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Journal of Drugs in Dermatology : JDD Dec 2022Therapies for plantar warts remain subjective and unclear, which has led to continual pursuit of an optimal treatment. As a consequence, many intralesional therapies...
BACKGROUND
Therapies for plantar warts remain subjective and unclear, which has led to continual pursuit of an optimal treatment. As a consequence, many intralesional therapies have emerged over the last decade. This warrants a systematic review from a clinical lens which provides updates on intralesional treatment options for plantar warts from the last decade.
METHODS
A PubMed/MEDLINE literature search was performed, in accordance with PRISMA reporting guidelines for systematic reviews. Original peer-reviewed articles on safety/efficacy of intralesional plantar wart treatments, published from January 2012 to January 2021, were considered for inclusion.
RESULTS
Twenty-6 studies were included and the following intralesional modalities were identified (median cure rates): vitamin D3 (80%), bleomycin (74%), 5-fluorouracil (59%), Candida antigen (66%), zinc sulfate (70%), and purified protein derivative (67%).
CONCLUSION
Intralesional vitamin D3, in particular, demonstrated promising results as a potential second- or even first-line agent although not accessible in the United States. Candida antigen and bleomycin are less effective than intralesional vitamin D3, but given their greater accessibility and superiority to cryotherapy, should continue to be considered for treating recalcitrant plantar warts. Moreover, the quadrivalent human papillomavirus (HPV) vaccine, showing success in case reports, warrants further attention for both the treatment and prevention of plantar warts. J Drugs Dermatol. 2022;21(12):1322-1329. doi:10.36849/JDD.6735.
Topics: Humans; Injections, Intralesional; Warts; Bleomycin; Cryotherapy; Antigens, Fungal; Cholecalciferol; Treatment Outcome
PubMed: 36468966
DOI: 10.36849/JDD.6735 -
BioMed Research International 2022Plantar warts are a common cutaneous disease of the sole of the foot caused by human papillomavirus. Photodynamic therapy has gained increasing attention in the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Plantar warts are a common cutaneous disease of the sole of the foot caused by human papillomavirus. Photodynamic therapy has gained increasing attention in the treatment of plantar warts.
OBJECTIVE
To investigate the effect of photodynamic therapy combined with transfer factor capsules in the treatment of multiple plantar warts.
METHODS
Sixty-one patients with multiple plantar warts who visited our outpatient department from September 2017 to August 2019 were randomly divided into two groups. Twenty-three patients received photodynamic therapy (treatment group) and thirty-eight received cryotherapy (control group). Both groups also received immune modulator transfer factor capsules. Skin lesion score, numeric rating scale- (NRS-) 10 score, recurrence rate, adverse reactions, and Dermatology Life Quality Index (DLQI) were analyzed in both groups.
RESULTS
The mean skin lesion score improved from 13.39 ± 3.88 before treatment to 1.48 ± 2.50 after the last treatment in the treatment group and from 12.47 ± 2.99 before treatment to 4.47 ± 3.67 after the last treatment in the control group. The success rate after 3 months of treatment was 86.96% in the treatment group and 39.47% in the control group. After 3 months of follow-up, the recurrence rate was significantly lower in the treatment group (20%) than in the control group (53.33%). The mean DLQI score at three months after treatment was significantly lower in the treatment group (3.61 ± 1.16) than in the control group (6.31 ± 2.59).
CONCLUSION
Photodynamic therapy combined with immunomodulators significantly increased the cure rate and reduced the recurrence rate of multiple plantar warts compared with traditional cryotherapy combined with immunomodulators.
Topics: Humans; Aminolevulinic Acid; Photochemotherapy; Transfer Factor; Capsules; Warts
PubMed: 36425335
DOI: 10.1155/2022/1220889 -
Journal of Ayub Medical College,... 2022Plantar wart is a common viral infection of the plantar surface of the foot. Multiple treatment modalities are available but there is no definitive management option.... (Comparative Study)
Comparative Study
BACKGROUND
Plantar wart is a common viral infection of the plantar surface of the foot. Multiple treatment modalities are available but there is no definitive management option. The aim of this study is to compare topical adapalene gel 0.1% with cryotherapy in patients presenting with plantar warts in terms of time taken for complete clearance of the lesions.
METHODS
The study was conducted at the Department of Dermatology, PNS Shifa Hospital, Karachi from 28th April to 28th October 2020. Eighty-four patients with plantar warts who fulfilled the inclusion and exclusion criteria were included in the study. Approval from the institutional ethical review committee was sought and written informed consent was taken from all the patients. Patients were divided into two groups, A (Adapalene 0.1% gel) and B (Cryotherapy) of 42 patients each. Adapalene gel was applied twice daily under occlusion at home and cryotherapy was done at the clinic after every two weeks. Patients were followed weekly from the onset of treatment and days taken for complete clearance of plantar warts were noted. Both the groups were compared for the outcome, i.e., time taken for complete clearance of lesions.
