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PubMed2004

Viral warts in children seen at a tertiary referral centre.

INTRODUCTION: This study aims to determine the epidemiology of viral warts in children seen at a tertiary referral centre and the treatments used. MATERIALS AND METHODS: This is a retrospective study of viral warts in children aged 12 years and below seen at the National Skin Centre in the year 2000. RESULTS: There were 302 cases of viral warts, 187 (61.9%) in boys and 115 (38.1%) in girls. The greatest number was seen at age 12 and none were noted in those below 1 year of age. The racial breakdown was as follows: 69.9% Chinese, 13.9% Malays, 11.3% Indians and 4.9% of other ethnic groups. Treatment with liquid nitrogen was used most commonly in 267 (88.4%) cases, with a clearance rate of 48.3%. Electrocautery was used in 11 cases with complete clearance in 8 cases. CONCLUSION: Viral warts are common in children, but uncommon in infants. There is no difference in distribution of warts among the races in Singapore. Liquid nitrogen and electrocautery are effective treatments of viral warts in children.

Age Distribution↗
PubMed2005

Cutaneous warts: an evidence-based approach to therapy.

Cutaneous warts are a common presenting complaint in children and adolescents. Common, plantar, or flat warts are cutaneous manifestations of the human papillomavirus. The treatment of warts poses a therapeutic challenge for physicians. No single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. These approaches are discussed to demonstrate the evidence supporting common therapies and provide a guideline for physicians. Evidence supports the at-home use of topical salicylic acid and physician-administered cryotherapy. Intralesional immunotherapy for nongenital cutaneous warts may be an option for large or recalcitrant warts.

Administration, Topical↗
PubMed1992

Controlled localized heat therapy in cutaneous warts.

BACKGROUND: Controlled localized heating as a method of superficial tissue destruction has been used in veterinary medicine for the treatment of benign and malignant tumors. The rationale for its use is that the diseased tissue being treated is more sensitive to the effects of heating than is normal tissue. This technology was applied to the treatment of common hand warts in a placebo-controlled study. OBSERVATIONS: Twenty-nine warts were treated one to four times (median, two times) at 50 degrees C for 30 to 60 seconds. Twenty-five (86%) of 29 treated verrucae regressed completely while seven (41%) of 17 control warts resolved during the course of the study. No wart that regressed regrew during the follow-up period (mean, 15.6 weeks). CONCLUSIONS: Controlled localized heating can cause the regression of hand warts. The 86% regression rate compares favorably with other wart treatment modalities. The mechanism of action and the effect of heat on these virally induced tumors is not known but may involve direct antiviral effects, physical destruction of the tumor, or the promotion of an inflammatory response that ultimately eradicates the lesion.

Adult↗
PubMed2006

Detection of high-risk human papillomavirus type 16/18 in cutaneous warts in immunocompetent patients, using polymerase chain reaction.

Cutaneous warts are caused by human papillomavirus (HPV). Prevalence studies of the types of HPV present in cutaneous warts have been carried out more frequently in immunosuppressed patients. The present study was designed to study the association of high-risk HPV in cutaneous warts of immunocompetent patients. A total of 45 cases of cutaneous warts from various sites in immunocompetent subjects were analyzed for HPV. Samples included both archival material i.e., paraffin embedded and fresh tissue. Highly sensitive and comprehensive polymerase chain reaction (PCR) methodology for detection of HPV of high oncogenic potential, HPV 16/18, was employed. Human papillomavirus 16 was detected in 3 (6.6%) patients. None of the lesions demonstrated HPV 18. None of the cutaneous warts demonstrated histopathological features associated with dysplasia or neoplasia. The identification of HPV 16 in cutaneous warts, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions. It remains of critical interest to determine whether these types are specifically associated with the development of malignant lesions analogous to those seen in anogenital cancer.

Abdominal Wall↗
PubMed1988

Hypnotherapy of a child with warts.

Hypnosis was used to treat a 7-year-old female with 82 common warts. The lesions had been present for 12-18 months and were refractory to routine dermatologic treatment. Hypnotic suggestions were given for the facial warts to disappear before warts from the rest of the body. After 2 weeks, eight of 16 facial warts were gone, with no other changes. After three additional biweekly sessions, all 82 warts were gone. To the author's knowledge, this is the first reported case of systematic wart removal in children. Discussion focuses on the relationship between psychological mechanisms and the immune system.

Anxiety↗
PubMed1977

[Immunotherapy of warts. Is it an experimental model for cancer immunotherapy?].

