Oral zinc sulfate treatment for viral warts: an open-label study

Viral warts, which are caused by the human papilloma virus, are a common problem in dermatology. Various modalities have been used to treat warts, but none are uniformly effective or directly antiviral. Recent studies show that oral zinc sulfate could be effective in the treatment of viral warts. Thirty-one patients with multiple, non-genital viral warts were recruited in this open-label clinical study. The patients were treated with oral zinc sulfate (10 mg/kg to a maximum dose of 600 mg/day) for 2 months and followed up with assessments for the resolution of their warts and for any evidence of recurrence after treatment. Among the 31 patients, 18 patients showed low serum zinc levels (58%). Of 26 patients who completed the study (84%), 13 (50%) showed complete resolution of their warts after 2 months of treatment. Complete responders remained free of lesions at 6-month follow-up. No serious side-effects were reported apart from nausea (16%), mild gastric pain (3%) and itching sensation (3%). Oral zinc sulfate was found to be a good option in the treatment of viral warts, as it was safe and effective without important side-effects.     

Cimetidine treatment for viral warts enhances IL-2 and IFN-gamma expression but not IL-18 expression in lesional skin

Cimetidine has been shown to improve various types of human neoplasms and more recently it has been shown to be effective in treating recalcitrant or multiple viral warts in some reports. However, it is not well understood why cimetidine is effective on those kinds of viral warts. We investigated 55 patients with multiple viral warts treated only with oral cimetidine for up to 4 months to examine the efficacy of treatment. The patients were divided into two groups: group A received oral cimetidine (<20 mg/kg/day) and group B received the drug (30 to 40 mg/kg/day). In addition, using real time PCR, we measured mRNA levels of the cytokines interleukin-2 (IL-2), IL-18, and interferon (IFN)-gamma taken from selected punch biopsy specimens before and during treatment. As a result, 34.5% (19/55) of the patients had a dramatic clinical improvement or complete remission (CR) of their viral warts and 23.6% (13/55) of the patients had partial responses (PR) within 4 months of cimetidine therapy. IL-2 and IFN-gamma mRNA levels were significantly increased and IL-18 mRNA levels were decreased in tissues of effectively treated viral warts. Our results show that the higher dose of oral cimetidine was more effective in treating multiple viral warts, that cimetidine activates Th1 cells to produce IL-2 and IFN-c and that their expression correlates with wart remission. These results suggest that cimetidine is an effective treatment for viral warts. In addition, based on the decrease in IL-18 mRNA elicited by the drug, IL-18 might be expressed by keratinocytes infected with HPV.     

The treatment of resistant warts with intralesional bleomycin: a controlled clinical trial

A controlled double-blind trial was carried out on fifty-nine matched pairs of hand warts in a group of twenty-four patients, with proven resistance to treatment, to study the effectiveness of the intralesional injection of 0.1% solution of bleomycin sulphate in normal saline, compared with a normal saline placebo injected into the paired warts in the same patient. We found that 87.5% of patients showed a more favourable response to bleomycin (P less than 0.001); 76% of the fifty-nine warts treated with bleomycin were cured by one to three injections of up to 0.2 ml of solution. Subsequently 75% of thirty-two patients with resistant hand warts and 66% of fifteen patients with mosaic plantar warts were cured of all their warts. No patient received more than 4 mg of bleomycin. No toxicity was experienced. Local pain was on the whole well tolerated. This form of treatment for resistant warts is reliable, safe and acceptable to patients.     

Intralesional injection of bleomycin sulphate into resistant warts in renal transplant recipients versus non-transplant warty patients.

Sixteen adult renal transplant patients and 20 non-transplant patients with warts underwent intralesional therapy with bleomycin sulphate. One unit/ml bleomycin sulphate was injected in 93 warts in renal transplant recipients and 100 warts in non-transplant patients with proven resistance to conventional treatment for at least 6 months. The treatment was compared with a normal saline placebo injected into the paired warts in the same patient. Thirty-four out of 93 warts (37%) in renal transplant recipients vs. 59 out of 100 warts (59%) in non-transplant patients were completely cured after one to three injections. We found bleomycin completely ineffective in 56 warts (60%) in renal transplant recipients, but ineffective in only 17 warts (17%) in non-transplant warty patients. None of the patients treated experienced any side effects except for local pain which was well tolerated, especially by non-transplant patients.     