RESULTS
The mean time for complete clearance of plantar warts in group A was 35.619±3.154 days and in group B, it was 50.404±3.178 days.
CONCLUSIONS
Adapalene gel 0.1% used for the treatment of plantar warts helped in complete clearance of lesions faster than cryotherapy.
Topics: Humans; Adapalene; Cryotherapy; Foot; Gels; Treatment Outcome; Warts
PubMed: 36377148
DOI: 10.55519/JAMC-03-10167 -
The American Journal of Case Reports Nov 2022BACKGROUND Plantar warts are benign skin tumors caused by the human papillomavirus (HPV). There are multiple treatments, but none ensure absolute success. Successful...
Cantharidin-Podophyllin-Salicylic Acid Formulation as a First-Line Treatment for Plantar Warts? A Case Report with Multiple Plantar Warts of Human Papillomavirus Biotype 27 and Previous Failed Treatments.
BACKGROUND Plantar warts are benign skin tumors caused by the human papillomavirus (HPV). There are multiple treatments, but none ensure absolute success. Successful treatment depends on several factors, such as the location, number of lesions, HPV biotype, and the patient's health condition. This report presents a 53-year-old woman who had multiple recalcitrant plantar warts with HPV biotype 27 that were treated using a cantharidin-podophyllin-salicylic acid (CPS) formulation after 2 failed treatments. CASE REPORT A 53-year-old woman was seen on October 25, 2021. She had 6 plantar warts due to HPV biotype 27, which was confirmed by polymerase chain reaction using a sample of hyperkeratosis scales obtained from the wart after debridement. Five cryotherapy sessions were applied, without clinical improvement. Two sessions of nitric-acid-zinc complex were then applied, from which the patient reported severe pain, without clinical improvement. Finally, 3 sessions of CPS formulation were applied, and the HPV remitted in all warts. CONCLUSIONS Conservative treatments, such as cryotherapy, have not been effective in a case of multiple recalcitrant plantar warts. The combined action of the 3 compounds of CPS formulation was key in the resolution of this case. Plantar wart treatment should be easy to apply, effective, fast, and efficient. In cases of recalcitrant or numerous warts, treatment should be more aggressive from the beginning if the patient's lifestyle allows it. It would be interesting to conduct randomized clinical trials to find out which patients could be indicated for the CPS formulation as a first line of treatment.
Topics: Female; Humans; Middle Aged; Papillomaviridae; Cantharidin; Podophyllin; Alphapapillomavirus; Papillomavirus Infections; Salicylic Acid; Warts; Treatment Outcome
PubMed: 36348614
DOI: 10.12659/AJCR.937867 -
Dermatologic Therapy Dec 2022Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.;...
Despite the considerably high prevalence of cutaneous warts, no optimally effective and safe treatment is available. Leaves of date palm (Phoenix dactylifera L.; Arecaceae) have long been used in Iran's folk medicine as a remedy for warts. To assess the state-of-the-art evidence on using P. dactylifera L. for warts, we conducted a systematic review using CINAHL (via EBSCO), Embase, Medline (via PubMed), ProQuest, Scopus, and Web of Science. We conducted an open-label uncontrolled pilot clinical study to evaluate the efficacy and safety of a proprietary topical date palm leaf-based ointment for the treatment of various types of nongenital warts. This study consisted of an 8-week treatment phase and a 4-week follow-up phase. The assessed outcomes included complete clearance, patient satisfaction (on Likert scale), and the occurrence of any adverse effect. The systematic review demonstrated that the effects of date palm on warts have not been scientifically studied. Thirty patients entered the study with a mean age of 29.5 years (SD = 14.04); among which 17 were female and 13 were male. The patients presented diverse types of warts: verruca vulgaris 15 (50%), plantar 9 (30%), plane 2 (7%), periungual 2 (7%), and warts at multiple sites 2 (7%). In this trial, 19 patients (63.3%) experienced complete clearance and 5 patients (16.6%) experienced partial clearance. Eight patients (26.67%) dropped out during the study. 21 (70%) patients were very satisfied (score on Likert scale = 5) while 1 (3.3%) patient with partial clearance was somewhat satisfied (score on Likert scale = 4). No adverse effect was observed. The results of this pilot study indicate that the date palm leaf-based ointment is a promising treatment whose efficacy and safety should be further investigated in a randomized controlled clinical trial.
