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.     

Effectiveness of intralesional vitamin D3 injection in the treatment of common warts: Single‐blinded placebo‐controlled study

Warts are common viral infection of the skin, usually treated with destructive methods like electrocautery, cryotherapy or laser ablation. Topical vitamin D has been used to treat warts with variable success is to evaluate the efficacy of intralesional vitamin D₃ injection in the treatment of common warts. Fifty patients were divided into two groups: 30 patients as cases group who received intralesional injection of 0.2 mL of vitamin D₃ (300,000 IU) into the base of mother wart for two sessions and another 20 patients as a control group who were injected with normal saline solution. Standardized photographs were taken before the procedure, and 1 month and 3 months after the procedure. The degree of the response was classified into complete, partial, and no response. Complete clearance of the target injected warts occurred in 40% of patients in cases group while it occurred only in 5% of patients in control group (p ≤ .001) that was statistically significant. Intralesional injection of vitamin D₃ may be considered a good and safe modality for the treatment of common warts.     

Intralesional vitamin D3 versus intralesional purified protein derivative in treatment of multiple warts: A comparative clinical and immunological study

Intralesional (IL) vitamin D3 is an emerging treatment for cutaneous warts. However, its effectiveness and exact mechanism is not fully evaluated. We aimed to compare the efficacy and safety of IL purified protein derivative (PPD) and IL vitamin D3 in multiple warts and to investigate their systemic effect clinically and immunologically. Forty‐five patients with multiple extragenital warts were treated with IL‐PPD (22 patients) or IL vitamin D3 injection (23 patients) for a maximum of three sessions at 3 week intervals. Decrease in size and number of warts and adverse effects were evaluated. Serum interleukin‐12 (IL‐12) and interferon‐gamma (IFN‐γ) levels were measured before and 3 weeks after the last session. Higher clearance rates for all warts were observed with IL‐PPD compared to IL vitamin D (59.1% vs. 21.7% complete clearance, p < .001). Significant increase was found in both serum IL‐12 and IFN‐γ after PPD treatment (p = .034 and p = .04, respectively), but only IFN‐γ after vitamin D3 treatment (p = 0.02). Both IL vitamin D3 and PPD showed positive results in treatment of multiple warts. However, PPD showed higher clinical efficacy and more increase in both IL‐12 and IFN‐γ levels.     

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature

Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Many of these options are destructive and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Systemic approaches such as immunotherapy have demonstrated success in treating multiple lesions by combining a targeted approach with upregulation of the host immune system. An extensive literature review was performed to evaluate the various vaccine antigens that have been used intralesionally to treat cutaneous and anogenital warts. The specific intralesional immunotherapies that have been studied include: Candida albicans; measles, mumps, and rubella; Trichophyton; and tuberculin antigens such as purified protein derivative, Mycobacterium w vaccine, and Bacillus Calmette‐Guerin. Intralesional vaccine injection represents a safe, effective, and tolerable treatment for warts, including recalcitrant and anogenital warts. This approach has been somewhat overlooked in the past despite substantial evidence of high response rates with a low side effect profile. Large comparative trials are necessary to determine the most effective immunotherapy treatment option as well as the most appropriate dosing parameters.     

Preventing human papilloma virus infection: another vaccination success

Human papillomavirus (HPV) is the commonest sexually transmitted infection. It has over 200 genotypes which, depending on the site of infection and type of virus, can give rise to cancers or warts. HPV infection is a prerequisite for cervical cancer and is associated to varying degrees with other anogenital cancers and, increasingly, with cancers of the oropharynx. It is also associated with anogenital warts which, while not life threatening, cause considerable morbidity. HPV vaccines have been available since 2006 and by mid-2021 have been introduced into over 110 countries. Trials and real world data have shown them to be safe and highly effective at preventing infection with HPV and anogenital warts. Data are also accumulating showing impressive reductions in cervical cancer. In UK, HPV vaccine mainly offered to girls and boys aged 12–13 years in a school-based programme. Uptake is generally high, but inequalities persist and there are concerns about the impact of a recent significant decline in uptake due to school closures arising from the COVID pandemic. HPV vaccine programmes have been significantly impacted by vaccine hesitancy in some countries, but experience in the Republic of Ireland and Denmark has shown that with involvement of the community, this can be successfully addressed. Modelling estimates that, by 2058, the vaccine will have prevented over 64,000 HPV-related cervical cancers and almost 50,000 other HPV-related cancers. The introduction of a vaccine containing nine HPV strains will further increase the number of cancers prevented. This short article outlines how HPV vaccination in adolescence is helping prevent serious illness in adult life.     