CO2 laser treatment of warts in immunosuppressed patients

BACKGROUND: A large proportion of chronically immunosuppressed patients suffer from recalcitrant viral warts. Furthermore, the incidence of nonmelanoma skin cancer is clearly elevated in this patient group and human papillomavirus is most likely to play a causal role in these neoplasms. OBJECTIVE: To analyze the effectiveness of treatment of viral warts with the CO(2) laser in immunosuppressed patients. METHODS: Multiple viral warts of 13 patients with immunosuppression, a majority of them renal allograft recipients, were treated with CO(2) laser in local or regional anesthesia. In case of recurrences, the lesions were treated again after 3 months. RESULTS: 12 of 13 patients experienced dramatic improvement after 1-3 treatment sessions, 6 of these patients showed full remission. Side effects such as postoperative pain or scarring were minimal. CONCLUSION: CO(2) laser treatment of recalcitrant warts in immunosuppressed patients shows promising results which are comparable to those in immunocompetent hosts. This offers a welcome enlargement of the array of therapies in this otherwise difficult-to-treat group of patients and may contribute to the reduction of risk factors for nonmelanoma skin cancer.     

Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study

BACKGROUND: The treatment of viral warts remains challenging. A variety of treatment modalities have been used with a range of success. Fluorouracil has been shown to be effective in treating warts but the method of its delivery directly onto the affected tissue has been of little efficacy. We evaluated the safety and efficacy of intralesional 5-fluorouracil in the treatment of verrucae. METHODS: Seventy-six patients with a total 315 verrucae were randomized to receive either a 5-fluorouracil, lidocaine and epinephrine (5-FU + LE) mixture or serum saline injection into the paired verrucae in the same patient. The mixture of 5-FU (4 cm(3), 50 mg/mL), lidocaine (1 cm(3), 20 mg/mL) and epinephrine (0.0125 mg/mL) was injected into the base of the wart using a mantoux needle. Each lesion was infiltrated with either of the solutions once a week for up to a maximum of 4 weeks, and the patients were followed up for 6 months. RESULTS: Complete response was noted in an average of 70% of the verrucae treated with the 5-FU + LE mixture and in 29% of those in the placebo group (P < 0.001). No clinically significant systemic and local adverse effects occurred. Pain and burning were noted as an immediate injection pain. Recurrence rates were evaluated and no statistically significant difference between the two groups was found. CONCLUSIONS: The results demonstrate that treatment of verrucae with 5-FU + LE mixture is safe and effective.     

Comparison of oral treatment with zinc sulphate and placebo in acne vulgaris

In a double-blind study 91 patients with acne vulgaris were treated either with oral zinc sulphate (0.4 g daily) or with a placebo. Forty-eight patients received zince treatment and 43 patients placebo. Significantly better results were demonstrated in favour of zince after 12 weeks.     

Oral zinc sulphate therapy in acne vulgaris: a double-blind trial

The effect of zinc sulphate and placebo was compared in a double-blind trial in 56 patients suffering from acne vulgaris. Serum vitamin A levels were studied in all, before and at the end of therapy, 29 patients received zinc sulphate 600 mg daily and 27 patients received placebo. Patients on placebo showed no improvement. After 12 weeks of treatment with zinc sulphate, 17 patients (58%) showed significant improvement. There was a statistically significant decrease in the number of papules, infiltrates and cysts. In zinc-treated cases there was statistically significant increase in serum vitamin A levels, while no change was found in the placebo group.     

Cryosurgery of genital warts in cases in which podophyllin treatment failed or was contraindicated.

