Verruca plana as a complication of CO2 laser treatment: A case report

Carbon dioxide (CO₂) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosmetic side effects. Here we report a case of verruca plana manifesting as a response to CO₂ laser treatment. A 74-year-old female with recent Mohs surgery for a basal cell carcinoma, presented for full-face-fractionated CO₂ treatment to address her surgical scars in addition to treating her mild diffuse actinic damage. Six weeks post treatment, the patient developed erythematous thin plaques over the areas that had been treated. Histology was consistent with verruca plana. Lesions showed mild improvement with topical tretinoin. Verruca plana are benign and typically self-limited; however, they can present a significant cosmetic burden to patients and are an important complication to consider when performing elective cosmetic procedures.     

扁平疣中西医治疗进展

综合近几年有关中西医治疗扁平疣的临床报道，从扁平疣的病因病机、内服法、外治法、针灸、中西医结合治疗法等方面进行综述，同时也提出了今后研究的发展方向。     

Topical garlic treatment for verruca plana triggers Koebner phenomenon: A case report

Background

Verruca plana is a benign proliferation of the skin caused by human papilloma virus (HPV) infection. Fresh garlic can serve as an alternative therapy, and it has shown considerable effectiveness as a topical treatment for verruca plana. However, topical garlic treatment for verruca plana triggered Koebner phenomenon (KP), which has not been previously reported.

Aim

The aim of our report is to explore the possible causes of this adverse reaction.

Method

We here describe a 20-year-old female patient who developed a beaded rash after garlic treatment for facial wart plana, known as autoinoculation or KP.

Results

Garlic may have caused damage to the surrounding normal skin through primary irritation or allergic reactions. Then, the HPV virus on the primary verruca plana took the opportunity to spread to the surrounding skin injured by garlic stimulation, triggering the KP.

Conclusion

When using garlic to treat verruca plana, the operator needs to precisely apply the mashed garlic to the warts, and this treatment is strictly prohibited for patients who are allergic to garlic. Avoid such adverse reactions.     

儿童额部以色素减退性丘疹为表现的扁平疣共聚焦图像特征

目的分析发生于儿童额部的以色素减退性丘疹为表现的扁平疣共聚焦激光扫描显微镜(RCM)影像学特征。方法对研究组9例发生于儿童额部的色素减退性扁平疣及对照组6例色素加深性扁平疣行RCM检查,再对该处皮损行组织病理学检查,并将结果进行对比分析。结果研究组及对照组组织病理学检查显示:棘层轻度增厚,棘细胞上层及颗粒层可见数量不等的空泡化细胞。RCM扫描图像显示:研究组9例患儿棘层上部及颗粒层可见大的多角形细胞;其中3例在棘层中上部可见大的多角形细胞与同心圆结构重叠和/或过渡区域,棘层中部可见到典型同心圆结构。对照组6例中4例见典型的同心圆样改变,另外1例见大的多角形细胞但不伴典型同心圆结构。结论儿童前额以色素减退性丘疹为表现的扁平疣其RCM图像具有独特的表现,可作为其诊断及鉴别诊断的重要工具。     

Enhancement of delayed hypersensitivity in guineapigs by H2-receptor antagonist

Guinea-pigs have been sensitized with dinitrochlorobenzene (DNCB) to produce type IV-reactions. The reactions spontaneously faded in the untreated animals. In contrast, in the group treated with cimetidine, the reaction remained essentially unchanged. Cimetidine thus caused an augmentation by preventing the spontaneous fading. The enhancement of the type IV-reaction by cimetidine is possibly caused by supression of regulatory T-lymphocytes through their H₂-receptors. The histamine content of the sensitized and challenged sites increased both in the untreated and cimetidine-treated groups.     

Dinitrochlorobenzene is inherently mutagenic in the presence of trace mutagenic contaminants

2,4-Dinitrochlorobenzene (DNCB) is used for immunotherapy of alopecia areata and verruca vulgaris. We initially postulated that the presence of mutagenic contaminants in commercially available DNCB might account for part of its mutagenicity. We have now characterized changes in the dose-mutagenic response curve of 99% DNCB modified by adding 1% concentrations of known contaminants: 1-chloro-2-nitrobenzene; 1,3-dinitrobenzene; and 2,4-dichloronitrobenzene. Dose-response curves were generated using Salmonella typhimurium tester strains TA-98 and TA-100 at concentrations of 0, 1, 5, 10, 25, 50, and 100 micrograms per plate in a modified Ames assay. We observed a linear dose-response relationship with a slight, but nonsignificant, shift to the right when contaminants were added. We conclude that DNCB is itself mutagenic, and that contaminants play a minor role in its observed mutagenicity.     

