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PubMed2003

Plantar warts treated with an immune response modifier: a report of two cases.

Viral warts are the most common disease of the skin and are caused by human papillomavirus (HPV). Plantar warts, a manifestation of infection by HPV-1, -2 and -4, tend to be smoother and flatter than common warts and can also be painful when pressure is applied. A variety of local treatments, including topical salicyclic acid, cryotherapy, topical 5-fluorouracil, intralesional interferons and photodynamic therapy, are available to treat plantar warts. Here we report two cases of plantar warts, which had been previously treated without success. Total clearance of the warts was observed in both cases after treatment with imiquimod 5% cream over a period of 12 weeks. No evidence of local skin reactions was observed in either case during the treatment period. Recurrent lesions were not evident in the follow-up period for each patient.

Adjuvants, Immunologic↗
PubMed1999

Density of viral particles in pre and post Nd: YAG laser hyperthermia therapy and cryotherapy in plantar warts.

BACKGROUND: Warts often present a difficult treatment problem for clinicians because of the lack of specific antipapillomavirus agents. Plantar warts, in particular, represent a therapeutic challenge. METHODS: Twenty-five patients with plantar warts were treated with Nd:YAG hyperthermia and another 25 were treated with cryotherapy. Biopsies were taken before and after treatment in both groups and were examined for the presence of human papillomavirus deoxyribonucleic acid (HPV DNA) using in situ hybridization (ISH). RESULTS: HPV DNA was detected in 100% of untreated warts and in 96% of cryotreated warts, but was not detected in any of the hyperthermia-treated warts. CONCLUSIONS: HPV is more vulnerable to hyperthermia than to cryotherapy.

Adolescent↗
PubMed2001

Topical formic acid puncture technique for the treatment of common warts.

BACKGROUND: Warts are a common chronic skin disorder that can be cosmetically disfiguring and, depending on the location, cause inhibition of function. The presence of dozens of topical and systemic treatments for warts is a testament to the lack of a rapid, simple, uniformly effective, inexpensive, nonscarring, and painless treatment. AIM: The purpose of this study was to determine the efficacy and safety of 85% formic acid application, an inexpensive therapy, for the treatment of warts. METHODS: A placebo-controlled, nonrandomized, open trial was performed in 100 patients with common warts attending Father Muller's Medical College Hospital, Mangalore. Fifty patients received 85% formic acid application and 50 patients received placebo (water) using a topical application/needle puncture technique every other day. RESULTS: Ninety-two per cent of patients who received formic acid application showed complete disappearance of warts after a 3-4-week treatment period, compared to 6% in the placebo group. CONCLUSIONS: The results show that 85% formic acid application is a safe, economical, and effective alternative in the treatment of common warts with few side-effects and good compliance. A multicenter trial is needed to examine the efficacy and safety of this treatment.

Administration, Topical↗
PubMed2001

Use of intralesional interferon-alpha for the treatment of recalcitrant oral warts in patients with AIDS: a report of 4 cases.

Four human immunodeficiency virus-positive homosexual men with 2- to 4.5-year histories of recurrent oral warts that had failed to respond to conventional surgical and other treatment modalities were offered treatment with interferon-alpha. All had multiple or large oral warts, 3 had skin warts, 2 had a history of anal warts, and 1 had penile lesions. All 4 patients were treated with a combination of intralesional and subcutaneous interferon-alpha. Adverse side effects were dose-related, mild, and transient; they included flulike symptoms (3 patients), hair loss and tachycardia (1 patient), and transient changes in the white blood cell count. All patients responded to therapy and remained free of disease up to 42 months. Intralesional injection with interferon-alpha appears to provide excellent clinical control for recurrent, multiple, and extensive oral warts in the human immunodeficiency virus-positive population, and is a useful adjunct to initial surgical removal of oral warts.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Clinical and immunohistochemical responses of plantar warts to topical immunotherapy with diphenylcyclopropenone.

A 30-year-old man with bilateral plantar warts of the mosaic type which had been resistant to standard treatment modalities was treated with diphenylcyclopropenone. After 10 weeks, the treated warts had disappeared; the untreated warts, although showing some involution, still persisted. The untreated warts, serving as a control to prove the effectiveness of topical immunotherapy, responded likewise to subsequent treatment with diphenylcyclopropenone. Wart regression was reflected histopathologically by decreases in acanthosis, papillomatosis, granular vacuolation, and hyperkeratosis. Immunohistochemically, Ki-67 expression was markedly reduced, and a reversal of the CD4/CD8 ratio was seen. These findings suggest a major role of a cell-mediated immune response in the spontaneous resolution of warts.

