Error of Immunity in 8 Patients.

Unusual viral skin infections might be the first clinical manifestation in children with an inborn error of immunity (IEI). We performed a prospective study from 1 October 2017 to 30 September 2021, at the Department of Pediatric Infectious Diseases and Clinical Immunity of Ibn Rochd University Hospital-Casablanca. During this period, on 591 patients newly diagnosed with a probable IEI, eight of them (1.3%), from six independent families, had isolated or syndromic unusual viral skin infections, which were either profuse, chronic or recurrent infections, and resistant to any treatment. The median age of disease onset was nine years old and all patients were born from a first-degree consanguineous marriage. By combining clinical, immunological and genetic investigations, we identified GATA2 deficiency in one patient with recalcitrant profuse verrucous lesions and monocytopenia (1/8) and STK4 deficiency in two families with HPV lesions, either flat or common warts, and lymphopenia (2/8), as previously reported. We also identified COPA deficiency in twin sisters with chronic profuse Molluscum contagiosum lesions, pulmonary diseases and microcytic hypochromic anemia (2/8). Finally, we also found one patient with chronic profuse MC lesions and hyper IgE syndrome, (1/8) and two patients with either recalcitrant profuse verrucous lesions or recurrent post-herpetic erythema multiforme and a combined immunodeficiency (2/8) with no genetic defect identified yet. Raising clinicians awareness that infectious skin diseases might be the consequence of an inborn error of immunity would allow for optimized diagnosis, prevention and treatment of patients and their families.

Comparison of intralesional bleomycin versus salicylic acid 16.5% and lactic acid 16.5% combination paint in management of plantar warts

BackgroundSalicylic and lactic acid (SAL) paint is commonly used to treat warts due to ease of application without any instrumentation. Intralesional bleomycin has been used for the treatment of warts since the 1970s with high efficacy even at low concentration. The aim of this study was to assess the efficacy of single dose of intralesional bleomycin in the treatment of plantar warts in comparison with a control group of similar sample receiving SAL paint application. MethodsPatients were randomly divided into two groups to receive either single dose of intralesional bleomycin injection or SAL paint application daily for maximum of two months. Plantar warts of the patients were assessed at baseline and with each return visit including a post-treatment follow-up of six months. ResultsOf the 100 patients enrolled in the study, 50 (50%) patients were treated with intralesional bleomycin, and 50 (50%) were treated with SAL paint. Out of total 441 treated warts in 100 patients, 198 (44.89%) warts were treated with intralesional bleomycin, and 243 (55.1%) warts were treated with SAL paint. The clearance rates in the context of number of patients and number of warts were 94% (47 out of 50) and 97.97% (194 out of 198) for bleomycin and 36% (18 out of 50) and 27.5% (67 out of 243) for SAL paint, respectively. ConclusionSingle dose of intralesional bleomycin injection is significantly more effective than SAL paint for the treatment of plantar warts.

Integrative analysis of gene expression and DNA methylation to identify biomarkers of non-genital warts induced by low-risk human papillomaviruses infection

BackgroundHuman papillomaviruses have been shown to dysregulate the gene expression and DNA methylation profiles of their host cells over the course of infection. However, there is a lack of information on the impact of low-risk HPV infection and wart formation on host cell's expression and methylation patterns. Therefore, the objective of this study is to analyse the genome and methylome of common warts using an integrative approach. MethodsIn the present study, gene expression (GSE136347) and methylation (GSE213888) datasets of common warts were obtained from the GEO database. Identification of the differentially expressed and differentially methylated genes was carried out using the RnBeads R package and the edgeR Bioconductor package. Next, functional annotation of the identified genes was obtained using the Database for Annotation, Visualization, and Integrated Discovery (DAVID). Network construction and analyses of the gene-gene, protein-protein, and signaling interactions of the differentially expressed and differentially methylated genes was performed using the GeneMANIA web interface, the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, and the Signaling Network Open Resource 2.0 (SIGNOR 2.0), respectively. Lastly, significant hub genes were identified using the Cytoscape application CytoHubba. ResultsA total of 276 genes were identified as differentially expressed and differentially methylated in common warts, with 52% being upregulated and hypermethylated. Functional enrichment analysis identified extracellular components as the most enriched annotations, while network analyses identified ELN, ITGB1, TIMP1, MMP2, LGALS3, COL1A1 and ANPEP as significant hub genes. ConclusionsTo the best knowledge of the authors, this is the first integrative study to be carried out on non-genital warts induced by low-risk HPV types. Future studies are required to re-validate the findings in larger populations using alternative approaches.

Recent Human Papillomavirus Vaccination is Associated with a Lower Risk of COVID-19: A US Database Cohort Study.

