Warts In Patients Research Articles

Functional characterization of CD4 and CD8 T cell responses among human papillomavirus infected patients with ano-genital warts.

Ano-genital warts are considered one of the commonest and highly infectious sexually transmitted infections. These warts are primarily caused by the human papillomavirus (HPV) of the family Papillomaviridae, genus alpha-papillomavirus, species 10 and types 6 and 11. However the high recurrence rate of warts is a matter of serious concern to the patients and a challenge for the treating physician. The conventional treatment options are targeted only to the local site of warts. There is no systemic treatment modality as there is limited understanding of the disease immune-pathogenesis. The role of cell-mediated immunity in combating HPV infection is not clearly defined. Hence the present study is aimed at investigating the CD4+ T helper (Th1 and Th2) and CD8+ T cell responses among wart patients. In this study, we compared HPV6 and HPV11 antigen-specific T cell responses among venereal wart patients relative to healthy controls. Significant decrease in percent frequencies of IFN-γ producing CD4+ and CD8+ T cells were observed in HPV infected wart patients. On the other hand, the frequency of CD4+ T cells expressing IL-4 was significantly increased in these patients as compared to healthy controls. The observed functional skewing of HPV specific T cells from Th1 to Th2 response in patients indicated suppressed immunity against the HPV. Moreover, decrease in CD8 T cell function correlated with poor wart clearance. Our findings open future avenues for exploring potential immunomodulation strategies as an adjunct to standard treatment for better management of these patients and prevention of recurrence.

Treating multiple and recalcitrant wart with autoimplantation technique

Background: Warts are benign tumors involving skin and mucous membrane that are caused by human papillomavirus (HPV). Several treatment modalities are available for treating multiple warts, but without any significant response or cost-effectiveness. Aims: This study aimed to evaluate the safety and efficacy of autoimplantation therapy in the treatment of recalcitrant and multiple warts. Materials and Methods: A total of 40 patients of multiple warts (more than five warts per patient), palmoplantar warts, recurrent warts, and resistant warts were enrolled in this study. A small piece of warty tissue was introduced in the wound with the help of 26 no. needle. Patients were assessed monthly and resolution after 3 months was considered complete clearance. Result: Out of 40 patients, 21 patients of verruca vulgaris (75%) and 10 patients of palmoplantar warts (83.3%) showed resolution within 3 months, accounting for a total clearance rate of 77.5%. Conclusion: Autoimplantation of wart using the pared stratum corneum of wart is a safe, efficacious, less painful, and in-office procedure for the treatment of multiple, recurrent, and palmoplantar warts.

Intralesional bleomycin in the treatment of common warts

Background: Warts are one of the most common benign growths in the dermatological outpatient department but are many times tough to treat as they are chronic, resistant, and relapsing to available treatment. A variety of therapeutic modalities have been used with varying degree of success. However, till date, no therapeutic modality had been fully successful. Aim and Objectives: The present study was conducted to evaluate the therapeutic efficacy and safety of intralesional (IL) bleomycin injection in common warts. Materials and Methods: A total of 50 patients of common warts were enrolled in this evaluator blinded randomized placebo-controlled study. Group A consists of patients to be treated with IL bleomycin, and Group B consists of patients to be treated with IL normal saline. A total of 25 patients were enrolled in each group. Patients of both groups were asked to follow-up after 4 weeks for maximum of 4 times, i.e. at 8 weeks, 12 weeks, at the end of 6 months as a final visit, and assessed clinically every time. Results: Out of 87 wart lesions in Group A patients, 81 (93.10%) showed a complete resolution. A progressive clearance of the warts was seen, after the first injection (64%) and second injection (36%), only 6 warty growths (7%) were nonresponders to treatment. However, in Group B, only 4 (5%) showed disappearance within 12 weeks and even after 6 months of follow-up (P < 0.05 by × 2 analysis and risk ratio = 7.67). Conclusion: IL bleomycin injection was significantly safer and effective, with better patient acceptance in treating common warts.