Successful treatment of verruca plana with NB‐UVB: A case report

Verruca plana is a kind of benign proliferative skin disease that generally occurs in exposed parts, but the treatment of warts poses a therapeutic challenge for physicians, as there is no method, among numerous approaches, that has been proven effective for completely curing this disease. We report a case of verruca plana cured by narrow‐band ultraviolet B (NB‐UVB), which provides a new treatment of verruca plana.     

咪喹莫特乳膏联合他扎罗汀凝胶外用治疗扁平疣疗效观察

目的观察咪喹莫特乳膏联合他扎罗汀外用治疗扁平疣的临床疗效。方法用5%咪喹莫特乳膏联合0.05%他扎罗汀凝胶或单用5%咪喹莫特乳膏治疗扁平疣,观察其临床疗效。结果治疗组有效率为87.50%,对照组为53.85%,差异有统计学意义(χ2=10.84,P<0.05)。结论咪喹莫特乳膏外用联合他扎罗汀凝胶治疗扁平疣有显著疗效。     

132例皮肤疣组织人乳头瘤病毒分型检测

目的 探讨皮肤疣组织中人乳头瘤病毒（HPV）的感染率和病毒型别。方法 门诊皮肤疣患者132例中寻常疣46例,跖疣38例,扁平疣48例。以特异性DNA序列为模板设计引物,进行PCR扩增,电泳,对结果进行分析。 结果 132例皮肤疣中,HPV阳性128例,感染率为97.0%,其中HPV2型阳性111例,感染率为84.1%。寻常疣、跖疣感染主要为HPV2、HPV1型,扁平疣感染主要为HPV2、HPV10、HPV3、HPV1型。89例为多重感染,感染率为67.4%,其中二重感染率为41.7%（55例）,三重感染率为21.2%（28例）,四重感染率为4.6%（6例）;寻常疣多重感染率为50.0%（23/46）,跖疣为76.3%（29/38）,扁平疣77.1%（37/48）。多重感染中,以HPV1 + 2型最多,有35例（39.3%）,其次为HPV1 + 2 + 10型,有12例（13.5%）。 结论 遵义皮肤疣感染以HPV2型为主,其次为1型;2型与多种皮肤疣感染有关;皮肤疣中多重感染率较高,其中扁平疣多重感染率最高;新发现HPV3、10型感染寻常疣,HPV10型感染跖疣,HPV1、7型感染扁平疣。     

Resolution of diffuse facial verruca plana following nonavalent human papillomavirus immunization

Treatment of verruca plana is often challenging, and multiple treatment modalities, both pharmacologic and destructive, are frequently necessary to clear lesions. We report a case of a 16‐year‐old girl with a 2‐year history of extensive verruca plana of the forehead, temples, and upper periorbital skin, recalcitrant to monotherapy with topical tretinoin cream, that completely resolved following first dose of nonavalent human papillomavirus (HPV) immunization.     

消平疣冲剂治疗扁平疣130例临床疗效观察

目的观察消平疣冲剂对扁平疣的临床疗效。方法治疗组130例用病毒灵片、消平疣冲剂、转移因子治疗,对照组40例用病毒灵片及转移因子治疗,均连用1个月。结果治疗组有效率为83.85%,对照组为50.00%。两组有效率比较差异有显著性(P<0.01)。结论消平疣冲剂对扁平疣有较好的治疗作用,且无不良反应。     

Laser and light therapy for facial warts: a systematic review

Facial verruca plana, or flat warts, are benign skin papillomas caused by human papillomavirus infections. A large portion of cases are refractory to treatment and can cause psychosocial distress in patients. Laser and light modalities offer an alternative therapeutic approach that has not been extensively explored. We systematically reviewed PubMed for studies describing treatment of facial verruca plana using lasers, photodynamic therapy and infrared coagulation. Final inclusion and review of eighteen studies suggests laser and light therapies to have considerable potential in the treatment of this recalcitrant condition. In particular, yttrium aluminium garnet lasers, infrared coagulation and photodynamic therapies have been reported to demonstrate efficacy. Further studies with larger power are required to determine which method should be established as the alternative treatment of choice for recalcitrant facial verrucae.     