The warts produced by virus Papova, provedly cancerous, have immunological characteristics that allow to establish some analogies with cancer. Its immunotherapy is studied with levamisole and by means of a delayed immunity reaction "in situ" with regulated intensity. The level of delayed immunity in the patient with warts is established by quantitative DNCB test, finding that the same is impaired in 60% of men and 87% of women. The levamisol therapy cures 54% of warts. The patients that not cure but improve their delayed immunity level after the treatment with levamisol, are submitted to external application of DNCB, using a concentration calculated on the quantitative test results. With regard to their delayed immunity we introduce a new group of patients: the hiperergic type or reactive to 2,5 microgram of DNCB that cures their warts by the sole action of the test. Once obtained the curve of the distribution of delayed immunity values in the warts population before and after the levamisole therapy, we observe that the first is identical to that of cancer patients. In view of the tight relation among diseases with impaired delayed immunity, such as warts, herpes, aphtas, piodermitis and cancer (residual or postsurgical), we propose the same management, control and immunotherapy for all of them.

Clinical Trials as Topic↗
PubMed1984

Warts among meat handlers.

The Amalgamated Meat Cutters and Retail Food Store Employees, Local 342, which represents meat handlers in the greater New York City area, wanted to determine whether warts were a significant problem among their membership. Findings from a prevalence study showed that the proportion of meat handlers who reported having warts (23.1%) was significantly higher than that for non-meat handlers (9.9%). The younger meat handlers had warts more frequently than did their older co-workers; there were no differences between the sexes. No one particular brand or type of meat could be associated with warts. Statistical tests of association indicated that meat handlers were more likely to have warts because of their occupation. We found that the switch to the Cryovac meat-packing process may have increased the likelihood of warts, although further study is needed to test that association.

Adolescent↗
PubMed1984

[Regression of plantar warts following treatment with diphencyprone].

Therapy-resistant plantar warts of 8 patients have been topically treated with diphencyprone, a new potent contact allergen. Three of the patients showed only one single aggregation of warts, which completely disappeared within two or three months after start of treatment. In the other five patients who had multilocular warts, a controlled trial was performed. In three of these patients only the treated warts resolved whereas the untreated ones persisted. In one case all warts disappeared already during the period of sensitization, and in the fifth patient the warts persisted without any change.

Administration, Topical↗
PubMed1978

Failure of flat warts to recur in electrosurgically altered skin.

Two men with recurring flat warts in the beard area have been observed for five and ten years, respectively. Both have depigmented patches at sites where flat warts had been removed by electrosurgical destruction. Crops of new warts appear periodically. These develop always on the normally pigmented skin and have never been found in the leukodermic areas. Flat warts have been observed repeatedly at the margin of depigmented and normal skin; these invariably enlarge toward the normal skin and never encroach on leukodermic skin. The failure of flat warts to develop in electrosurgically treated skin, if substantiated, would indicate that local tissue factors influence resistance to development of flat warts. Perhaps this phenomenon is similar to that reported in Darier's disease, where partial-thickness excision of involved skin has resulted in resistance to recurrent disease.

Electrosurgery↗
PubMed1997

Pulsed dye laser efficacy as initial therapy for warts and against recalcitrant verrucae.

Pulsed dye (vascular) laser therapy is effective against verrucae (warts) that have not responded to other treatments. These observations suggest that vascular laser therapy might be particularly efficacious against verrucae not previously treated. Of the thirty-two patients with verrucae in this study, nineteen had been previously treated (recalcitrant group) and thirteen had not (no prior treatment group). All warts were treated an average of 1.72 times with the Candela vascular laser at 585 nm, 8 J/cm2. Patients were treated at one- to two-month intervals. Response rates were as follows: 68 percent of the recalcitrant warts were completely cleared, and 47.1 percent of the warts with no prior treatment were completely cleared. In the recalcitrant group, 45.9 percent were treated three times, the maximum number of treatments offered. In the no prior treatment group, only 5.9 percent of warts were treated at all three laser clinics offered. Vascular laser therapy appears to be effective as therapy in the treatment of verrucae, especially those that have not been eradicated by other treatments. Patients who had received no prior treatment for their warts were less likely to proceed with therapy, but had a satisfactory clearance rate with minimal treatment.

Adolescent↗
PubMed1986

Immunohistologic analysis of the phenomenon of spontaneous regression of numerous flat warts.