Clinical outcomes and recurrences after homologous autoimplantation therapy for warts: A prospective study

Background: Warts are mucocutaneous infections caused by human papillomavirus (HPV). Of the various modalities of treatment currently available, no single modality is uniformly efficacious and recurrences are common. Homologous autoimplantation is a minimally invasive procedure, which treats warts by stimulating a specific immune response against HPV. Aim: The aim of the study was to evaluate the clinical outcomes and recurrences after a single sitting of homologous autoimplantation therapy for multiple nonvenereal warts. Materials and Methods: Single homologous autoimplantation of wart tissue was done in 75 patients of multiple facial, palmoplantar, or common warts, reporting to a tertiary care dermatology center. They were assessed at 3 months for the outcome of the procedure, and those with complete clearance were followed up for 1 year for any recurrences. Results: Complete clearance was observed in 30 (40%) of the cases and 10 (13.3%) cases showed moderate clearance. In 13 (17.3%) cases, there was mild clearance, whereas 22 (29.3%) patients did not show any response to treatment. Patients with facial warts showed good therapeutic response with complete clearance seen in 62.5%, compared to plantar warts, where complete clearance was achieved only in 16%. At the end of the study period, recurrence was seen in only 1 (3.33%) patient in the complete clearance group. Conclusion: Autoimplantation therapy as a one time minimally invasive procedure has moderate efficacy in treating multiple warts with the best outcome being for facial warts. The virus-specific immunity generated in the process reduces the chances of recurrences.

Estimating the burden of genital warts in Taiwan

Genital warts prevalence estimates were extracted from a daily record of patients examined from 31 October 2011 to 4 May 2012 by 67 physicians in Taiwan. Physicians recorded the total number of patients and genital warts patients seen daily for 2 weeks. These physicians also completed a survey regarding healthcare resource use, treatment, follow-up care, and referral patterns. Patient psychosocial impact was estimated using a self-administered survey. The overall prevalence of genital warts in Taiwan was estimated at 1.1%, with a higher prevalence among men. A total of 146 genital warts case patients were included in the study (76 men, 70 women). Median costs for diagnosis and treatment were US$222 for male and US$351.8 for female patients. Male genital warts subjects reported a negative psychosocial impact on their well-being and health-related quality of life - psychosocial impact results are reported in the Supplementary Material file. Genital warts prevalence was higher among male patients; female patients incurred higher costs. Among men, genital warts had a negative psychosocial impact on well-being and health-related quality of life.

Prevalence of cutaneous warts in patients with systemic lupus erythematosus: a systematic review.

The aim of this study was to review and evaluate systematically the scientific evidence on the relationship between systemic lupus erythematosus (SLE) and cutaneous warts (CW) caused by human papillomavirus (HPV) infection. With strict inclusion and exclusion criteria, we extensively searched the PUBMED, BVS (Virtual Health Library), and SCOPUS databases for the studies that evaluated the prevalence of CW in patients with SLE. Secondary references were additionally obtained from the selected articles. Only four articles met the research criteria and showed a higher frequency of CW in SLE patients compared to healthy controls. One of them highlighted about rheumatoid factor (RF) in the sera of patients with SLE and found an inverse correlation between the occurrence of warts and RF autoantibody. Moreover, most of the selected articles showed that the presence of CW did not correlate with the use of immunosuppressive drugs. Therefore, these findings suggest that the prevalence of CW in patients with SLE is probably high due to the defects in immune mechanisms, independently of immunosuppressive drugs.