Administration, Cutaneous↗
PubMed2005

Detection and identification of human papillomavirus types isolated from Korean patients with flat warts.

Flat warts, also called verruca planna (VP) or juvenile warts, are benign epithelial proliferations of the skin caused by infection with human papillomaviruses (HPV). Several HPV types are known to be associated with flat warts, and particularly HPV type 3 and 10 have been most frequently reported in other countries. In this study, for the detection and typing of human papillomavirus isolated from Korean patients with flat warts, polymerase chain reaction (PCR) and restriction endonuclease digestion were carried out with a set of restriction endonucleases, using the cloned HPV DNA and DNA from clinical specimens. A unique digestion pattern for HPV type 3 and 10, a form of miniature fingerprinting, enabled us to identify HPV type from the amplified fragments. A total of thirty clinical samples, as either frozen tissue or paraffin-embedded tissue, were investigated to verify the type. All the clinical samples except one were con-firmed to be type 3, one of the most frequently observed types in flat warts, and one sample was neither type 3 nor type 10. Further investigation of the unidentified sample by DNA sequencing and sequence alignment with other known HPV types revealed that the sample was a variant of HPV type 94, one of the EV-related HPVs, with the closest evolutionary distance to the HPV type 10 among the known flat wart-associated HPV types.

Adult↗
PubMed1976

Generalized warts and immune deficiency.

A case of common variable hypogammaglobulinaemia with associated impairment of cell mediated immunity and severe wart virus infection is described. The defect of cell mediated immunity is thought to have predisposed this patient to the development of persistent wart infection which in turn grossly depressed the body's cellular immunity and thus allowed widespread dissemination of the warts. The rapid restoration of cell mediated immunity which followed the reduction in the antigenic load of wart virus by diathermy treatment was followed by the spontaneous regression of all the patient's warts. This unusual case may provide some insight into the complex relationship between wart virus infection and the immune system of the host.

Adult↗
PubMed1992

Modern treatment of warts: cure rates at 3 and 6 months.

Four-hundred consecutive referrals with viral warts of the hands and/or feet were investigated to determine the cure rate from a combination of cryotherapy, keratolytic wart paint and paring. For treatment failures after 3 months, the value of continuing cryotherapy and of additional treatment with the immunomodulator inosine pranobex were assessed. Subjects were treated for 3 months with wart paint and cryotherapy and were randomized to receive, or not, paring in addition. Those who did not respond by 3 months were randomized to receive, or not, 3 months further cryotherapy, and to receive inosine pranobex 60 mg/kg/day for 1 week each month, or matching placebo. Fifty-two per cent of subjects were cured by 3 months. The chance of cure was inversely related both to the length of history and to the diameter of the largest wart. Paring improved the cure rate for plantar warts but not for hand warts. During the second 3 months the cure rate fell to 41%. Neither cryotherapy nor inosine pranobex significantly improved this response.

Adolescent↗
PubMed1994

New types of human papillomaviruses and intracytoplasmic inclusion bodies: a classification of inclusion warts according to clinical features, histology and associated HPV types.

Two new types of intracytoplasmic inclusion bodies (ICBs) associated with distinct clinical features, and the presence of DNA of distinct types of human papillomaviruses (HPVs) are reported. One hundred and seven cutaneous warts containing ICBs were grouped into three categories according to distinct clinicopathological features: 67 were wart lesions with well-known granular (Gr)-ICB, 13 were punctate keratotic lesions with filamentous (Fl)-ICB and 31 were pigmented warts with homogeneous (Hg)-ICB. Molecular biological studies were performed in order to assess a specific association of each group of warts with distinct types of HPV. HPV-1 DNA sequences were detected in all the lesions with a Gr-ICB. Punctate keratotic lesions with Fl-ICB were associated with HPV-63, which was newly cloned from such a lesion. One of the samples also contained HPV-1 DNA. Pigmented warts with Hg-ICBs contained one of the related HPVs, i.e. HPV-4, HPV-60 or a novel type of HPV, HPV-65. Based on these associations, a classification of inclusion warts is proposed.

Adolescent↗
PubMed2005

Lack of evidence for local immune activity in oral hairy leukoplakia and oral wart lesions.

