OK-432 Therapy for Recalcitrant Warts

Twelve patients with warts recalcitrant to various treatments, including cryotherapy, were treated with OK-432 injection therapy. Six patients received only subcutaneous injection, three received only intralesional injection, and the other three received both subcutaneous and intralesional injections. Complete clearing of the warts occurred in nine (75%) of 12 patients, while the other three patients were not cured. Grouping the patients by the method of injection, the success rate of subcutaneous injection was 5/9 (55.6%), and that of intralesional injection was 4/6 (66.7%). Although five patients complained of mild fever and malaise, these side effects gradually disappeared during the repeated injections. OK-432 injection is considered as a hopeful therapy for recalcitrant warts.     

生殖器疣癌变过程中凝集素受体的分布

应用生物素－抗生物素－酶标技术对ＢＳＬ、ＤＢＡ、ＬＣＡ、ＰＮＡ及ＵＥＡ１在生殖器疣癌变过程中定位发现：ＰＮＡ及ＵＥＡ１受体在正常表皮阴性、ＰＩＮⅢ／ＣＩＮⅢ中等强度阳性及生殖器癌强阳性。另外，随着细胞异型性增加，ＢＳＬ受体表达增强，ＤＢＡ反而减少，ＬＣＡ变化不显著。提示ＰＮＡ及ＵＥＡ１可制成探针用以区分生殖器疣与癌，其典型的染色特征可能提示重度非典型增生和恶性病变。     

Warts in primary schoolchildren: prevalence and relation with environmental factors

Background  Warts are very common in primary schoolchildren. However, knowledge on wart epidemiology and causes of wart transmission is scarce.
Objectives  To determine the prevalence of warts in primary schoolchildren and to examine the relation with environmental factors in order to provide direction for well-founded recommendations on wart prevention.
Methods  In this cross-sectional study, the hands and feet of 1465 children aged 4–12 years from four Dutch primary schools were examined for the presence of warts. In addition, the children's parents completed a questionnaire about possible environmental risk factors for warts.
Results  Thirty-three per cent of primary schoolchildren had warts (participation rate 96%). Nine per cent had hand warts, 20% had plantar warts and 4% had both hand and plantar warts. Parental questionnaires (response rate 76%) showed that environmental factors connected to barefoot activities, public showers or swimming pool visits were not related to the presence of warts. An increased risk of the presence of warts was found in children with a family member with warts [odds ratio (OR) 1·9, 95% confidence interval (CI) 1·3–2·6] and in children where there was a high prevalence of warts in the school class (OR per 10% increase in wart prevalence in school class 1·6, 95% CI 1·5–1·8).
Conclusions  One-third of primary schoolchildren have warts. This study does not find support for generally accepted wart prevention recommendations, such as wearing protective footwear in communal showers and swimming pool changing areas. Rather, recommendations should focus on ways to limit the transmission of wart viruses within families and school classes.     

男性生殖器疣中人乳头瘤病毒基因分型研究进展

人乳头瘤病毒(HPV)感染是全球最常见的性传播疾病(STD)之一。近年来研究证实HPV感染与男性生殖器疣和恶性肿瘤同样具有密切关系。本文就男性HPV感染的近况以及HPV的基因分型在男性生殖器疣中的研究进展作一综述。     

Efficacy of Silver Nitrate Pencils in the Treatment of Common Warts

Common warts are an important issue, especially in children and young adults. The methods proposed for common wart treatment are painful, destructive, and require special experience and devices. The chemical cauterization effect of silver nitrate on warts is noted in the classical pharmaceutical textbooks. In order to test this effect for this purpose, a placebo controlled clinical study was performed on 70 patients. On 35 randomly selected patients, a silver nitrate stick was used, and, on the other 35 patients, black ink was used. At the end of this study, of the patients treated with the silver nitrate stick, 15 (43%) were completely healed, 9 (26%) were partially healed, and 11 (31%) were not healed. Of the patients treated with black ink, 4 (11%) were completely healed, 5 (14%) were partially healed, and 26 (74%) patients were not affected. Thus the silver nitrate stick affected the warts of 24 (69%) patients. Therefore, this method appears to be an effective, economic, and easily applicable treatment for common warts.     