A total of 56 cases with warts in which podophyllin treatment was either contraindicated or a failure, were treated with nitrous oxide using a Keymed 500 cryosurgical appliance. Forty-three patients who completed treatment were followed-up for three months. Thirty-seven of these had received applications of podophyllin twice weekly for an average period of three months before cryosurgery. The remaining cases in whom podophyllin was considered to be contraindicated included five with vulval warts (two were pregnant, two were bronchial asthmatics taking oral prednisolone, and one was taking oral clomiphene citrate), and a diabetic patients with penile warts. Thirty-two were cured and 11 relapsed. The latter were re-treated at the end of the follow-up period with two freezing cycles of 45 seconds at an interval of 30 minutes. Seven were cured and the remaining four men who failed to respond belonged to the podophyllin-resistant group and included three with metal warts and one homosexual with anogenital warts. Cryosurgery gave a cumulative success rate of 91%. A single freezing cycle was free from complications but a double freezing cycle was often followed by severe local reaction.     

电灼联合胸腺五肽治疗男性肛周尖锐湿疣97例的疗效观察

目的:观察电灼联合胸腺五肽用于治疗男性肛周尖锐湿疣的疗效。方法:97例于初次发病的男性肛周尖锐湿疣患者,年龄在17~52岁之间,予以随机分为治疗组及对照组。两组患者均予以电灼清除所有可见皮损,治疗组术后肌肉注射胸腺五肽10mg/d,持续10d,两组随访观察3~6个月后分析讨论。结果:治疗组患者在随访期间复发率为4.0%,显著低于对照组(19.2%),差异具有统计学意义(P<0.05)。结论:电灼联合胸腺五肽治疗男性肛周尖锐湿疣在控制复发率方面疗效满意,值得临床应用。     

Epidermodysplasia verruciformis: association with isolated IgM deficiency and response to treatment with acitretin

We describe a 25-year-old woman, who had extensive, large viral warts consistent with epidermodysplasia verruciformis (EV) since she was 6-year-old. Laboratory studies revealed an isolated IgM-deficiency, but the patient demonstrated no other abnormalities. She was treated with oral acitretin (0.5-1 mg/kg/day) for six months and her skin lesions improved slightly. However, after discontinuing the treatment, the lesions came back but she declined further treatment.     

Modern treatment of warts: cure rates at 3 and 6 months

Four-hundred consecutive referrals with viral warts of the hands and/or feet were investigated to determine the cure rate from a combination of cryotherapy, keratolytic wart paint and paring. For treatment failures after 3 months, the value of continuing cryotherapy and of additional treatment with the immunomodulator inosine pranobex were assessed. Subjects were treated for 3 months with wart paint and cryotherapy and were randomized to receive, or not, paring in addition. Those who did not respond by 3 months were randomized to receive, or not, 3 months further cryotherapy, and to receive inosine pranobex 60 mg/kg/day for 1 week each month, or matching placebo. Fifty-two per cent of subjects were cured by 3 months. The chance of cure was inversely related both to the length of history and to the diameter of the largest wart. Paring improved the cure rate for plantar warts but not for hand warts. During the second 3 months the cure rate fell to 41%. Neither cryotherapy nor inosine pranobex significantly improved this response.     

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.     

Combined therapy trial with interferon alpha-2a and ablative therapy in the treatment of anogenital warts.

OBJECTIVE: To determine whether the combination of systemically administered interferon alpha-2a and ablative surgery for the treatment of genital and/or perianal warts produces a 30% or greater improvement in lasting response rate compared with a control group receiving a combination of placebo and ablative therapy. DESIGN: Randomised, triple-blind, placebo-controlled trial using 1 or 3 MIU of interferon alpha-2a or placebo administered subcutaneously three times weekly for 10 weeks in combination with ablative surgery. SETTING: International, multicentre study in 10 genitourinary medicine clinics. PATIENTS: Two hundred and fifty patients with anogenital warts. MAIN OUTCOME MEASURES: Lasting response at week 38. RESULTS: Standard efficacy analysis at week 38 showed a lasting response in 51% (35/68) of 3 MIU interferon-treated patients, 48% (30/63) of 1 MIU interferon-treated patients and 43% (29/67) of placebo-treated patients. CONCLUSIONS: With the doses and regime described, treatment with interferon alpha-2a in combination with ablative therapy is not significantly superior in the treatment of anogenital warts than placebo and ablative therapy.     

