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PubMed1990

Double-blind randomized clinical trial of self-administered podofilox solution versus vehicle in the treatment of genital warts.

PURPOSE: Genital warts are a highly prevalent and chronic sexually transmitted disease for which there is no completely satisfactory therapy. Conventional ablative therapy requires repeated treatment, often for months or years. This study was undertaken to evaluate the safety and efficacy of 0.5% podofilox in patient-administered treatment of penile warts. PATIENTS AND METHODS: Thirty-eight men with penile warts were randomly assigned to double-blind, self-administration of 0.5% podofilox solution or placebo, twice daily for 3 days per week for 4 weeks. Eleven podofilox and 15 placebo recipients with residual warts then received an additional 4 weeks of open-label treatment. RESULTS: By the end of treatment, podofilox recipients had their mean wart number and area reduced to 15.9% and 5.1% of baseline values, compared to 97.4% and 92.9% in the placebo group (p = 0.0001). Local adverse reactions were more common in the podofilox group, but were transient. Complete disappearance of warts was observed in 25 (53.3%) of 45 treatment courses, including open-label treatment. Recurrences of warts after therapy were frequent. Only 21% of patients remained free of warts 2 weeks after completing treatment, and subsequent recurrences were noted in all patients available for long-term follow-up, which is a common limitation of ablative therapy for genital warts. CONCLUSION: Podofilox 0.5% solution is effective in treating penile warts and is well tolerated in a self-administered regimen. Podofilox 0.5% offers potential advantages in safety and cost over podophyllin resin therapy of genital warts.

Adult↗
PubMed1992

Ribavirin mitigates wart growth in rabbits at early stages of infection with cottontail rabbit papillomavirus.

The challenge to develop antiviral agents effective against DNA viruses such as human papillomavirus (HPV) has been dependent on finding an animal model which mimics the human forms of the disease. We have used an existing model system for the purpose of measuring the effect of antiviral drugs on the inhibition of growth of these lesions. This was based upon domestic rabbits which efficiently grow cutaneous papillomas (warts) when infected with cottontail rabbit papillomavirus (CRPV). One agent which had shown significant success in achieving these goals was ribavirin. Ribavirin was administered intradermally shortly prior to infection at multiple sites with CRPV. Following daily injections of this drug for eight weeks, we have shown a dose-dependent response which had markedly reduced the number of warts, the time of first appearance of warts and reduced the tumor mass as compared to placebo-treated control animals. At the highest dose of ribavirin tested, 30 mg/kg/day, compared to controls, the average reduction in the number of warts was 52%, the average time of first appearance of warts was 49% longer, and the average mass of the warts was reduced by 98%. No detectable antibodies to CRPV were observed in any of the animals. The only side effects which were observed was focal alopecia, and a decrease in body growth upon prolonged treatment, both of which were completely reversible. Pharmacokinetic studies established the metabolism of ribavirin over a 24-h period of time. Ribavirin administered beginning 12 or 30 days post-infection, while not reducing the number of warts, slightly retarded the growth of warts as determined by date of first appearance of warts and mass of warts.

Animals↗
PubMed1983

Bleomycin in the treatment of recalcitrant warts.

Bleomycin is gaining increasing popularity in the treatment of warts, but its efficacy has not been examined in well-controlled studies. We evaluated bleomycin in a double-blind placebo-controlled crossover study in recalcitrant warts treated unsuccessfully by conventional methods. Patients were assigned alternately to placebo or bleomycin groups and treated by intralesional injections of bleomycin, 1 U/ml, or saline, at 2-week intervals. If warts persisted, patients were changed after two injections to the alternate group and retreated with up to two further injections. Forty patients entered the study. Of 151 warts treated with intralesional bleomycin, 123 were cured after one or two injections (81%). The cure rate for plantar warts (60%) was lower than that for periungual warts (94%) and warts elsewhere on the extremities (95%). Fifty-five warts were injected with normal saline; none was cured. Responding warts showed a hemorrhagic eschar and healed without scarring, atrophy, or pigmentary change. Pain was usually mild and patient acceptance superior to that with liquid nitrogen. There was no evidence of systemic toxicity. Bleomycin is highly efficacious in the treatment of recalcitrant warts, is convenient, and has high patient acceptance. Long-term safety requires further study.