Cryotherapy of viral warts: a sustained 10-s freeze is more effective than the traditional method

BACKGROUND: Cryotherapy is a standard treatment for viral warts. Although textbooks recommend treating until there is a halo of ice around the wart (traditional freeze), many authors advocate more aggressive cryotherapy. There are no previously published studies assessing the efficacy of longer freezing times. OBJECTIVES: To compare the efficacy of the traditional freeze and a sustained 10-s freeze in the treatment of common viral warts with liquid nitrogen. METHODS: Patients attending a dedicated wart clinic were randomized to receive either a traditional freeze or a 10-s sustained freeze with liquid nitrogen delivered by a spray gun. Two hundred patients were recruited, 100 in each group. RESULTS: After five treatments, 49 patients in the 10-s freeze group were clear of warts (64% of non-defaulters) as compared with 31 (39%) of those in the traditional freeze group (chi2 = 6.7; P = 0.009). Seventy-four patients in the 10-s freeze group as compared with 59 in the traditional freeze group had either improved or cleared after five treatments (chi2 = 5.0; P = 0.02). Morbidity was significantly greater in the 10-s freeze group. Sixty-four patients suffered pain or blistering as compared with 44 in the traditional freeze group (chi2 = 10.8; P = 0.0045). Five patients were withdrawn from the 10-s freeze group because of pain as compared with one patient in the traditional freeze group. CONCLUSIONS: A 10-s sustained freeze is more effective in the cryotherapy of viral warts but carries a significantly greater morbidity in terms of pain and blistering.     

Clearance of recalcitrant warts in a pediatric patient following administration of the nine-valent human papillomavirus vaccine

Verruca vulgaris is a common, benign infection of the skin and mucous membranes caused by human papillomavirus (HPV). Although many therapeutic options for warts exist, they have limited efficacy and there is no definitive cure for warts. We report the case of a 10-year-old girl with recalcitrant cutaneous warts persisting more than two years which resolved completely following vaccination with the nine-valent HPV vaccine.     

Cercarial dermatitis contracted via contact with an aquarium: case report and review

Cercarial dermatitis ('swimmer's itch') is an itchy inflammatory response to the penetration of the skin by non-human Schistosoma parasites. It is commonly contracted while swimming or wading in lakes. We report a biology teacher who developed the dermatitis after cleaning the school aquarium in which he kept a water snail and some fish.     

Oral zinc sulphate in the treatment of recalcitrant viral warts: randomized placebo-controlled clinical trial

BACKGROUND: Viral warts are common dermatological diseases; although the rate of spontaneous recovery is high, it usually takes a long time, and some patients might not show this spontaneous healing. Zinc has an important effect on the immune system and it has been used as an immunomodulator to treat a variety of skin disorders. OBJECTIVE: To assess whether oral zinc was effective in treating viral warts of patients evaluated between May 1999 and April 2000. PATIENTS AND METHODS: This was a placebo-controlled clinical trial. Eighty patients with viral warts (common, plantar and plane) were all resistant to all forms of treatment. Each patient had > 15 warts. Forty patients were treated by oral zinc sulphate at a dose of 10 mg kg(-1) daily up to 600 mg day(-1) and followed-up for resolution of their warts and for any evidence of recurrence for 2-6 months. Another 40 patients were given a placebo oral treatment in the form of glucose, and followed-up for the same period. RESULTS: Only 23 patients of the first group (zinc treated) and 20 patients of the second group (placebo treated) completed the study. In all patients the serum level of zinc was low. In the zinc-treated group, the overall response was complete clearance of warts observed in 20 patients (86.9%) after 2 months of treatment. Fourteen patients (60.9%) showed complete disappearance of their warts after 1 month. Three patients (13.3%) failed to respond to the treatment after 2 months of therapy. The response to treatment was directly related to the increment in serum zinc level. No patient of the placebo-treated group showed any response. CONCLUSIONS: We conclude that zinc sulphate at a dose of 10 mg kg(-1) daily seems to be a highly efficacious therapeutic option for recalcitrant viral warts and proved to be safe with few adverse effects.     

