Treatment of Recalcitrant Viral Warts with Combination Therapy of Systemic Acitretin and Diphenylcyclopropenone Immunotherapy

Viral warts are benign proliferations of the epithelium caused by human papilloma virus (HPV) infection. Diverse therapeutic options are available for viral warts, depending on extension and severity of the disease. We report a case of a 19-year-old man who presented with multiple viral warts on hands and feet for 5 years. He was treated at other clinics before visiting our hospital, but there was no improvement. We treated the lesions with a combination therapy of systemic acitretin and diphenylcyclopropenone (DPCP) immunotherapy for 6 months. A significant improvement was observed during the 12th week of therapy. Herein, we report a case of recalcitrant viral warts showing complete regression when a combination therapy of oral acitretin and immunotherapy was administered.     

二苯环丙烯酮治疗斑秃16例疗效观察

目的观察斑秃患者局部外用二苯环丙烯酮(DPCP)治疗的临床疗效。方法应用DPCP治疗16例斑秃患者,2%DPCP外搽秃发区致敏,1周后用0.001%DPCP外搽患者头皮,每周1次,并据患者反应增加浓度观察其治疗反应及副作用,并与局部外用米诺地尔酊2次/d进行对照。结果治疗组坚持治疗的11例患者中,8例出现终毛生长,有效率为72.73%,达到良好反应的中位时间为(9.07±3.96)月,停止治疗后复发率为25.00%,12.50%患者出现较严重副作用。对照组13例坚持治疗,4例患者出现终毛生长,有效率30.77%,复发率为25.00%。治疗组疗效明显优于对照组(P<0.05)。结论 DPCP治疗斑秃有效率高,安全性相对较好,是值得推荐的一种有效治疗方法。     

二苯环丙烯酮局部治疗斑秃的疗效分析

目的：分析斑秃患者局部外用二苯环丙烯酮（DPCP）疗效的影响因素。方法：对36例斑秃患者进行外用DPCP治疗,详细记录其临床资料及副作用;并对患者进行血清学检查、组织病理活检。结果：斑秃患者DPCP治疗总有效率为56.5%,复发率为23.1%。16.7%患者出现较明显副作用（严重接触性皮炎、白癜风）。副作用组患者在治疗前的血清IgE浓度明显高于有效组患者（P=0.03）。另外,患者年龄、发病年龄、病程、脱发面积、维持治疗浓度、自身免疫性疾病病史、异位性疾病病史和斑秃家族史、皮损病理改变与DPCP治疗的疗效无明显相关性。结论：外用DPCP治疗斑秃安全性较高,可避免长期使用皮质类固醇激素和免疫抑制剂的毒副作用,治愈率也较高。治疗前进行血清IgE测定可提前发现对治疗不耐受患者。     

二苯环丙烯酮局部免疫治疗斑秃的研究进展

国际上以二苯环丙烯酮(DPCP)在局部皮损上诱发接触性皮炎治疗重型斑秃应用最广泛,目前已有近30年历史,取得了良好的疗效。DPCP治疗斑秃的有效率多在50%～60%之间,常见的副作用为局部接触性皮炎,复发率10.6%～68.9%。DPCP治疗斑秃机制不明,目前认为可能是多环节性的,主要包括改变炎症细胞亚群、拮抗Th1免疫反应,重建Th1和Th2的平衡以及引入抑制性T细胞等。本文对有关DPCP局部免疫治疗斑秃的相关文献进行了综述。     

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。     

The Use of Diphenylcyclopropenone in the Treatment of Recalcitrant Warts

Background: The treatment of recalcitrant palmoplantar and periungual warts using topical immunotherapy with diphenylcyclopropenone (DPC) was reviewed retrospectively over a seven-year period. Methods: Two hundred eleven patients were sensitized during this time. The patients consisted of 90 males and 121 females and were between 5 and 78 years old. Twenty-three patients were lost to followup. Of the remaining, 4 were undergoing treatment at the time of evaluation, 1 patient failed sensitization, and 1 patient became pregnant. Four discontinued because of side effects, 3 because of financial reasons, and 18 patients discontinued treatment prior to completing the minimum required applications (defined as 6), producing a dropout rate of 12% (25/211). Three patients had additional treatment during the course of DPC and were not included in the study. The remaining 154 patients were classified as nonresponders or responders. Results: The responders consisted of 135 individuals (87.7%) that had complete clearance of warts. Reported adverse effects were local and included with pruritus (15.6%), with blistering (7.1%), and with eczematous reactions (14.2%). The majority of the patients tolerated the treatment very well. One patient developed local impetigo. Patients had an average of 5 treatments over a 6-month period. Conclusions: Topical immunotherapy using DPC is an effective treatment option for recalcitrant warts. It should be considered as first-line treatment for warts based on its high response rate, absence of scarring, and painless application.     