Oral zinc sulphate in the treatment of acute cutaneous leishmaniasis

A clinical trial to evaluate the efficiency of oral zinc sulphate in the treatment of cutaneous leishmaniasis was conducted. One-hundred and four patients with parasitologically proven cutaneous leishmaniasis were included in the trial. Patients were assigned randomly to receive 2.5, 5 or 10 mg/kg of zinc sulphate orally, and a control group of patients did not receive any treatment. All patients were followed up for 45 days. At the end of the follow-up period, lesions were assessed and parasitological proof of cure or otherwise was sought. Results showed that the cure rate for the 2.5 mg/kg group was 83.9%, for the 5 mg/kg treatment group it was 93.1% and for the 10 mg/kg treatment group it was 96.9%. No lesions in the control group showed any sign of healing during the follow-up period. Therefore, oral zinc sulphate can be recommended as a very safe therapy for cutaneous leishmaniasis.     

Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study.

OBJECTIVE--To compare patient tolerance and treatment efficacy of subcutaneous interferon (IFN) alpha 2a plus cryotherapy versus cryotherapy alone in treatment of primary anogenital (AG) warts. DESIGN--Randomised placebo controlled observer blind study. Statistical analysis was by chi square and Mann Whitney U tests. PATIENTS--60 patients with newly diagnosed AG warts. INTERVENTION--29 and 31 patients were treated with subcutaneous IFN alpha 2a plus cryotherapy or placebo injections plus cryotherapy, respectively. MAIN OUTCOME MEASURES--Clinical presence or absence of AG warts. Patients wart-free at 8 weeks were asked to re-attend at 12 weeks; those with persistent warts at 8 weeks were withdrawn from the study. RESULTS--At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not significant); corresponding figures at 12 week review were 29.6% (8/27 patients) and 40% (10/25 patients) respectively (not significant). There was no difference in treatment response between males and females. Recurrence of warts at three month review, in patients cleared of warts at 8 weeks, was seen in 50% (8/16) and 37.5% (6/16) of patients in the IFN and placebo groups respectively (not significant). Multiple warts and the presence of perianal/anal canal warts, either alone or concurrent with warts on the genitalia, at first clinic attendance, were adverse prognostic indicators (p less than 0.001, and p = 0.05 respectively). Cervical human papilloma virus (HPV) infection, exophytic or subclinical, was present in 58.3% and 77.2% of females in the IFN and placebo groups respectively, at trial entry. Although these lesions were not directly treated, colposcopic resolution was seen in 12.5% of affected women, in both treatment groups, by the end of the 7 week treatment period. Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p less than 0.01). Severe influenza like symptoms occurred, after the first three injections only, in one patient treated with IFN; all other reported side effects were mild. CONCLUSIONS--Subcutaneous IFN alpha 2a combined with cryotherapy is no more effective than cryotherapy alone in the treatment of primary AG warts. The presence of multiple warts and perianal/anal canal warts are adverse prognostic indicators.     

Behandlung von therapieresistenten Verrucae vulgares mit einem Ciclopirox-haltigen Lack

BACKGROUND AND OBJECTIVE: Anti-inflammatory actions of ciclopirox, an antifungal agent, have been described previously. We assessed the effectiveness of ciclopirox in the treatment of viral warts. PATIENTS/METHODS: Twenty-three immunocompetent patients (age 9-61 years) with common warts at the hands, feet and in the face resistant to conventional therapy were treated. Following keratolysis with a salicylic acid-containing patch, an 8% ciclopirox lacquer was applied 1-2 times daily. At the beginning and the end of the treatment lesions were photographed and the time span (minimum 4 weeks) until complete resolution was documented. RESULTS: In 7 patients complete remission, and in 12 patients partial remission was achieved. Only 4 patients did not show any effect under topical ciclopirox treatment (mean duration of therapy 3.2 +/- 2.1 months). The overall response rate was 82.6%. Local side effects like erythema or pruritus were not reported. CONCLUSION: Our data suggest that a ciclopirox lacquer may be helpful in the treatment of common warts. However, the data have to be confirmed in a randomized controlled trial in the future.     