扁平疣的自愈与人乳头瘤病毒活性的关系

目的　观察不同型别扁平疣皮损内HPVDNA的相对数量和分布情况 ,了解HPVDNA的活性和扁平疣自愈之间的关系。方法　将扁平疣皮损按临床表现分为 4型 ,用HPV通用型探针、原位杂交的方法对不同型的皮损HPVDNA变化情况进行观察。结果　一型皮损内HPVDNA的原位杂交多为阴性或者基底层很淡着色 ;多数的二型皮损中HPVDNA原位杂交为淡着色 ,分布于基底层、棘层 ,有时为强着色 ;三型皮损的着色强度类同于二型 ,并且在强着色处可见淋巴细胞浸润和角质形成细胞变性坏死 ;四型皮损HPVDNA的表现情况类同于一型。同一皮损内的着色有时分布不均 ,表现为原位杂交上的灶性着色增强。HPVDNA大多情况下出现在细胞核内 ,有时在胞质和 /或细胞间隙。结论　在扁平疣自行消退的过程中存在着HPVDNA复制的活跃、增多、扩散的过程。     

光动力联合二氧化碳激光治疗顽固性跖疣的研究

目的观察外用5-氨基酮戊酸(5-ALA)光动力联合二氧化碳(CO2)激光治疗顽固性跖疣的临床疗效。方法收集顽固性跖疣患者30例,超脉冲CO2激光去除厚硬的角质层,20%5-ALA霜封包4～5 h,633 nm的红光照射20 min(126 J/cm2),用聚合酶链反应技术(polymerase chain reaction,PCR)技术进行人乳头瘤病毒(humanpapillomavirus,HPV)病毒分型,分析各型HPV对光动力治疗反应的差异。结果本组30例患者经3次光动力治疗,16例患者完全缓解(完全缓解率53.3%),4例(13.3%)患者部分缓解,10例(33.3%)患者无反应。各型HPV对光动力治疗的反应差异无统计学意义。结论外用5-ALA光动力联合二氧化碳激光治疗顽固性跖疣是一种新的、有效的、安全的治疗方案,可以作为跖疣的二线治疗方案。     

草分枝杆菌注射液联合酞丁胺治疗甲周疣32例疗效观察

目的观察草分枝杆菌注射液联合酞丁胺搽剂治疗甲周疣的疗效。方法将64例甲周疣患者随机分成治疗组32例,予草分枝杆菌注射液肌肉注射和外搽酞丁胺搽剂;对照组32例,疣体采用液氮冷冻治疗,观察治疗时间均为2个月。结果治疗组痊愈率65.63%,有效率90.63%;对照组分别为21.88%,65.56%,两组临床疗效比较,差异有显著性(P均<0.05);随访3个月,两组复发率分别为9.25%,57.10%,差异也有显著性(P<0.05)。结论草分枝杆菌联合酞丁胺治疗甲周疣的疗效好、安全、无痛苦、无毒副作用,治疗后不遗留瘢痕,复发率低,易于接受,是治疗多发性甲周疣的有效方法。     

Cold urticaria as a complication of cryotherapy in the treatment of viral warts

Cryotherapy with liquid nitrogen has been established as the first-line treatment for pediatric patients with viral warts. Cold-induced urticaria (CU) is a rare skin reaction triggered by cold stimuli. We present the case of a pediatric patient with viral warts who developed CU after receiving cryotherapy.     