High-grade Dysplasia in Anogenital Warts of HIV-Positive Men

ImportanceHuman papillomavirus (HPV)-induced anogenital lesions are very frequent in men who have sex with men (MSM) who are HIV-positive (HIV+). Anogenital warts (AGWs) are considered benign lesions caused by low-risk HPV-types, whereas anogenital dysplasias are potential cancer precursors associated with high-risk HPV-types. Both types of lesions can usually be distinguished clinically.ObjectiveTo describe a case series of HIV+ MSM with typical AGW that harbored different grades of dysplasia.Design, Setting, and ParticipantsFor this retrospective virological analysis, we recruited 25 HIV+ MSM with AGWs (n = 38) harboring areas of dysplasia and 22 patients who were HIV-negative (HIV−) with AGWs seen between February 2013 and March 2015 at a tertiary dermatological referral center for anal cancer screening. Dysplasia-containing AGW tissue of HIV+ MSM were compared with randomly selected AGWs of patients who were HIV−.Main Outcomes and MeasuresHistopathological analysis, immunohistochemical staining for p16INK4a and Ki67, HPV-typing, and viral load determination in AGWs of HIV+ compared with patients who were HIV−.ResultsOverall, 25 HIV+ MSM with AGWs (mean [SD] age, 47.3 [11.1] years) harboring areas of dysplasia and 22 patients who were HIV− (5 women, 17 men; mean [SD] age, 35.5 [12.8] years) with AGWs were included in this study. The 38 dysplasia-containing AGWs of HIV+ MSM harbored low-grade dysplasia in 6 cases (16%), high-grade dysplasia in 31 cases (81%), and areas of invasive anal carcinoma in 1 (3%) case. With the exception of 1 biopsy, all low-grade lesions were p16INK4a-negative, whereas 25 of 31 (81%) AGWs with high-grade lesions or an anal carcinoma were p16INK4a-positive. Only low-risk HPV-types were present in 11 samples (29%; 2 low-grade lesions and 9 high-grade lesions), low-risk and high-risk types were found in 19 samples (50%; 1 low-grade lesion and 18 high-grade lesions), and only high-risk HPV-types were present in 8 samples (21%; 3 low-grade lesions, 4 high-grade lesion, and 1 cancer-containing lesion). High low-risk HPV DNA loads were found in low-grade and high-grade lesions, while high high-risk HPV DNA loads were only found in AGWs harboring high-grade lesions. The 22 AGWs of patients who were HIV− showed no signs of dysplasia, and p16INK4a-staining was always negative. All of these samples carried low-risk HPV types, and in 2 cases high-risk HPV-types were detected additionally.Conclusions and RelevanceIn contrast to immunocompetent patients, AGWs of HIV+ MSM may harbor high-grade dysplasia or even invasive squamous cell carcinoma. A substantial proportion of theses lesions may only contain low-risk HPV-types. Anogenital warts in patients who are HIV+ should be evaluated histopathologically to exclude cancer precursors.

Tandem repeats of TSER significantly influence the efficacy of 5-fluorouracil in the treatment of plantar warts.

To identify potential genetic risk markers associated with 5-fluorouracil (5-FU) treatment outcomes in plantar warts patients. In this study, 126 plantar warts patients were treated with an intralesional mixture of 5-FU, lidocaine and epinephrine. Treatment outcomes were compared with DNA mutation analysis. More patients with TSER 3R/3R genotype failed 5-FU treatment than TSER 2R/3R+2R/2R (72.1 vs 43.8%; odds ratio: 3.32; 95% CI: 1.26-8.72; p = 0.013). In addition, the regression modeling identified patient age and TSER 3R allele as covariates of the risk of 5-FU treatment failure (p = 0.025). TSER 3R/3R of TYMS gene was found to be the major risk of treatment failure. This genetic marker provides a potential treatment stratification target to modulate 5-FU treatment in plantar wart patients.

Clinicoepidemiological Study of Different Types of Warts.

Background. Warts are cutaneous and, sometimes, mucosal lesions caused by one of the several human papilloma viruses. Aim. Assessment of the clinicoepidemiological aspects of warts. Materials and Methods. One hundred consecutive patients of warts presenting to the department of our institution were assigned two broad locational groups: genital and nongenital warts, the latter subdivided into common, plane, palmoplantar, mosaic, and digitate/filiform. Results. Ninety had nongenital and 10 had genital warts in our study; common (42%), palmoplantar (20%), and plane (18%) were the common types of the nongenital warts. All the genital warts were acuminate. In the second decade, the commonest age group, encompassed all patients of mosaic, 40% of palmoplantar, and 20% of genital warts. Overall male (66%) preponderance xisted. All cases of filiform warts were males. Mosaic warts affected females more commonly. Students (32%), laborers (28%), and housewives (16%) were the usual occupations. Cosmetic concern (92%), pain (16%), and itching (15%) were the common complaints. All patients of genital warts sought treatment within 6 months. Conclusions. Common, palmoplantar, and plane warts were the common types of nongenital warts. Overall prevalence peaked during the second decade but one-third of the cases of plane warts occurred during the first. Extremities were the most common sites (66.7%); face was the next commonly (23%) involved.