Among various tumors induced by human papilloma virus (HPV), flat warts are unique in that they show a systemic regression phenomenon after sudden occurrence of inflammation in all the tumors, leaving permanent immunity to flat warts in the host. When studied immunohistochemically, the presence of HPV antigen using papilloma virus genus-specific antiserum in 31 cases of regressing flat warts was not found; whereas it was demonstrated in the nuclei of upper epidermal cells of ordinary flat warts in 12 of 19 cases (63%). T-cell phenotype assessment in nine regressing flat warts using monoclonal antibodies showed that helper/inducer subsets constituted a major peritumoral dermal infiltrate with a moderate number of intermingling OKT6+ cells. In contrast, the tumoral epidermis was invaded by almost equal number of suppressor/cytotoxic T-cells and helper/inducer T-cells, where at least some keratinocytes also expressed HLA-DR antigen in addition to Langerhans cells. Most T-cells expressed HLA-DR antigen, a marker of activation, but only a small number of them were Tac antigen+, i.e., bearing interleukin 2 receptors. Leu 7+ natural killer cells were seldom found in the infiltrate. These data provide evidence that T-cell-mediated immune attack against tumor cells and not against intranuclear HPV antigen, induces the systemic spontaneous regression of numerous flat warts in humans.

Antigens, Viral↗
PubMedDate not supplied

Ano-genital warts in children: Sexual abuse or not?

Child sexual abuse is a problem that affects many Americans. The diagnosis of sexual abuse is typically made on the basis of the child's history. Objective evidence of sexual abuse, including abnormal physical findings noted on physical examination or the presence of a sexually transmitted disease, are rare. Ano-genital warts are one of the most common sexually transmitted diseases found in adults. However, is the presence of ano-genital warts in children evidence of sexual abuse? The link between ano-genital warts and child sexual abuse requires an understanding of wart transmission and incubation period to properly interpret their significance. Ano-genital warts in children have serious medical, social, and legal implications. It is important that primary care providers have an understanding of the appearance, mode of transmission, and incubation period of human papilloma virus in children. Implications for practice will provide guidelines for diagnosing, evaluating, and properly managing ano-genital warts in children.

Adolescent↗
PubMed2002

WARTS tumor suppressor is phosphorylated by Cdc2/cyclin B at spindle poles during mitosis.

Identification of physiological substrates for Cdc2/cyclin B is crucial for understanding the functional link between mitotic events and Cdc2/cyclin B activation. A human homologue of the Drosophila warts tumor suppressor, termed WARTS, is a serine/threonine kinase and a dynamic component of the mitotic apparatus. We have found that Cdc2/cyclin B forms a complex with a fraction of WARTS in the centrosome and phosphorylates the Ser613 site of WARTS during mitosis. Immunocytochemical analysis has shown that the S613-phosphorylated WARTS appears in the spindle poles at prometaphase and disappears at telophase. Our findings suggest that Cdc/cyclin B regulates functions of WARTS on the mitotic apparatus.

Amino Acid Sequence↗
PubMed2002

Imiquimod 5% cream is an acceptable treatment option for external anogenital warts in uncircumcised males.

OBJECTIVES: To determine the safety and efficacy of imiquimod (Aldara) 5% cream in the treatment of prepuce-associated warts in uncircumcised males. METHODS: An open-label study in six UK medical centres with 35 uncircumcised males with prepuce-associated warts treated with imiquimod 5% cream three times per week for up to 16 weeks. Other anogenital warts were also treated. RESULTS: Three times weekly application of imiquimod was found to be safe, with erythema as the most commonly reported local skin reaction. Forty per cent of patients had complete clearance of anogenital warts within 16 weeks. CONCLUSIONS: Imiquimod cream at a dosing regimen of three times per week, is effective and has an acceptable safety profile in the treatment of prepuce associated warts and other external anogenital warts in uncircumcised males.

Administration, Cutaneous↗
PubMed2000

Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study.