Bleomycin↗
PubMed1986

Reduced dose of bleomycin in the treatment of recalcitrant warts.

The effectiveness of intralesional bleomycin (1 U/ml) in the treatment of warts refractory to conventional methods of treatment has been shown in well-controlled studies. We have now evaluated more dilute concentrations of bleomycin in the treatment of recalcitrant warts. Warts were assigned for therapy with intralesional bleomycin at a concentration of 0.25 U/ml, 0.5 U/ml, or 1 U/ml at 3-week intervals. If warts persisted after three injections or had recurred by 3 months' follow-up, treatment was considered a failure. Twenty-six patients whose warts had persisted after conventional treatment entered the study. Three patients had spontaneous regression of untreated warts during therapy and were not included in the results. Of seventy-nine warts treated with intralesional bleomycin, sixty-two (78%) were cured after one to three injections. Responding warts showed a hemorrhagic eschar even with the lower bleomycin concentrations and healed without complication. Almost all treated warts responded, although not all were cured. Treatment with bleomycin at 0.5 U/ml was as effective as treatment with 1 U/ml. Bleomycin at 0.25 U/ml is effective therapy but not enough warts were treated to permit a conclusion when compared with higher concentrations.

Adult↗
PubMed2003

Successful treatment of recalcitrant warts in pediatric patients with carbon dioxide laser.

AIM: Warts are difficult to treat and none of the several modes of treatment suggested for their cure has been proven to be the most effective. We evaluated the efficacy of a modification of the CO (2) laser technique for recalcitrant warts in pediatric patients. PATIENTS AND METHODS: During a period of 5 years, 40 consecutive pediatric patients (average age: 12.7 +/- 2.8 years) were treated by CO (2) laser for 54 recalcitrant warts. Previous treatments were caustic and/or surgical procedures (average 2.7 procedures). Local anesthesia or digital block was performed in all patients, with intravenous sedation in two patients. The laser was used at 5 W in super-pulse mode throughout the procedure. The skin was cut with the focused laser beam in a circular fashion, about 5 mm around the wart, until all the layers of the skin down to the subcutaneous tissue were penetrated. The lesion was drawn aside and excised, using the laser beam as a scalpel. No curettage was used. The base of the wart was then vaporized with the laser in a defocused fashion, until a clean surgical field was obtained. Follow-up was weekly up to 1 month, and at 3, 6, and 12 months. RESULTS: Warts were located on fingers (24 cases), in the plantar area (10 cases), on hands (9 cases), knees, and legs (4 cases each), arms (2 cases) and elbow (1 case). Twenty-seven patients (67.5 %) had a solitary wart and the other 13 children had multiple warts (up to 6) at one or more locations. Fingers were the most common location of multiple warts (10 cases). All patients underwent the procedure in one session. No case of intractable operative bleeding, local infection, or prolonged exudative drainage was encountered. One patient complained of severe transient postoperative pain. The healing time was 4 to 5 weeks. At 12 months, there was no recurrence of the warts. No significant or disabling scarring was noticed, but hypopigmentation was noted in 11 cases (27.5 %). CONCLUSION: This technique provides a high success rate with minimal side effects and is well tolerated by young patients.

Adolescent↗
PubMed2001

Treatment of common warts and actinic keratoses by Er:YAG laser.