BACKGROUND: Oral warts, caused by human papillomavirus (HPV), and oral hairy leukoplakia (OHL) caused by Epstein-Barr virus (EBV), are common oral manifestations in HIV-infected persons. Although both conditions occur most often with reduced blood CD4+ T-cell numbers, oral warts and OHL rarely occur simultaneously, suggesting that dysfunctions in other secondary local immune parameters are also involved. The present study evaluated tissue-associated proinflammatory and T-helper cytokine and chemokine mRNA expression and the presence of T cells in each lesion. METHODS: Biopsies were taken from lesion-positive and adjacent lesion-negative sites of HIV+ persons with oral warts or OHL and lesion-negative sites from HIV+ persons who were oral HPV or EBV DNA-positive (matched controls). Cytokine/chemokine mRNA expression was quantified by real-time polymerase chain reaction. CD3, CD4, and CD8 cells were identified by immunohistochemistry. RESULTS: No differences were detected in tissue-associated cytokine/chemokine mRNA expression in warts or OHL when compared to lesion-negative sites. Immunohistochemical analysis of T cells showed CD8+ cells exclusively, but few cells were present in either lesion. No differences were detected between lesion-positive and -negative control sites of each pathologic condition. CONCLUSION: Little evidence was found for local immune reactivity to either oral warts and OHL, suggesting that CD4+ T cells are a primary host defense against both oral warts and OHL, but with nonimmune factors potentially responsible for the divergent prevalence of each.

AIDS-Related Opportunistic Infections↗
PubMed1989

Comparison of human papillomavirus type 1 serotyping by monoclonal antibodies with genotyping by in situ hybridization of plantar warts.

Thirty plantar warts were analyzed for the presence of HPV-1 type-specific and PV genus-specific capsid antigens by immunofluorescence (IF) using monoclonal and polyclonal antibodies and type-specific HPV-1 DNA employing in situ hybridization methods. Fifteen of 30 plantar warts were positive by IF for PV genus-specific structural viral antigens. Thirteen of the 15 productively infected plantar warts expressed intranuclear HPV-1 type-specific capsid antigens and viral DNA, which were detected in the same distribution in each individual wart. The 2 productively infected plantar warts that did not react with HPV-1 type-specific MoAbs did not react with HPV-1 type-specific DNA by in situ hybridization. Thus, serotyping of HPV-1 capsid antigens by monoclonal antibodies is concordant with genotyping of HPV-1 viral DNA by in situ hybridization in productively infected plantar warts.

Antibodies, Monoclonal↗
PubMed1979

Effect of injections of small doses of human fibroblast interferon into genital warts. A pilot study.

Eleven male patients with genital warts were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts. The changes in size of the treated warts compared with that of the controls suggested that interferon did inhibit the growth of the warts. The dose given was probably insufficient for a dramatic effect. In one patient, however, a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size.

Adolescent↗
PubMed1984

Thymus derived lymphocytes (T cells) in patients with genital warts.

Thymus derived lymphocytes (T cells) were counted in the peripheral blood of 30 patients with genital warts and in 20 healthy controls. The control group was made up of 10 healthy patients with no history of warts and 10 who had been cured of warts for at least 12 months. We found that patients with genital warts had a significantly lower number of T cells despite an adequate number of circulating lymphocytes in the peripheral blood. We therefore suggest that a functional defect of lymphocytes ("dyslymphocytosis") could be the cause of genital warts either in their primary or recurrent form. These abnormal lymphocytes return to their normal function after the disappearance of genital warts.

Adolescent↗
PubMed1993

Contact immunotherapy with squaric acid dibutylester for warts [corrected].

The efficacy of squaric acid dibutylester (SADBE), a topical allergen, was investigated in the treatment of 20 patients with warts. All patients had multiple or warts recalcitrant to other therapies or hesitated to have the painful cryotherapy. The patients with warts present for a mean of 15.3 months (range 1-36) were successfully sensitized with 2% SADBE in acetone. Then the warts were treated with a 0.1 or 0.01% SADBE application once a week or every other week, so as to maintain a mild contact dermatitis. Twelve of the 20 patients (60%) were completely cured after an average of 6 applications (range 2-12). Five patients (25%) showed either a poor or no response even after 9-18 applications. Three patients (15%) exhibited contact dermatitis either at the sensitization or the treatment site. Our study shows that this therapy, although not always safe, is effective in treating warts in some patients, who either hesitate at conventional cryotherapy or have warts resistant to other therapies. The safety of this method remains to be evaluated.