Therapeutic Effect of Dinitrochlorobenzene (DNCB) on Verruca Plana and Verruca Vulgaris

Fifty-nine patients with verrucae (45 with verrucae plana and 14 with verrucae vulgaris) were treated with dinitrochlorobenzene (DNCB) as a topical application on the normal uninvolved skin of the shoulder for sensitization and challenge. The patients were sensitized with 0.5 ml of 0.4% DNCB solution and then challenged with 0.1% DNCB ointment twice a week. Six cases of verrucae plana and 1 case of verrucae vulgaris were completely cured by sensitization only and 32 cases of verrucae plana and 7 cases of verrucae vulgaris were completely resolved by repeated challenges. The therapeutic effect was better in verrucae plana (84.4%) than in verrucae vulgaris (57.1%), and the verrucae were completely resolved within 10 weeks in more than 90% of the patients cured by challenge. The side effects of DNCB were mild allergic contact dermatitis and slight transitory hyperpigmentation at the site of application.     

香蓝驱毒颗粒治疗扁平疣临床疗效及对IL-10、IFN-γ的影响

目的探讨中药香蓝驱毒颗粒对扁平疣患者白细胞介素(IL)-10、干扰素(IFN)-γ水平的影响。方法对照组60例扁平疣患者外用α-2b干扰素凝胶,治疗组60例扁平疣患者在对照组治疗方案的基础上口服香蓝驱毒颗粒,均用药6周。采用ELISA(双抗体夹心法)测定治疗组及对照组扁平疣患者治疗前后及正常人群组血清IL-10及IFN-γ水平。结果治疗前扁平疣患者组IL-10水平高于正常人组(P0.01),IFN-γ水平低于正常人组(P0.01)。治疗组与对照组治疗前IL-10及IFN-γ水平无统计学意义(P0.05)。治疗6周后,治疗组IL-10水平下降,IFN-γ水平升高,与治疗前比较,差异均有统计学意义(P0.01)。对照组IL-10及IFN-γ水平与治疗前无统计学意义(P0.05)。结论中药香蓝驱毒颗粒治疗扁平疣,可能与增强扁平疣患者的免疫功能有关。     

Detection of Human Papillomavirus infection in trichilemmomas and verrucae using in situ hybridization

Background: It is hypothesized that trichilemmomas are 'burned out' verrucae. By performing in situ hybridization using HPV type-specific probes, we explored this concept.
Methods: Verrucae vulgaris and plantaris were positive controls, and inverted follicular keratoses (IFKs) were negative controls. Additionally, all lesions were tested for HPV genital types (low and high risk).
Results: We analyzed 9 trichilemmomas, 20 verrucae vulgaris, 8 verrucae plana, 3 verrucae plantaris and 6 IFKs. All trichilemmomas were negative for HPV types 1, 2 and genital types. Conversely, 9/20 verrucae vulgaris, 2 verrucae plantaris, and 1 verruca plana were positive for HPV type 2. Among HPV-2 positive lesions, 2/2 verrucae plantaris and 1 verruca vulgaris (chin) were strongly positive for genital-type HPV. One verruca plana (shin) was positive for genital-type HPV only. All 6 IFKs were HPV negative.
Conclusions: Using HPV type 1 and 2-specific probes and mixed genital-type probes, we were unable to detect HPV in trichilemmomas. This suggests that HPV-1, HPV-2 and low and high risk genital-type HPVs are not involved in the histogenesis of trichilemmoma. We also showed that genital HPV types could be present in non-genital verrucae.     