BACKGROUND AND OBJECTIVES: The use of ablative lasers in the treatment of common warts and precancerous actinic keratoses has been reported in the literature, showing variable response rates and relapse rates. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 microm allows precise ablation avoiding strong inflammation. The authors have evaluated the potential benefits of Er:YAG laser treatment for difficult-to-treat warts and actinic keratoses. PATIENTS AND METHODS: A total of 69 patients with difficult-to-treat warts (periungual or plantar) with a mean age of 30.1 +/- 16.1 years (range 11-58 years), and 29 patients with actinic keratoses with a mean age of 73.5 +/- 9.7 years (range 58-90 years) were treated by Er:YAG laser. Ablative therapy was performed with a spot size of 3 mm, a frequency between 8 Hz and 15 Hz, and a fluence of 5.7-11.3 J cm(-2) (warts) or 5.7-7.1 J cm(-2) (actinic keratoses). RESULTS: After a single laser treatment a complete response (CR) was observed in 50 patients with warts (72.5%). Plantar warts were more resistant (13.5% non-responder) compared with periungual warts (5.9% non-responder). Twelve patients with a CR showed a relapse within 3 months after treatment (24.0%). All but one suffered from plantar warts. Twenty-six patients with actinic keratoses showed a CR after a single laser treatment, and in three patients a partial response (PR) was achieved. None of the patients treated with Er:YAG laser developed pigment changes, wound infections or scarring. CONCLUSION: Treatment of common epithelial lesions such as common warts or actinic keratoses by Er:YAG laser is safe and effective. In patients with plantar warts, however, a significant rate of relapse may occur, requiring additional therapy.

Adolescent↗
PubMed1982

Correlation between human papillomavirus (HPV) type and histology of warts.

Forty warts from different patients and of different clinical type were examined histologically and virologically. Eight lesions were found to be associated with human papillomavirus type 1 (HPV 1), 15 tumors were induced by HPV 2, HPV 3 was detected 4 times, HPV 4 twice, and HPV 6 eleven times. HPV 3, HPV 4, and HPV 6 induced warts revealed a correlation between histology and virus type. They are characterized by the so called "edematous type clear cells". In HPV 3 associated flat warts pycnotic nuclei were mainly localized in the center of large vacuoles. In genital warts sickle shaped nuclei were pushed to the margin of the vacuolized cells. The histology of HPV 1 and HPV 2 induced warts was more heterogenous. With one exception HPV 1-induced lesions represented typical myrmecia warts, varying in the number and shape of inclusion bodies. HPV 2 associated common warts, however, revealed 3 very distinct histologic features: (1) Inclusion wart typical for HPV 1, (2) Classical common wart with marked condensation of keratohyalin granules, (3) Warts with extreme vacuolization of squamous and granular cells leading to a honeycomb-like picture.

Animals↗
PubMed1976

In vitro lymphocyte stimulation by wart antigen in man.

The lymphocyte transformation test was used to study cell-mediated immunity to wart antigen in patients with active wart infections, in patients with past history of warts and in control subjects. A common pattern was established with wart antigen; a control baseline, followed by a rise of 14C thymidine uptake in the 'active' group and a further elevation in the 'past history' group. Five patients with active warts were followed up and re-examined at various intervals after successful wart resolution; all except one responded to wart antigen by increased DNA synthetic activity after the wart resolution. This increased response was specific for wart antigen and could still be detected 6 months after wart resolution.

Adolescent↗
PubMed1976

Common warts: immunity as a result of therapy.

Warts that don't regress frequently have wart cell specific immune globulin M(IgM), but no wart virus specific Immune Globulin M (IgM) in the circulatory system. Warts that regress spontaneously have multiple circulating antibodies-wart cell specific IgM, IgG, and IgA. When the antibodies of IgG class appear in the circulation, the warts will commonly disappear. Topical application of cell toxic, irritant materials will elicit discernible amounts of virus specific IgM and IgG. Those B Cells which produce IgG have a "computer bank memory" and IgG should be recalled if wart virus antigen reappears as a result of reinfection. Therefore, persistent, consistent, topical application of irritant modalities to warts that will cause them to regress and disappear, should confer immunity on the individual through the production of wart virus specific IgG. Over a seven-year span 150 cases of wart were cleared in our office by an irritant method. In that group of cases there were eight recurrences. Two cases cleared spontaneously within two weeks, and four cleared with an acute inflammatory response within a few days of reirritation.

Adolescent↗
PubMed1991

[An end to office hours for warts? A randomized study of the effectiveness of liquid nitrogen and of the Histofreezer].