OBJECTIVE: The purpose of this double-blind, placebo-controlled study was to evaluate the safety, clinical efficacy and tolerability of imiquimod (2%) in cream to cure external genital warts in males. METHODS: Preselected male patients (n=60) ranging between 18 and 50 years of age (mean 24.2) harbouring 558 lesions (mean 9.3) with clinical, histopathological and polymerase chain reaction (PCR) confirmed diagnosis of human papilloma virus (HPV) infection were randomized to two parallel groups. Each patient was allocated a precoded 25g tube, and instructions on how to apply the trial medication to their lesions at home once daily for three consecutive days per week (max. 12 application in 4 weeks). To evaluate the safety, clinical efficacy and tolerance, patients were exa-mined on a weekly basis. Cure was defined as the total elimination of treated warts with PCR, and Southern blot hybridization confirmed negative HPV DNA. RESULTS: By the end of the treatment, 40% (24/60) patients and 49.8% (278/558) warts were cured. Breaking the code revealed that imiquimod cream had cured 70% (21/30) patients and 86.8% of warts, while placebo healed three subjects and 28 warts (P=0.0001). Eleven patients (18.3%), predominantly in the imiquimod cream group, experienced mild to moderate, non-objective, drug-related side effects with no dropouts. The study was followed up for 18 months from the first day of the treatment, and among the 26 cured patients, one in the imiquimod cream group and two in the placebo had a relapse after 14 months. CONCLUSION: The study demonstrated that 2% imiquimod in cream with mild non-objective side effects is safe, tolerable and significantly more effective than placebo in curing external genital warts in males.

Administration, Cutaneous↗
PubMed2002

Treatment of anogenital warts with imiquimod 5% cream followed by surgical excision of residual lesions.

Cytodestructive or surgical therapy for patients with anogenital warts is frequently associated with recurrence. In February 1997, the US Food and Drug Administration approved imiquimod as a 5% cream for the treatment of anogenital warts. Activity of the drug results primarily from interferon alfa and other cytokine induction in the skin. These cytokines stimulate several other aspects of the innate immune response. In addition, imiquimod stimulates acquired immunity, in particular the cellular arm that is important for control of viral infections and tumors. Published studies indicate that imiquimod results in complete clearance of warts in more than 50% of patients. Residual warts can be surgically excised. Our long-term follow-up (ie, 2 to 7 years) of patients who had a 16-week course of imiquimod cream with subsequent removal of remaining warts showed a much lower rate of recurrence in comparison with those patients who were treated with surgery alone. Therefore, treatment with imiquimod followed by excision of residual lesions may provide long-term clearance of anogenital warts in those patients in whom imiquimod monotherapy is insufficient.

Adjuvants, Immunologic↗
PubMed1999

Phase IIa safety and immunogenicity of a therapeutic vaccine, TA-GW, in persons with genital warts.

A fusion protein vaccine consisting of human papillomavirus 6 L2E7 with Alhydrogel was developed for the treatment of genital warts. Twenty-seven subjects with genital warts received 3 immunizations over 4 weeks in an open-label study. The vaccine was well-tolerated, and all subjects made serum IgG antibodies, predominantly IgG1, against L2E7. Nineteen of 25 tested persons made antigen-specific T cell proliferative responses to L2E7, and peripheral blood mononuclear cells when cultured with L2E7 in vitro produced both interferon-gamma and interleukin (IL)-5, although IL-5 predominated after the final vaccination. Five subjects completely cleared warts within 8 weeks. Subjects whose warts were not cleared by 8 weeks were offered conventional therapy. Recurrence of warts was not seen in any of the 13 persons whose warts cleared by vaccine alone or with conventional therapy. While these preliminary results of the use of this therapeutic immunogen are encouraging, proof of efficacy will require randomized double-blind trials.

Adult↗
PubMedDate not supplied

Detection of human papillomavirus DNA in the urogenital tracts of men with anogenital warts.

Increasing evidence suggests that human papillomavirus (HPV) infection of the female anogenital tract is multifocal. Less is known of the distribution of HPVs in men. To investigate this, a prospective study was conducted of 116 men consecutively attending a clinic for ablative treatment of anogenital warts. Wart tissue, urethral swabs, and urine were obtained from each patient. HPV DNA was extracted from the specimens and amplified using the polymerase chain reaction (PCR). HPV types 6, 11, 16, 18, 31, and 33 were identified using Southern blotting of the PCR product, followed by hybridization. HPV DNA was detected in 112 (96.6%) of 116 wart specimens and there was urethral infection with HPV in 26 (22.4%) of the men. Eleven (61.1%) of 18 urethral specimens taken with a loop and 22 (20.0%) of 116 urethral specimens taken using a cotton-tipped swab contained HPV DNA. One (6.3%) of 16 urine samples tested contained HPV DNA. HPV types 6 and 11 were found in the urethra most commonly when warts were seen near the urinary meatus, although HPV occurred in the urethras of men without clinically apparent meatal warts. The proportion of urethral samples with HPV DNA, including HPV types 16, 18, 31, and 33, was independent of the location of visible warts at the time of sampling.

Adolescent↗