自然消退倾向跖疣皮损中朗格汉斯细胞与T淋巴细胞检测分析

目的通过对自然消退倾向跖疣及无消退迹象跖疣皮损中朗格汉斯细胞与T淋巴细胞的检测分析,探讨跖疣的发生、发展与局部免疫的相关性。方法根据近期疣体数目增减及疣体大小、自觉症状情况,在皮肤科足病专科门诊收集自然消退倾向跖疣22例与无消退迹象跖疣18例。用外科手术的方法将两组患者疣体切除,所取疣体皮损,常规石蜡切片,用CD1a,CD3,CD4,CD8单克隆抗体进行免疫组化染色,比较两组患者CD1a+朗格汉斯细胞(LC),CD3+,CD4+,CD8+平均密度,CD4+/CD8+比值及LC的形态分布,观察两组患者的局部免疫状况。结果与自然消退倾向组相比,无消退迹象组CD1a+LC大多散在分布于表皮下部,树突状突起明显减少、缩短或消失;无消退迹象组CD1a+LC,CD4+平均密度及CD4+/CD8+比值明显低于自然消退倾向组(P<0.05);无消退迹象组CD8+平均密度明显高于自然消退倾向组(P<0.05);两组中CD3+平均密度差异无统计学意义(P>0.05)。结论在无消退迹象组中存在局部免疫缺陷,局部免疫的恢复与疣体的自行消退有相关性。     

Treatment of Common and Plane Warts in Children with Topical Viable Bacillus Calmette‐Guerin

Abstract: Treatment of verrucae in children is difficult and may be painful using traditional methods, especially if they are multiple or on the face. The objective of the current study was to evaluate the efficacy and safety of topical application of viable Bacillus Calmette‐Guérin (BCG) in a paste formula as a new immunotherapeutic modality in the treatment of common and plane warts in children. The present study included 80 children with common and plane warts at different sites on the body. They were divided into two groups. Group A (40 patients) received topical viable BCG and group B (40 patients) received topical saline as control. All patients and controls had received a previous vaccination of BCG. BCG was applied once weekly for six consecutive weeks. Patients who had partial or no response received another course of treatment for another 6 weeks. Follow‐up was at 6 months to detect any recurrences. A highly significant difference was found between the therapeutic response of common and plane warts to BCG and saline (placebo) (p < 0.001). Complete response was achieved in 65% of children with common warts and 45% of patients with plane warts. No response was detected in the control group. No recurrences or side effects were observed in the BCG group. Topical immunotherapeutic BCG is a new, effective, safe treatment option for children with common and plane warts.     

Treatment of Anogenital Warts in Children with Topical 0.05% Podofilox Gel and 5% Imiquimod Cream

A retrospective analysis of 25 infants and young children with anogenital warts was performed by chart review and telephone interview. Fifteen of 17 patients treated with podofilox 0.5% gel and 6 of 8 patients treated with imiquimod 5% cream improved or cleared with therapy. Only one patient stopped treatment because of irritation. Our experience suggests that these agents can be used safely and effectively in young children. Controlled prospective studies should be undertaken to further evaluate the use of podofilox and imiquimod in the treatment of symptomatic anogenital warts in children.     

皮肤光老化的外用药物预防与治疗

光老化是指皮肤衰老过程中由光线特别是紫外线辐射所造成的损伤。皮肤光老化可并发多种皮肤病甚至与皮肤肿瘤的发生有病因学的联系。因此,预防和治疗皮肤光老化很有必要。随着对光老化认识的加深,对其预防与治疗的方法也取得了相应进展。为此,综述了近年来皮肤光老化预防和治疗中应用的包括防晒剂、维A酸类、绿茶等多种外用药物,并从作用机制、临床应用及疗效等方面逐一介绍。     

Comparative Evaluation of Topical 10% Potassium Hydroxide and 30% Trichloroacetic Acid in the Treatment of Plane Warts