OBJECTIVE: Comparison of the effectiveness of liquid nitrogen and of cryotherapy by means of the Histofreezer in the treatment of hand warts. DESIGN: Randomized therapeutic trial. SETTING: Six general practices in Limburg, The Netherlands. PATIENTS AND METHODS: Of the patients 43 (with 83 warts) were treated with nitrogen (if necessary twice) and 50 (with 108 warts) with the Histofreezer (if necessary 4 times), with a final control visit after 2.5 months. After a training session, the general practitioners performed the treatments and the observations. In these groups, 7 patients (with 18 warts) and 10 patients (with 20 warts) respectively did not fully comply with the protocol. At the start the number of warts per patient, their size, protruberance and localization were registered. Statistical analysis was performed by chi 2 test (unpaired case) in an intention to treat approach and of compliers only. OUTCOME MEASURES: Disappearance of warts, pain (on a 3-point scale), wounds, depigmentation. Non-compliers were asked by telephone if their warts had been cured. RESULTS: Of all patients 58% was cured by liquid nitrogen and 28% by Histofreezer (p = 0.01). Among the compliers these percentages were 67% and 35% of the patients (p = 0.01) and 66% and 49% of the warts (p = 0.08). The treatments were about equally effective in dorsal non protuberant and small (less than 5 mm) warts, and among young (less than 20 years) patients. CONCLUSION: The overall results of liquid nitrogen were better. The Histofreezer seems to be attractive in certain cases (e.g. children), but this should be the subject of further study.

Adolescent↗
PubMed2002

Imiquimod 5% cream in the treatment of anogenital warts in female patients.

OBJECTIVE: To investigate the efficacy and safety of imiquimod 5% cream in the treatment of anogenital warts in a female population. METHODS: In two open-label studies, female patients with anogenital warts applied imiquimod 5% cream three times a week for up to 16 weeks. Patients who cleared their warts were monitored for a 6-month follow-up period. Patients could be re-treated with imiquimod 5% cream for up to an additional 16 weeks if their warts recurred or new warts developed during the follow-up period. The treatment period could also be extended for up to an additional 16 weeks if patients only experienced partial clearance during the initial 16-week treatment period. RESULTS: Of the female patients who applied imiquimod 5% cream, 75% (449/600) experienced complete clearance of their warts (treatment failure analysis). This includes 46 patients who experienced total clearance when they applied imiquimod for longer than 16 weeks as their warts had only partially cleared in the initial 16 weeks of therapy. During the 6 months of follow-up after the initial treatment period, 15% of patients had recurrent warts. Thirty-nine (75%) of those patients experienced total clearance again after they re-applied imiquimod for up to an additional 16 weeks. The most frequently observed local skin reaction was erythema. CONCLUSION: In these studies, imiquimod 5% cream was an effective and well-tolerated treatment for anogenital warts in females and continued to be safe and effective in the small proportion of patients who needed to re-apply imiquimod after wart recurrence.

Adult↗
PubMed1998

Treatment of genital warts with an immune-response modifier (imiquimod).

BACKGROUND: Genital warts are a common sexually transmitted disease caused by human papillomavirus. Imiquimod is a novel immune-response modifier capable of inducing a variety of cytokines, including interferon alfa, tumor necrosis factor-alpha, as well as interleukins 1, 6, and 8. In animal models imiquimod has demonstrated antiviral, antitumor, and adjuvant activity. In vitro, imiquimod has no antiviral or antitumor activity. OBJECTIVE: Our purpose was to determine the safety and efficacy of topical imiquimod for the treatment of external genital warts. METHODS: This prospective double-blind, placebo-controlled, parallel design clinical trial was performed in three outpatient centers, a public health clinic, a university-based clinic, and a private practice. One hundred eight patients with external genital warts (predominantly white men) were entered into the trial. Fifty-one patients were randomly selected to receive 5% imiquimod cream; 57 patients were randomly chosen to receive placebo cream. Study medication was applied three times weekly for up to 8 weeks. Patients whose warts cleared completely were observed for up to 10 weeks to determine recurrence rates. RESULTS: In the intent-to-treat analysis, the warts of 37% (19 of 51) of the imiquimod-treated patients and 0% (0 of 57) of the placebo group cleared completely (p < 0.001). In addition, many patients experienced a partial response. A reduction in baseline wart area of 80% or more was observed in 62% of imiquimod-treated patients (28 of 45) and 4% of the placebo group (2 of 50) (p < 0.001); a 50% reduction or more in wart area was noted in 76% of imiquimod-treated patients (34 of 45) and 8% of placebo recipients (4 of 50) (p < 0.001). Of imiquimod-treated patients whose warts cleared completely and who finished the 10-week follow-up period, 19% (3 of 16) experienced recurrences of warts. Imiquimod-treated patients experienced a significantly greater number of local inflammatory reactions than the placebo group. Symptoms and signs associated with the local inflammatory reactions included itching (54.2%), erythema (33.3%), burning (31.3%), irritation (16.7%), tenderness (12.5%), ulceration (10.4%), erosion (10.4%), and pain (8.3%). There were no differences in systemic reactions or laboratory abnormalities between treatment groups. CONCLUSION: Topical 5% imiquimod cream appears to have a significant therapeutic effect in the treatment of external genital warts.