Risk Factors for Urethral Condyloma among Heterosexual Young Male Patients with Condyloma Acuminatum of Penile Skin

To our knowledge, this is the first study that focuses on risk factor of urethral condyloma (UC). The subjects of our study included genital warts patients who had been diagnosed as having condyloma acuminatum of penile skin (CAPS) with/without UC. Relationship with UC of number of life time female partners, co-infection with urethritis, circumcision status, number of CAPS and wart diameter were studied by use of multivariate analysis. Co-infection with urethritis, circumcision status were risk factors of UC in heterosexual young male patients with CAPS. This information will be helpful for providing more professional counseling to patients with genital warts.

Study of Homologous Autoimplantation Therapy for Treatment of Multiple Warts in Patients Attending the Dermatology out Patient Department

&lt;strong&gt;Introduction&lt;/strong&gt;: Warts are benign tumours that commonly involve skin and other epithelial tissues. There is no single treatment modality that is 100% effective. In multiple warts, especially on face, palms, and soles destructive procedure are inappropriate and impractical. Homologous autoimplantation is a simple technique, which helps in inducing cell mediated response, causing clearance of warts. &lt;strong&gt;Aims and objectives&lt;/strong&gt;: To evaluate the effect of homologous autoimplantation therapy in treatment of multiple warts. To study the untoward effects of this treatment. Material and methods: A total of 49 patients of viral warts were included in study. Homologous autoimplantation of wart was done and regular follow up was done to see the result. &lt;strong&gt;Results&lt;/strong&gt;: Out of 49 patients, in 24 patients there was good response, 14 showed moderate response, 5 showed poor response and in 6 patients there was no response. &lt;strong&gt;Conclusion&lt;/strong&gt;: Homologous autoimplantation is an easy, minimally invasive technique which clears multiple, recurrent and recalcitrant warts.

Study of Homologous Autoimplantation Therapy for Treatment of Multiple Warts in Patients Attending the Dermatology out Patient Department

Introduction : Warts are benign tumours that commonly involve skin and other epithelial tissues. There is no single treatment modality that is 100% effective. In multiple warts, especially on face, palms, and soles destructive procedure are inappropriate and impractical. Homologous autoimplantation is a simple technique, which helps in inducing cell mediated response, causing clearance of warts. Aims and objectives : To evaluate the effect of homologous autoimplantation therapy in treatment of multiple warts. To study the untoward effects of this treatment. Material and methods: A total of 49 patients of viral warts were included in study. Homologous autoimplantation of wart was done and regular follow up was done to see the result. Results : Out of 49 patients, in 24 patients there was good response, 14 showed moderate response, 5 showed poor response and in 6 patients there was no response. Conclusion : Homologous autoimplantation is an easy, minimally invasive technique which clears multiple, recurrent and recalcitrant warts.

Study of Cryotraphy results in warts in patients referring to Dermatology Department of Sina Hospital, Iran

Study of Cryotraphy results in warts in patients referring to Dermatology Department of Sina Hospital, Iran

A prospective study of prathisaraneeya apamarga kshara in comparison with prathisaraneeya palasha kshara in patients with charmakeela (warts) and kadara (corns)