Background:Warts are benign proliferations of skin and mucosa caused by the human papillomavirus (HPV). Plane warts are caused by HPV types 3, 10, 28, and 41, occurring mostly in children and young adults. Among the treatment modalities, topical application of trichloroacetic acid (TCA) is age old. Potassium hydroxide (KOH) has a keratolytic effect on virus-infected cells. It is less irritating, less painful, less scar forming, and can be safely used in children too. Hence, it could be a better topical agent in the treatment of plane warts.Results:Statistically no significant difference (P = 0.07) was found between the objective therapeutic response to 10% KOH and 30% TCA at the end of study (12 weeks). However, subjective response to 10% KOH was better and statistically significant (P = 0.03). There was no recurrence of warts seen on follow-up for 3 months of complete responders in both the arms.Conclusion:10% KOH is found to be equally effective in the treatment of plane warts compared to 30% TCA with the advantage of faster onset of action and tendency of completely clearing warts with fewer side effects.     

Treatment of palmoplantar warts with a diphencyprone and salicylic acid ointment

We report on 50 consecutive suitable patients with one or more palmoplantar warts who were treated with a patient-applied ointment comprising 0.1% diphencyprone and 15% salicylic acid in white soft paraffin. All patients sensitized to diphencyprone were followed up clinically and assessed by patient questionnaire. The intention to treat success rate in this series was 88%. The time to wart clearance ranged from less than 4 weeks to 4 months. In our patient group, 90% rated their treatment as 'excellent' or 'good', whereas 10% stated that the reaction induced by diphencyprone was 'too severe'. Our results are compared with those previously published using diphencyprone in the treatment of palmoplantar warts.     

二硝基氯苯(ONC日)治疗皮肤疣临床观察

自1980年1月始,我科应用DNCB治疗各种皮肤究40例,现将初步观察小结如下:一、一般情况:男性22例,女性18例,病程最长者3年,短者3月,年龄在1144岁之间.40例病人均经过各种治疗(手术切除、电灼、冷冻、局部腐蚀以及服药等),效果均不好.     

特异性免疫治疗对单核细胞及其来源的树突状细胞表型的早期影响

目的探讨抗原特异性免疫治疗对单核细胞及其来源的树突状细胞表达与免疫相关的重要表型的早期影响。方法 20名接受黄蜂毒液免疫治疗的患者,在治疗前(day0)和治疗后第1天(day1)、第3天(day3)和第5天(day5)抽取外周静脉血分离单核细胞(Mo),其中10名患者的单核细胞在体外培养6d诱导分化为单核细胞来源的树突状细胞(MoDC),流式细胞仪检测其表面ILT3,ILT4,B7H1,B7H2,MHCⅠ,MHCⅡ,CD80和CD86的表达。结果单核细胞和MoDC表面ILT3和ILT4表达显著增高,B7H1和CD86表达显著降低,与治疗前比较,差异有统计学意义(P<0.01)。未观察到B7H2,MHCⅠ,MHCⅡ和CD80的显著性改变(P>0.05)。结论单核细胞和MoDC表面的ILT3,ILT4,B7H1和CD86分子参与抗原特异性免疫治疗的早期耐受。     

咪喹莫特乳膏治疗鲍恩样丘疹病疗效观察

目的 探讨5%咪喹莫特乳膏治疗鲍恩样丘疹病（BP）的疗效和对复发的影响.方法 回顾性分析39例鲍恩样丘疹病患者,第一组15例,单纯外用5%咪喹莫特乳膏,每周3次,疗程8周.第二组12例,应用CO2激光治疗.第三组12例,CO2激光联合5%咪喹莫特乳膏治疗.三组随访时间均为3个月.结果 第一组33.33%（5/15）的患者获得痊愈,无1例复发,不良反应主要表现为红斑、水肿、糜烂和疼痛,无系统不良反应.第二组CO2激光治疗后,12例全部痊愈,但66.66%（8/12）患者复发.第三组治疗后12例痊愈,仅25%（3/12）患者复发.结论 5%咪喹莫特乳膏是治疗鲍恩样丘疹病的有效药物,尤其是对皮损较小者,疗效好、复发率低.对于肥厚性和/或伴有轻度疣状损害者,CO2激光治疗后联合5%咪喹莫特乳膏可降低复发率.