Cryotherapy of common viral warts at intervals of 1, 2 and 3 weeks

We studied the efficacy, and time to clearance, of more frequent cryotherapy of viral warts, by randomizing 225 patients to receive treatment at 1-, 2- or 3-weekly intervals. The mean times to clearance of warts in each group were 5.5, 9.5 and 15 weeks in the weekly, 2-weekly and 3-weekly groups, respectively (P < 0.01). Cure rates after 3 months correlated with frequency of treatment (P < 0.05). After 3 months, 43% (66% of non-defaulters) had cleared in the group treated weekly, 37% (47%) of the group treated every 2 weeks, and 26% (30%) of those treated every 3 weeks. The mean numbers of treatments needed to achieve clearance were similar in each group (5.5, 4.75 and 5 treatments). After 12 treatments, cure rates were similar for all three groups: 43% for the weekly- treated group (3 months), 48% for the 2-weekly group (6 months), and 44% for the 3-weekly group (9 months). Percentage cure is related to the number of treatments received, and independent of the interval between treatments. A more rapid cure may, therefore, be achieved by more frequent treatment.     

Outcome of carbon dioxide laser therapy for persistent cutaneous viral warts

Twenty-two adults with persistent, symptomatic viral warts on the hands or feet which had failed to respond to conventional therapy were treated by carbon dioxide (CO2) laser ablation under local anaesthesia. Four patients did not return for follow-up treatment. Of the remaining 18 patients, 12 had plantar warts, the other six had warts on the hands that were mainly periungual. The median duration of the warts prior to laser treatment was 5 years. The areas treated were solitary in eight and multiple in 10 cases. After an average follow-up period of 10 months (minimum 6 months), all of the treated areas were clear of warts in 10 patients (56%), some had cleared in three, and all the treated warts had relapsed in the other five patients. Side-effects were commonly observed, especially post-operative pain, temporary loss of function of the treated part and scarring. The use of the CO2 laser may clear otherwise resistant viral warts but a significant morbidity may occur with this method of treatment.     

The treatment of common warts with infrared coagulation

Treatment of warts can involve medical and surgical methods. Infrared coagulation is a surgical method very rarely used in the treatment of warts. We planned an open-labeled prospective study to research the effect of infrared coagulation in the treatment of common warts, comparing it with electrocoagulation, and discussing its applicability as an alternative therapy regimen. Eighteen patients with common warts were included in this study. There were 49 warts of various sizes (1 mm to 1 cm) in these 18 patients. Twenty-seven warts were treated with infrared coagulation, and 22 warts were treated with electrocoagulation. Sixteen patients were treated with both infrared coagulation and electrocoagulation; two patients were treated with only infrared coagulation. The patients were followed-up for six months after treatment. Changes in sizes of warts, healing times, and cure rates were compared by Mann-Whitney U test. The mean healing time was 35.5 +/- 5.7 days with infrared coagulation and 32.9 +/- 4.0 days with electrocoagulation. There was not any significant difference between healing times (p > 0.05). Bacterial infection was seen on seven (31.8%) warts treated with electrocoagulation, but no side effects were seen with infrared coagulation. There was a significant difference between side effect rates in two groups (p < 0.01). Nine (33.3%) of the warts treated with infrared coagulation and seven (31.8%) of the warts treated with electrocoagulation recurred in the six-month follow-up period. The overall cure rates at the end of the follow-up period were 66.7% and 68.2% respectively. There was not any significant difference between the cure rates in the two groups (P > 0.05). We conclude that infrared coagulation is a safe and cheap method and should be kept in mind as an alternative modality for the treatment of common warts.