Liquid nitrogen cryotherapy of common warts: cryo-spray vs. cotton wool bud

BACKGROUND: Viral warts represent a large workload for dermatology departments. Cryotherapy with liquid nitrogen is the most widely used method of treatment by dermatologists and is increasingly used by general practitioners in the U.K. Existing data relating to the response to cryotherapy are virtually all derived from the use of a cotton wool bud as the applicator. There is an increasing trend to use the cryo-spray to freeze warts and it has been assumed that this is equally effective. In view of the workload involved it is important to test this assumption. OBJECTIVES: This prospective study was undertaken to compare these two methods of liquid nitrogen cryotherapy with regards to cure rate after 3 months of treatment. METHODS: Patients referred to two hospital dermatology departments with hand or foot warts were allocated to have liquid nitrogen applied with either a cryo-spray or with a cotton wool bud. Using either technique, liquid nitrogen was applied until ice-ball formation had spread from the centre to include a margin of 2 mm around each wart. Treatment was done fortnightly for up to 3 months. Plantar warts were pared and treated with a double freeze-thaw cycle. The endpoint of the study was complete clearance of all warts. RESULTS: Three hundred and sixty-three patients were enrolled, mean age 21 years (range 3-75), 188 male and 175 female. The mean duration of the warts was 98 weeks (median 78, range 2-936). The number of warts on the hands and feet varied from one to 80 (mean 5). The treatment groups were comparable with regards to baseline demographics. Two hundred and seven patients were evaluable. Cure rates at 3 months were 47% in the cotton wool bud group and 44% in the cryo-spray group (P = 0.8). Warts that had been present for 6 months or less (n = 31) had a greater chance of clearance (84%) compared with warts that had been present for more than 6 months (39%, n = 176) (P < 0.0005). CONCLUSIONS: Cryotherapy with liquid nitrogen for hand and foot warts in our study was equally effective when applied with a cotton wool bud or by means of a spray.     

Intralesional 2% zinc sulfate solution for plane warts: A case report

Warts are benign epithelial proliferations of the skin and mucous membranes caused by human papilloma viruses (HPVs). Plane warts are mainly caused by HPV‐3 and HPV‐10. There is no absolute effective single treatment, and multiple treatment modalities may be combined. One must take into consideration the probability of spontaneous regression, and so the therapeutic approach should not be too aggressive. We report a case of 11 years immunocompetent child presenting with recalcitrant multiple plane warts who was successfully treated with intralesional 2% zinc sulfate solution injection in one lesion after a failure of many other treatment modalities. Our case may represent a starting point for further studies to evaluate the best dose used for management and to avoid any side effects. Intralesional zinc sulfate injection could be a promising treatment option for plane warts.     

Recalcitrant viral warts treated by diphencyprone immunotherapy

Recalcitrant viral warts are a troublesome therapeutic problem. Immunotherapy with the universal allergic contact sensitizer diphencyprone (DCP) has been used successfully in such cases. We have reviewed our experience of the use of DCP in the treatment of resistant hand and foot warts during an 8-year period. Sixty patients were sensitized to DCP during this time; the median duration of warts was 3 years. Twelve patients defaulted from treatment. Of the remaining 48 individuals, 42 (88%) cleared of all warts. The median number of treatments to clear was five (range one to 22) and the median time to clear was 5 months (range 0.5-14). Adverse effects occurred in 27 of 48 patients (56%), most commonly painful local blistering (n = 11), blistering at the sensitization site (n = 9), pompholyx-like reactions (n = 7) and eczematous eruptions (n = 4). Three of those who defaulted did so due to side-effects, one became pregnant and eight dropped out for unknown reasons. Three of the 48 patients who cleared or had at least six treatments also discontinued DCP therapy due to side-effects, but most tolerated treatment well. Twenty-five patients were followed up for periods of 1 month to 8 years (median 2 years) and none had a recurrence. DCP immunotherapy is an effective option for the treatment of recalcitrant viral warts but patients must be motivated to attend for sequential applications and must be warned about potential uncomfortable side-effects.