Background: Charmakeela and Kadara are the diseases which have signs and symptoms similar to Warts and Corns respectively. Objectives: Kshara karma is mentioned under kshudra roga adhikaras by Acharya Sushruta under the context of Kshara karma adhyaya for the treatment of Charmakeela and Kadara. Methods: In our study, clinically diagnosed 30 patients were enrolled and divided into two groups. Out of 30 patients, 15 patients were assigned to Group 1 for prathisaraneeya kshara karma with Apamarga kshara and another 15 patients were assigned to Group 2 for prathisaraneeya kshara karma with Palasha kshara considering its effect on two subjective symptoms (pain &amp; burning sensation) and two objective signs (regression of lesion &amp; discharge) on day one with a follow up treatment on 3rd, 5th and 7th day. Results: Our study had 18 cases of warts and 12 cases of corns respectively. Group 1 had nine patients of warts and six patients of corns respectively. The result of our study reveals that, six patients of warts and four patients of corns had a reduction in pain, burning sensation, discharge and complete regression of lesion. Two patients of warts and one patient of corns had scarring after seven days and one patient each from warts and corn had recurrence in Group 1 after eight weeks, whereas four patients of warts and four patients of corns had complete regression of lesion, three patients of warts and one patient of corn had scarring which was noticed after seven days of the treatment and two patients of warts and one patient of corn had recurrence after four weeks in Group 2. Conclusion: Even though scarring was seen in a few patients, the size of the scar was lesser than the lesion existed before in Group 1 (Pratisaraneeya Apamarga kshara) compared to Group 2 (Pratisaraneeya Palasha kshara). The scar was acceptable by the patients in comparison with the original lesion. Pratisaraneeya Apamarga kshara showed greater improvement in corns and warts when compared to pratisaraneeya Palasha kshara.

Distribution of genital wart human papillomavirus genotypes in China: A multi-center study

Although it is understood that low-risk human papillomavirus (HPV) genotypes are associated with genital warts, there have been very few published studies reporting the genotype-specific prevalence of HPV among Chinese population. The aim of the study was to assess the prevalence of HPV genotypes in genital warts across China, and thus to evaluate the potential benefit of a quadrivalent HPV vaccine in this population. The tissue samples of a total of 1,005 genital warts cases were collected from seven geographical regions of China. HPV genotypes were analyzed using the general primer PCR and sequence-based typing method. Prevalence differences between sexes, geographical regions and age groups were assessed. The overall prevalence of HPV DNA in genital warts patients was 88.7% (891/1,005). Low-risk genotypes predominated, with a prevalence of 78.1% (785/1,005). The most prevalent genotypes were HPV-6 (41.3%), HPV-11 (37.6%) and HPV-16 (10.4%). Among HPV positive patients, single infections were more frequent (866/891, 97.2%) than co-infections (25/891, 2.8%). Both the overall prevalence of HPV DNA and that of HPV-6/-11/-16 (positive for any of the three types) decreased with age (P-trend = 0.010 and P-trend = 0.025, respectively). The prevalence of HPV-6/-11 (positive for either HPV type) and HPV-16 varied by geographic region (P = 0.003 and P ≤ 0.001, respectively). The prevalence of HPV-16 in female patients between urban and rural areas showed a marginally significant difference (P = 0.05). In sum, the results provide strong evidence that, in China, the most prevalent HPV genotypes in genital warts are HPV-6, HPV-11 and HPV-16. This indicates that a quadrivalent HPV vaccine may decrease the incidence of genital warts in the future.

AB0687 Factors associated with common warts in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE)

BackgroundPrevious studies demonstrated an increased prevalence of human papillomavirus (HPV) related CW in patients with SLE.1 Problems associated with previous published series include the fact that sample sizes were small...

Clinical and immunologic results of local hyperthermia at 44 °C for extensive genital warts in patients with diabetes mellitus

Background: Genital warts are more extensive and difficult to treat in patients with diabetes mellitus due to defective immune responses.Purpose: Our aim was to confirm the suitability of local hyperthermia for the treatment of genital warts in patients with diabetes mellitus and to investigate the immune cells in lesional areas at different time intervals after treatment.Methods: We treated three diabetic patients with extensive genital warts by local hyperthermia at 44 °C for 30 min a day for 3 consecutive days plus 2 additional days 1 week later, then once a week till there showed signs of clinical clearance. Immunohistochemical profile was described on serial biopsies from a patient with confluent plaques.Results: The warty lesions in the patients resolved in 6, 4 and 9 weeks, respectively. Immunohistochemical staining in the regressing warts revealed abundant infiltrating CD4+ T and CD8+ T lymphocytes (P < 0.01), as well as macrophages and CD1a+ dendritic cells.Conclusions: This preliminary study suggested that local hyperthermia was a safe and effective single modality in the treatment of genital warts in diabetic patients and could induce a rapid immune response in lesional skin.

Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy

To present computed tomography (CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy. From January 2009 to November 2011, 56 patients were collected through the histopathology and Picture Archiving and Communication Systems records, which revealed 5 basal cell adenoma (BCA), 16 pleomorphic adenoma (PA), 25 Warthin's tumor (War-T), 3 Kimura's disease (KD) and 7 parotid carcinoma (PCa) cases. All the CT images were retrospectively analyzed by two radiologists in consensus, based on their description of morphology (location, number, size, margin and fibrous capsule) and enhancement patterns of masses. In addition, the diagnostic efficiency of diagnostic strategy is tested. War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years; the significant difference was seen in War-T vs PA and BCA vs PA. About 40% of War-Ts presented with bilateral multifocal lesions, a higher ratio than others. Seventy two percent of War-Ts were limited to the superficial lobe, followed by BCA 60% and PA 40%. Vessel facing sign and enlarged lymph nodes were both frequent in War-T, which respectively accounts for 84% and 76% of cases. Rapid contrast enhancement and decreases were unique for War-T. BCA and PA showed obvious delayed enhancement. The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency, with high accuracy, sensitivity and specificity. Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data. A diagnostic strategy with high diagnostic efficiency was established.

Pre-vaccination incidence of genital warts in 15–23-year-old women and men attending youth clinics in Stockholm, Sweden

Human papillomavirus (HPV) vaccines were introduced to the market in 2006 and 2007. The present pilot study was designed to examine the incidence of genital warts in the population up to 23 y of age in the county of Stockholm before the start of mass HPV vaccination. Data from the electronic health records of 9 youth clinics in the county of Stockholm were collected retrospectively for the y 2006-2008. In total, 49,985 patients visited the study youth clinics during 2006-2008. Of these, 1817 were denoted genital warts patients. An extrapolation of the study data was done in an attempt to estimate the annual number of genital warts cases in the full Stockholm County population aged 15-23 y. Results showed that there were approximately 1792 genital warts patients in the age group 15-23 y each year in Stockholm County. Female cases represented approximately 62% of all cases in the age group 15-23 y. The peak incidence was at around 20 y of age for females, while males had a more flattened peak incidence around 19-23 y of age. This pilot study demonstrates that, compared to other reported data, genital warts are at least as common in Sweden as in other countries among 15-23 y old females and males.

A randomized trial of immunotherapy for persistent genital warts

Aim To determine whether immunotherapy with HPV6 L1 virus like particles (VLPs) without adjuvant (VLP immunotherapy) reduces recurrence of genital warts following destructive therapy.Trial design A randomized placebo controlled blinded study of treatment of recurrent genital warts amenable to destructive therapy, conducted independently in Australia and China.Methods Patients received conventional destructive therapy of all evident warts together with intramuscular administration of 1, 5 or 25 µg of VLP immunotherapy, or of placebo immunotherapy (0.9% NaCl), as immunotherapy at week 0 and week 4. Primary outcome, assessed at week 8, was recurrence of visible warts.Results Of 33 protocol compliant Brisbane recipients of placebo immunotherapy, 11 were disease free at two months, and a further 9 demonstrated reduction of > 50% in total wart area. Wart area reduction following destructive treatment correlated with prior duration of disease. Among 102 protocol compliant Brisbane recipients of VLP immunotherapy, disease reduction was significantly greater than among the placebo immunotherapy (50% ± s.e.m. 7%) recipients for subjects receiving 5 µg or 25 µg of VLP immunotherapy/dose (71% ± s.e.m.7%) but not for those receiving 1 µg VLP immunotherapy/dose (42% ± 7%). Of 52 protocol compliant placebo immunotherapy recipients in Wenzhou, 37 were disease free at two months, and a further 8 had > 50% disease reduction. Prior disease duration was much shorter in Wenzhou subject (8.1 ± 1.1 mo) than in Brisbane subjects (53.7 ± 5.5 mo). No significant reduction in mean wart area was observed for the 168 Wenzhou protocol compliant subjects who also received VLP immunotherapy.Conclusions This study confirms the findings in a previous open label trial that administration of VLP immunotherapy may assist in clearance of recurrent genital warts in patients for whom destructive therapy is unsuccessful and that unsuccessful destructive therapy is more common with increasing prior disease duration.