Adjuvants, Immunologic↗
PubMedDate not supplied

Detection of human papillomavirus by the polymerase chain reaction in histologically normal penile skin adjacent to penile warts.

BACKGROUND AND OBJECTIVES: Anogenital warts frequently recur following ablative treatment, and in the female, has been attributed to the presence of latent HPV infection outside the treatment margins. GOAL OF THIS STUDY: To determine whether HPV DNA sequences were detected by PCR in histologically normal penile skin adjacent to penile warts and to correlate recurrence of warts following surgical ablation to the presence of HPV DNA in histologically normal penile skin. STUDY DESIGN: Prospective cohort study of 25 heterosexual men with penile warts. Biopsies of clinically healthy penile skin 1 cm from the nearest penile lesion (wart with/without surrounding acetowhite changes) were processed for histology and HPV DNA analysis. The penile wart was processed for HPV DNA analysis only. Recurrence of penile warts was correlated to HPV status of adjacent histologically normal penile skin using Fisher's exact test (FET). RESULTS: Sequences homologous to HPV DNA were detected in 77% of biopsies of histologically normal penile skin. Agreement in HPV DNA type between penile wart and the adjacent histologically normal penile skin was only 30%. Recurrence of warts was noted in 46% of men by 16 weeks, and was not predicted by the detection of HPV DNA in the adjacent histologically normal penile skin (P = 0.16, FET). CONCLUSIONS: These findings suggest that extending the treatment margins 1 cm beyond the visible lesion is ineffective in eradicating the virus and preventing recurrence of warts.

Adolescent↗
PubMed1993

Ano-genital warts in consecutive male heterosexual patients referred to a CO2-laser clinic in Copenhagen.

The relation between sexual practices and location of anogenital warts is discussed. Results were derived from clinical examination and interview of 56 consecutive male patients referred to CO2-laser treatment of therapy-resistant genital warts, at a clinic at the Department of Dermatovenereology, Gentofte Hospital, located in the northern area of Copenhagen. Twenty (100%) patients with anal warts and 36 (100%) patients with penile warts all claimed to be strictly heterosexuals. None of the patients interviewed had had anoreceptive coitus or been engaged in sexual practices with oro-anal contact. The study population otherwise had a heterosexual profile with approximately one fifth of the patients having had other sexually transmitted diseases, mainly chlamydia. The group of patients with anal warts had significantly fewer known sex partners with genital warts (25% versus 58%, p < 0.05) compared to the patients with penile warts. All patients received one or more CO2-laser treatments using local anesthesia, resulting in cure rates of 80% (16/20) and 89% (32/36) in men with anal warts and penile warts, respectively. Anal warts seem to be much more common in a heterosexual male population. There is a need to elucidate the nature and epidemiology of anal human papillomavirus infection in heterosexual males.

Anus Diseases↗
PubMed1998

High-grade dysplasia in genital warts from two patients infected with the human immunodeficiency virus.