咪喹莫特乳膏联合卡介菌多糖核酸治疗扁平疣疗效观察

目的探讨咪喹莫特乳膏联合卡介菌多糖核酸治疗扁平疣的临床疗效和安全性。方法78例患者随机分为两组,试验组40例外用5%咪喹莫特乳膏,每晚1次,对照组38例外用0.1%维A酸乳膏,每晚1次,两组同时肌肉注射卡介菌多糖核酸2mL,每周3次,8周为一疗程。结果试验组有效率为85.00%,对照组为55.26%,两组比较差异有显著性(P<0.01),试验组的有效率高于对照组。治疗过程中试验组3例、对照组5例出现不良反应。结论咪喹莫特乳膏联合卡介菌多糖核酸治疗扁平疣有较好的疗效,安全性高,不良反应少。     

疣状肢端角化症的临床及病理特点研究

目的：探讨疣状肢端角化症的临床及病理特点。方法：分析本文及近40年来13篇文献报道的17例肢端角化症先证者的临床及病理资料。结果：发病年龄，10例（59％）〈20岁，7例（41％）〉25岁；有家族史者10例（59％）。皮损主要分布于双手背、足背及前臂、小腿伸侧。皮损表现16例（94％）为扁平疣样损害，1例表现为寻常疣样损害，6例（35％）伴有掌跖角化，5例（29％）伴有指趾甲受累，3例（18％）伴有毛囊角化病。皮损组织病理均表现为表皮明显角化过度、颗粒层及棘层增厚、乳头瘤样增生及塔尖样表皮局限性隆起等特征性变化，无角化不全及空泡化细胞。结论：疣状肢端角化症大部分患者有家族史，常于加岁前发病。皮损主要分布四肢伸侧，基本皮疹为扁平疣样的褐色扁平丘疹。皮损病理显示表皮明显角化过度、乳头瘤样增生及塔尖样表皮局限性隆起等特征性变化，是诊断疣状肢端角化症的主要依据。     

调Q Nd:YAG激光联合局部用药治疗扁平疣疗效观察

目的观察调Q Nd:YAG激光联合维A酸乳膏和重组人干扰素α-2b凝胶治疗扁平疣的疗效。方法将70例扁平疣患者随机分为两组,实际完成疗程67例,A组34例,B组33例,两组均予调Q Nd:YAG激光532nm波长治疗1～4次,每次间隔2周。A组采用调Q Nd:YAG激光治疗痂脱落后外用0.1%维A酸乳膏,每晚1次;白天外用重组人干扰素α-2b凝胶,4次/d,共4周。B组单采用调Q Nd:YAG激光治疗。结果 A组治愈率(94.12%)、有效率(97.06%)、复发率(6.25%)与B组治愈率(69.70%)、有效率(75.76%)、复发率(30.43%)相比,差异均有统计学意义(P均<0.05)。结论调QNd:YAG激光联合维A酸乳膏和重组人干扰素α-2b凝胶治疗扁平疣安全性高,治愈率高,复发率低。     

Extensive presentation of verruca plana in a healthy individual

A 27-year-old healthy man presented with non-itchy hyperpigmented skin lesions involving the trunk of duration 3 years. Examination revealed numerous coalescing, rough, slightly elevated brownish papules involving large areas of back, chest, and abdomen. There were no other cutaneous or systemic findings. Cutaneous biopsy was suggestive of verruca plana, which confirmed our clinical diagnosis. Here, we report this case of verruca plana due to its rare extensive involvement and unusual site in a non-immunocompromised individual.     

扁平疣皮肤镜和反射式共聚焦显微镜图像特征分析

目的 采用皮肤镜和反射式共聚焦显微镜(RCM)观察扁平疣的图像特征.方法 临床未经治疗的扁平疣患者88例,每例选1处典型皮损先后行皮肤镜及RCM检查,记录并统计各项图像特征.结果 88例扁平疣患者皮肤镜检测显示,48例(54.55％)可见淡红色背景,40例(45.45％)可见淡黄色背景,84例(95.45％)可见散在数量不等的点状出血.RCM检测显示,48例(54.55％)可见类似洋葱皮样的同心圆结构.病程大于1年的57例患者中,44例(77.19％)可见类似洋葱皮样的同心圆结构;病程小于1年的31例患者中,仅有4例(12.90％)可见类似结构,两组检出率差异有统计学意义(x2=33.47,P＜0.05).88例中,86例(97.73％)真表皮交界处可见基底层色素增加,真皮乳头环完整,真皮乳头内血管扩张充血,真皮乳头内可见1～2个增生的毛细血管管腔.8例患者治疗2周后皮肤镜及RCM下观察,上述特征明显消失.结论 结合临床表现,皮肤镜和RCM的图像特征可能为扁平疣的诊断提供帮助.