Administration, Cutaneous↗
PubMed2002

The importance of patient and healthcare provider perceptions in the evaluation of imiquimod and other prior treatments for anogenital warts.

The experience and satisfaction of healthcare providers and patients were assessed for various treatment options for anogenital warts. Patients were asked about their immediate experience with imiquimod cream 5% and - for patients with recurrent warts - their recall of prior experiences with other treatment options. Surveys were completed pre-study by 744 patients and post-study by 399 patients and 69 healthcare providers; obstetricians/gynaecologists were the predominant (25 of 69; 36%) specialty. Approximately two-thirds (475 of 744; 64%) of patients in the pre-study survey had previously been treated for anogenital warts. Patients with recurrent warts were generally dissatisfied with prior therapies. In post-study surveys, imiquimod received favourable ratings from patients with recurrent warts and from patients treated for the first time. Healthcare providers rated imiquimod favourably for overall acceptance, convenience, and compliance. Perceptions of various treatments for anogenital warts by patients and healthcare providers can vary considerably. Therefore, comparative studies should include assessments of these perceptions to gain a full understanding of the relative merits of the therapies under investigation.

Administration, Topical↗
PubMed1999

[Warts, swimming pools and atopy: a case control study conducted in a private dermatology practice].

OBJECTIVE: Our purpose was to study two risk factors of warts, i.e., swimming pool frequentation and atopy. PATIENTS AND METHODS: A case-control study was performed in four dermatologists' private offices. The cases were patients consulting for the first time for warts; the controls were patients consulting for the first time for acne. RESULTS: Univariate analysis performed in 153 questionnaires (including 86 cases and 67 controls) showed an association between warts with swimming pool frequentation one year before consulting and between warts and history of atopy. Multivariate analysis showed an association between warts and history of atopy (OR: 4.20; confidence interval at 95 p. 100 = (1.52-11.6). The link between warts and frequentation of swimming pool one year before is not significant (OR: 1.81; confidence interval at 95 p. 100 = (0.78-4.21)) but shows a tendency. DISCUSSION: This last point should be confirmed in further studies. Additionally, this study showed that this kind of clinical research can be carried out in dermatologist private practice.

Acne Vulgaris↗
PubMed2001

Warts of the nail unit: surgical and nonsurgical approaches.

BACKGROUND: Warts are the most common nail tumor and mostly affect children and young adults. Periungual warts are usually due to HPV-1, 2, and 4. Development of periungual warts is favored by maceration and trauma, especially nail biting. OBJECTIVE: To discuss the biology, clinical features, and medical and surgical treatment of periungual warts. METHODS: Review of the literature and personal experience. RESULTS: The natural course of warts makes aggressive approaches restricted to selected cases. Medical treatments, usually topical, include keratolytic agents, virucidal agents, and immunomodulators. All choices have been utilized successfully, but keratolytic agents are the best first-line approach. Surgical treatments include cryotherapy, surgical excision, electrosurgery, infrared coagulation, localized heating with a radio-frequency heat generator and laser therapy, especially the Er:YAG laser, which has an excellent safety profile. CONCLUSIONS: Definitive cure is not guaranteed by any therapy and periungual warts can recur and become larger after correct treatment.

Diagnosis, Differential↗
PubMed1960

Cantharidin treatment of digital and periungual warts.

Seventy-six digital and periungual warts in 40 patients were treated topically with cantharidin, a potent blistering agent. The material, dissolved in equal parts of acetone and collodion, was applied directly to the warts. Occlusion facilitated blistering. No pretreatment was required. The warts were re-treated at weekly intervals until clinically cured.Fifty-six per cent of digital warts and 33 per cent of periungual warts cleared after a single application of cantharidin. Few required more than three treatments. Observation was continued for more than six months in more than half of the cases. Cure was lasting in about 70 per cent of the cases in which the long term result was known. Cantharidin ranks with liquid nitrogen in effectiveness, but it is painless to apply and does not cause scarring. For these reasons it is especially useful in children.The main disadvantage is pain and tenderness at the treated site for two to four days in some patients. This can be avoided by careful application of the drug. Occasionally new warts appear at the edge of the cantharidin blister. They are best treated by curettage and desiccation.

Blister↗