Cancer-associated human papillomavirus (HPV) types are detected in genital warts removed from immunosuppressed individuals more commonly than from those occurring in otherwise healthy individuals. The prognosis of genital warts containing cancer-associated HPV types is not known. Because it is assumed that genital warts are benign lesions, they are usually treated by destructive therapies without prior knowledge of histopathology. The aim of the present study was to determine whether genital warts from individuals with or without human immunodeficiency virus (HIV) contain high-risk HPV types or areas of dysplasia. The study design was a nonrandomized analysis of genital warts removed by excision biopsy from 15 HIV-infected patients and 15 HIV-negative patients. The tissue was analyzed for HPV DNA by hybrid capture, and microscopic sections of each biopsy were examined for areas of dysplasia. Genital warts from HIV-infected patients contained cancer-associated ("high risk") HPV types in 9 of 15 cases, including 1 that contained only a high-risk type. High-grade dysplastic abnormalities were present in 2 of the 15 lesions from this group, both of which contained high-risk HPV types. Four genital warts removed from HIV-negative patients contained high-risk HPV types, but none contained dysplastic abnormalities. It is concluded that genital warts from HIV-infected patients often contain high-risk HPV types. Such lesions may exhibit dysplastic changes. The frequency of dysplastic changes in genital warts from HIV-infected patients is not known. Biopsy of genital warts may be indicated prior to additional therapy in HIV-infected patients, and surgical removal should be considered as a preferred treatment option in these patients.

Anus Diseases↗
PubMed2002

The efficacy of duct tape vs cryotherapy in the treatment of verruca vulgaris (the common wart).

OBJECTIVE: To determine if application of duct tape is as effective as cryotherapy in the treatment of common warts. DESIGN: A prospective, randomized controlled trial with 2 treatment arms for warts in children. SETTING: The general pediatric and adolescent clinics at a military medical center. PATIENTS: A total of 61 patients (age range, 3-22 years) were enrolled in the study from October 31, 2000, to July 25, 2001; 51 patients completed the study and were available for analysis. INTERVENTION: Patients were randomized using computer-generated codes to receive either cryotherapy (liquid nitrogen applied to each wart for 10 seconds every 2-3 weeks) for a maximum of 6 treatments or duct tape occlusion (applied directly to the wart) for a maximum of 2 months. Patients had their warts measured at baseline and with return visits. MAIN OUTCOME MEASURE: Complete resolution of the wart being studied. RESULTS: Of the 51 patients completing the study, 26 (51%) were treated with duct tape, and 25 (49%) were treated with cryotherapy. Twenty-two patients (85%) in the duct tape arm vs 15 patients (60%) enrolled in the cryotherapy arm had complete resolution of their warts (P =.05 by chi(2) analysis). The majority of warts that responded to either therapy did so within the first month of treatment. CONCLUSION: Duct tape occlusion therapy was significantly more effective than cryotherapy for treatment of the common wart.

Adhesives↗
PubMed1980

Involuting common warts. Clinical and histopathologic findings.

Patterns of regression in common warts were studied. Patients with multiple verrucae vulgaris lesions applied topical agents to the warts and were observed at regular intervals until the lesions disappeared. Regression took place without the warts turning black in all but one instance. All warts did not disappear simultaneously; some lesions persisted weeks after others had disappeared. Microscopic examination in five patients of a wart persisting after most had regressed demonstrated mononuclear cell infiltration, exocytosis, and degenerative epidermal changes. Failure to demonstrate cellular infiltration in regressing common warts in earlier studies was probably due to concentration on studying only warts that had turned black. The regression of some of the warts in patients with multiple common warts may serve as an indicator that involution is in progress. Utilization of this observation to recognize clinically the period of involution may make possible studies during the critical phase of the involutionary process.

Administration, Topical↗
PubMed1988

Therapeutic evaluation for intralesional injection of bleomycin sulfate in 143 resistant warts.

A 1 U/ml solution of bleomycin sulfate in physiologic saline solution was injected intralesionally in 38 patients, and was compared with physiologic saline solution injection into paired warts in the same patient. No patient received more than 2 ml of bleomycin. Ninety-seven of 143 warts (67.8%) showed complete resolution after one or two bleomycin injections, while 25 warts (17.5%) showed incomplete resolution. Bleomycin local injection failed to elicit any therapeutic response in 21 warts (14.7%). The cure rate was 77% for warts on the extremities, 71.4% for periungual warts, and 47.6% for the plantar warts. The responsive warts showed hemorrhagic eschars that healed without scarring. It is concluded that this form of treatment for resistant warts, up to the dose used, is safe, reliable, and accepted by the patient.

Adolescent↗