卡介苗多糖核酸联合异维A酸治疗扁平疣疗效观察

目的：：观察卡介苗多糖核酸联合异维A酸治疗扁平疣的临床疗效和安全性。方法：70例扁平疣患者随机分为观察组和对照组各35例。对照组口服异维A酸软胶囊10 mg,bid,4周后改为10 mg,qd。观察组在对照组基础上加用卡介苗多糖核酸1 ml,im,隔日一次。治疗8周后,比较两组患者治疗前后T淋巴细胞群和免疫球蛋白水平变化,评价两组临床疗效及不良反应情况。结果：治疗后,两组患者的T细胞群水平、IgG、IgA均得到明显改善(P<0.01),且观察组除IgM外的各项指标改善效果均明显优于对照组(P<0.05)。观察组患者的起效时间明显短于对照组(P<0.01),总有效率明显高于对照组(P<0.05)。两组药品不良反应发生率差异无统计学意义(P>0.05)。结论：卡介苗多糖核酸联合异维A酸软胶囊治疗扁平疣,可显著改善患者的免疫功能状况,提高临床疗效,明显优于单独使用异维A酸。且安全性较高。     

Efficacy of intralesional methotrexate in the treatment of plantar warts

Warts are tumors or growths caused by infection with human papilloma virus (HPV). Currently, over 170 HPV types have been identified. This study aimed to evaluate the efficacy and safety of intralesional injection of methotrexate (MTX) for the treatment of plantar warts. Sixty patients presented with plantar warts were divided into two groups. Group A patients were injected with intralesional MTX (2 mg/ml). Group B patients were injected with intralesional saline as a placebo. The injections were repeated every week for a maximum of six sessions or until complete clearance, whichever was earlier. The patients were followed up for 6 months after the last injection. In the intralesional MTX group, 2 patients (6.7%) showed complete improvement, 8 patients (26.7%) showed partial improvement, and 20 patients (66.7%) showed no improvement. In the intralesional saline group, 3 patients (10%) showed complete improvement, 4 patients (13.3%) showed partial improvement, and 23 patients (76.7%) showed no improvement. Reported adverse events were local reactions in the form of swelling, pain, and infection in both groups. There was no statistically significant difference between the therapeutic responses to intralesional MTX injection and saline.     

Intralesional zinc sulfate 2% vs intralesional vitamin D in plantar warts: A clinicodermoscopic study

Verrucae are benign proliferations seen in skin due to infection with papillomaviruses. There are different treatment strategies for warts but all of these treatments are painful, time consuming, expensive, and recurrence is common. To evaluate and compare the efficacy of intralesional 2% zinc sulfate solution vs vitamin D3 in the treatment of plantar warts, as well as reporting the side effects. This three‐armed randomized clinical trial included 105 patients presented with plantar warts divided into three groups, 35 patients per group. The first group received intralesional 2% zinc sulfate, the second group received intralesional 2% vitamin D3, and the third group received normal saline. Four sessions were done, one every 2 weeks. At the end of the study, patients showing complete response were more in zinc group (71.4%), vitamin D3 group (62.9%) compared to saline group (40%). Most of the patients in zinc group showed severe pain during injection (48.6%), most of the patients in vitamin D3 group showed mild pain (80%), while most of the patients in saline group showed no pain (57.1%). Both intralesional 2% zinc sulfate and vitamin D3 are effective in treatment of plantar warts, with zinc sulfate being more effective.     

CO2点阵激光联合伊可尔治疗难治性掌跖疣疗效观察

目的观察CO₂点阵激光联合伊可尔治疗难治性掌跖疣的临床疗效及安全性。方法:选取掌跖部多发,经其他疗法治疗后复发的难治性掌跖疣患者58例,患者平均分为两组,对照组29例先选择激光功率0.5-2W将皮损磨削薄直至焦痂或点状出血,之后采用CO₂点阵模式10-20mJ/cm2治疗,每周治疗一次,连续治疗4周。观察组29例观察组:CO₂点阵激光治疗仪器及治疗方法与对照组相同。激光治疗完毕,使用伊可尔药水棉片湿敷患处2小时,激光治疗后连续湿敷伊可尔棉片5天,停药2天至下一次激光治疗后继续湿敷,连续治疗4周。2组均随访观察6个月。结果:58例患者均完成治疗,治疗4周后,观察组总有效率93.10%,病损清除率为77.82%,均高于对照组的72.41%、60.81%,组间差异均有统计学意义(P<0.05)。6个月后,观察组复发率10.34%,对照组复发率37.93%,组间差异有统计学意义(P<0.05),两组不良反应差异无统计学差异。结论:CO₂点阵激光联合伊可尔治疗难治性掌跖疣疗效优于单用CO₂点阵激光。联用伊可尔降低了难治性掌跖疣的复发率,并且操作简便,安全性高。