Topics: Humans; Male; Female; Adult; Phoeniceae; Ointments; Pilot Projects; Warts; Plant Leaves; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36346021
DOI: 10.1111/dth.15968 -
Frontiers in Bioengineering and... 2022Microneedles have garnered significant interest as transdermal drug delivery route owing to the advantages of nonselective loading capacity, minimal invasiveness, simple... (Review)
Review
Microneedles have garnered significant interest as transdermal drug delivery route owing to the advantages of nonselective loading capacity, minimal invasiveness, simple operation, and good biocompatibility. A number of therapeutics can be loaded into microneedles, including hydrophilic and hydrophobic small molecular drugs, and macromolecular drugs (proteins, mRNA, peptides, vaccines) for treatment of miscellaneous diseases. Microneedles feature with special benefits for cutaneous diseases owing to the direct transdermal delivery of therapeutics to the skin. This review mainly introduces microneedles fabricated with different technologies and transdermal delivery of various therapeutics for cutaneous diseases, such as psoriasis, atopic dermatitis, skin and soft tissue infection, superficial tumors, axillary hyperhidrosis, and plantar warts.
PubMed: 36324904
DOI: 10.3389/fbioe.2022.1032041 -
Indian Dermatology Online Journal 2022
PubMed: 36226009
DOI: 10.4103/idoj.idoj_311_21 -
Cutis Aug 2022
Topics: Foot Diseases; Gout; Humans; Injections, Intralesional; Papillomavirus Vaccines; Symptom Flare Up; Warts
PubMed: 36219651
DOI: 10.12788/cutis.0595 -
Journal of Evidence-based Medicine Sep 2022Cutaneous warts caused by human papillomavirus are benign proliferative lesions that occur at any ages in human lives. Updated, comprehensive and systematic...
AIM
Cutaneous warts caused by human papillomavirus are benign proliferative lesions that occur at any ages in human lives. Updated, comprehensive and systematic evidence-based guidelines to guide clinical practice are urgently needed.
METHODS
We collaborated with multidisciplinary experts to formulate this guideline based on evidences of already published literature, focusing on 13 clinical questions elected by a panel of experts. We adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to form classification of recommendations as well as the improved Delphi method to retain respective recommendations with a consensus degree of over 80%.
RESULTS
Our guideline covered aspects of the diagnosis and treatment of cutaneous warts such as diagnostic gold standard, transmission routes, laboratory tests, treatment principle, clinical cure criterion, definitions, and treatments of common warts, flat warts, plantar warts, condyloma acuminatum, and epidermodysplasia verruciformis. Recommendations about special population such as children and pregnant women are also listed. In total, 49 recommendations have been obtained.
CONCLUSIONS
It is a comprehensive and systematic evidence-based guideline and we hope this guideline could systematically and effectively guide the clinical practice of cutaneous warts and improve the overall levels of medical services.
Topics: Child; Female; Humans; Papillomaviridae; Pregnancy; Warts
PubMed: 36117295
DOI: 10.1111/jebm.12494 -
Dermatologic Therapy Nov 2022Plantar warts continue to represent a therapeutic challenge due to treatment resistance and high recurrence rates. Intralesional methotrexate, a cytotoxic...
Plantar warts continue to represent a therapeutic challenge due to treatment resistance and high recurrence rates. Intralesional methotrexate, a cytotoxic chemotherapeutic agent with in-vitro anti-viral properties has been used for many dermatological indications. Two previous studies evaluated intralesional injection of diluted methotrexate (in 0.5, 1, and 2 mg/ml dilutions) in the treatment of warts and found it poorly effective. The concentrations used in these studies were much lower than those used for other indications. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional injection of full concentration (25 mg/ml) methotrexate in the treatment of plantar warts. Twenty patients with plantar warts, 10 (50%) males, and 10 (50%) females, with mean ± SD age of 28.45 ± 8.66 years (range, 18-46 years) received biweekly sessions of intralesional methotrexate (25 mg/ml) until complete clearance or for a maximum of 6 sessions. Complete clearance of warts was achieved in 2 (10%), 6 (30%), and 7 (35%) patients after 4, 5, and 6 sessions, respectively. Another 8 (40%) patients showed partial improvement after 6 sessions. The response rate did not correlate significantly with the number of warts. Nine (45%) patients did not report any side effects. Pain and bruises were reported by 8 (40%) and 6 (30%) patients, respectively. These findings suggest that biweekly sessions of full (25 mg/ml) concentration of methotrexate are a safe and effective treatment for plantar warts. It may be considered an alternative line of treatment for resistant cases.
Topics: Male; Female; Humans; Adolescent; Young Adult; Adult; Middle Aged; Pilot Projects; Methotrexate; Prospective Studies; Warts; Injections, Intralesional; Treatment Outcome
PubMed: 36101002
DOI: 10.1111/dth.15815