To explore the association between human papillomavirus (HPV)vaccination and risk of coronavirus disease 2019 (COVID-19). Specifically, our study aimed to test the hypothesis that HPV vaccination may also induce trained immunity, which would potentially reduce the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and improve clinical outcomes. Several vaccines have been reported to trigger non-specific immune reactions that could offer protection from heterologous infections. A recent case report showed that verruca vulgaris regressed after COVID-19, suggesting a possible negative association between COVID-19 and HPV infection. We enrolled 57,584 women with HPV vaccination and compared them with propensity score-matched controls who never received HPV vaccination in relation to the risk of COVID-19 incidence. Cox proportional hazard regression analysis was conducted to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses stratified by age, race, comorbid asthma, and obesity were performed. The risk of COVID-19 incidence was significantly lower in those who had recently received the HPV vaccine (within 1 year after HPV vaccination, aHR: 0.818, 95% CI 0.764-0.876; within 1-2 years after HPV vaccination, aHR: 0.890, 95% CI 0.824-0.961). Several limitations were recognized in this study, including residual confounding, problems of misclassification due to the use of electronic health record data, and that we were unable to keep track of the patients' HPV infection status and the HPV antibody levels in those who had received the vaccine. Recent HPV vaccination was associated with a lower risk of incident COVID-19 and hospitalization. Based on the promising protective effect of HPV vaccine shown in this study, these findings should be replicated in an independent dataset. Further studies are needed to provide a better understanding of the underlying mechanisms and the differences in risks among 2-, 4-, or 9-valent HPV vaccine recipients.

An Unexpected Diagnosis of MAGT1 Deficiency in a Patient with CVID-like Features, Molluscum Contagiosum and Atopy

Case DescriptionA 6-year-old boy presented to the immunology clinic with recurrent infections. He started to have recurrent otitis media at the age of 18 months. He also had multiple sinus infections and 3–4 episodes of pneumonia. Immunologic evaluation revealed an IgG of 498 (ref 608–1229 mg/dL), an IgA of 20.8 (ref 33–200 mg/dL) and an impaired response to the Streptococcus pneumoniae vaccine. T and B lymphocyte counts were normal. He was started on subcutaneous immunoglobulin replacement therapy after which his IgG level normalized and his frequency of sinopulmonary infections improved. He also has a history of eczema, chronic cough and environmental allergies for which he receives allergen-specific subcutaneous immunotherapy in addition to treatment with an inhaled corticosteroid and omalizumab. The patient also had persistent skin warts on his hands and extensive molluscum contagiosum lesions. He underwent targeted genetic testing for a primary immunodeficiency which revealed a hemizygous pathogenic variant in the magnesium transporter 1 (MAGT1) gene (c.580dup; p.Ser194Phefs*3). This variant is a duplication at nucleotide position 580 that creates a premature stop codon 3 amino acids downstream from this location. The patient subsequently underwent a carbohydrate deficient transferrin test (CDT) for congenital disorders of glycosylation (CDG) that revealed moderately elevated transferrin mono-oligosaccharide to di-oligosaccharide and Apo CIII-1/Apo CIII-2 ratios, consistent with the diagnosis of MAGT1-CDG (XMEN; X-linked immunodeficiency with magnesium defect, EBV infection, and neoplasia). Additionally, NKG2D surface expression was reduced by ~90% on the CD8T cells, and by ~85% on the NK cells in the patient sample compared to the control sample assessed in parallel. The patient continues to test negative for EBV infection by PCR. ConclusionXMEN disease (OMIM number 300853) is a rare, combined immunodeficiency resulting from a mutation in the magnesium transporter 1 gene (MAGT1) located on the X chromosome. Only 36 patients have been reported to have this disease thus far. While the clinical phenotype is variable, the disease is often associated with EBV infection. This case is unique in that the patient was diagnosed due to a history of severe warts, atopy, and hypogammaglobulinemia in the absence of EBV infection.

The frequency of warts among patients attending at department of dermatology and venereology, in Al-Sadar Hospital in Baghdad, IRAQ

Background: Human papilloma virus [HPV] infection is a very common dermatological disease, as most people will experience infection during their lifetime. Objective: To find the frequency of warts among patients attending at Department of Dermatology and Venereology, in Al-Sadar Hospital in Baghdad. IRAQ. Patients and Methods: A descriptive cross sectional study was conducted during the period from the first of January to 31 of March 2021. This study included 7453 patients. Results: the percentage of patients with warts was 1171[15.71%] with the higher number and percentage in females 622 [53.12 %] than in males 549[46.88 %]. The differences among age groups were significant (P=0.03). Also the differences due to month were significant. Conclusions: There was high frequency of viral warts among patients attending at Department of Dermatology and Venereology at Al-Sadar Hospital especially at the children and young adult age groups.

Dermoscopic Findings in Clinically Diagnosed Cases of Plantar Warts, Corns, and Calluses: A Cross-Sectional Study.

With the naked eye, it can frequently be challenging to tell a plantar wart from a corn or callus. A non-invasive diagnostic method called dermoscopy allows for the inspection of morphological features that are not apparent to the unaided eye. This study aimed to examine the dermoscopic findings in pared and unpared cases of palmoplantar warts, corns, and calluses. Seventy patients who had palmoplantar warts, corns, and calluses were included in this study. A predesigned structured format was used to document the dermoscopic findings. The majority of patients (51.4%) had warts followed by callus (28.6%) and corn (20%). On dermoscopic examination, all unpared and pared cases of warts had homogenous black/red dots. Translucent central core was present in 92.85% unpared and 100% pared lesions of corns. Homogenous opacity was present in 75% unpared and 100% pared cases of callus. There was no association between unpared and pared lesions(p>0.05). The accuracy of identifying various clinical types of cutaneous warts, calluses, and corns can be improved by dermoscopy without paring.