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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 -
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 -
Dermatologic Therapy Jun 2022Recent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than... (Meta-Analysis)
Meta-Analysis
Recent systematic reviews of plantar warts continue to consider cryotherapy as one of the treatments of choice, but this method appears to have lower cure rates than alternative treatments. A systematic review using meta-analyses of the efficacy of cryotherapy in plantar warts treatment was performed. Systematic electronic searches were conducted. The primary endpoint was complete clearance of plantar warts. Risk-of-bias assessment was based on Cochrane Handbook recommendations. Meta-analyses used Review Manager v5.4.1 software. Cryotherapy appears to have lower cure rates than other treatments (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.78) with substantial heterogeneity (I = 80%). A second subgroup analysis had low heterogeneity (I = 28.2%). Subgroup analysis showed that plantar wart cure rates were significantly lower with cryotherapy compared to the physical treatment group (OR 0.05, 95% CI 0.01-0.49) with substantial heterogeneity (I = 79%), and antiviral, chemotherapy, and retinoid group (OR 0.30, 95% CI 0.14-0.66) without heterogeneity (I = 0%). Intralesional versus spray-on cryotherapy appears to be more effective (OR 0.21, 95% CI 0.09-0.48). No difference in efficacy between two rounds of 10-s and four rounds of 5-s freeze-thaw cycles in cryotherapy was found. Evidence of the superiority of antivirals and chemotherapy over cryotherapy in the treatment of plantar warts was found. However, no evidence supports the superiority or inferiority of cryotherapy compared to other treatments.
Topics: Antiviral Agents; Cryotherapy; Dermatologic Agents; Humans; Treatment Outcome; Warts
PubMed: 35365922
DOI: 10.1111/dth.15480 -
Clinics in Dermatology 2021Plantar warts are among the most common skin conditions and are classically resistant to treatment. To perform an evidence-based evaluation of the efficacy and safety of...
Plantar warts are among the most common skin conditions and are classically resistant to treatment. To perform an evidence-based evaluation of the efficacy and safety of available treatment options for plantar warts, we conducted a systematic review of PubMed and Cochrane databases to identify large interventional and observational studies involving more than 100 patients who were treated for plantar warts from inception to October 2020. We identified only nine contributions meeting our inclusion criteria (N ≥ 100), representing 1,657 adult and pediatric patients with plantar warts. Treatments included in this review were topical keratolytic agents, cryotherapy, laser therapies, and intralesional and systemic treatments. Our evidence-based review of the larger studies suggests keratolytic agents and destructive treatments, in particular salicylic acid and cryotherapy, remain the primary treatments for plantar warts. Treatment with pulsed dye laser had the lowest rate of recurrence. Newer treatments and intralesional treatments were not represented owing to lack of large studies involving these modalities.
Topics: Adult; Child; Cryotherapy; Dermatology; Humans; Keratolytic Agents; Salicylic Acid; Treatment Outcome; Warts
PubMed: 34809773
DOI: 10.1016/j.clindermatol.2021.05.024 -
Expert Review of Molecular Diagnostics Dec 2021Human papillomavirus has been reported as the etiological cause of most cervical cancers and other potentially malignant lesions. It also affects other areas, producing...
INTRODUCTION
Human papillomavirus has been reported as the etiological cause of most cervical cancers and other potentially malignant lesions. It also affects other areas, producing benign tumors on the skin. Plantar warts are a common problem found in clinical practice and share signs and symptoms with other dermatological conditions. Diagnosis of HPV infection remains a hot topic in research.
METHOD
The present work systematically reviews the literature on the diagnostic techniques available in the clinical setting for any type of lesion produced by the virus and compares the techniques identified to those found in use for foot lesions.
RESULTS
Results showed a variety of diagnostic methods, including molecular techniques, which exhibit more sensitivity than other methods but are less frequently applied to plantar lesions, where visual inspection is the most frequent method but can lead to errors.
CONCLUSION
The techniques identified need to be applied to plantar lesions to improve differential diagnosis in clinical practice.
EXPERT OPINION
Research will continue to grow and a proper diagnostic technique for plantar lesions will be available in the near future.
Topics: Alphapapillomavirus; Female; Humans; Papillomaviridae; Papillomavirus Infections; Uterine Cervical Neoplasms; Warts
PubMed: 34752720
DOI: 10.1080/14737159.2021.2004889 -
Dermatologic Therapy Mar 2021
PubMed: 33810638
DOI: 10.1111/dth.14941 -
Dermatologic Therapy Jan 2021There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the... (Review)
Review
There are a wide variety of treatments for plantar warts, but none has been shown to be effective in all patients. We aimed to perform a systematic review of the efficacy of different topical treatments on plantar warts. Systematic electronic searches (Pubmed, Cochrane Library, Embase, and Web of Science) were conducted in April 2020. Meta-analyses, systematic reviews, and retrospective or prospective clinical trials of the effects of topical and nonsurgical treatments of plantar warts were included. Two authors performed the study selection and data extraction. Any discrepancies between the two reviewers were discussed with a third reviewer. Forty-four studies were included. The average cure rates of the most frequent treatments were variable across the studies: cryotherapy (45.61%), salicylic acid (13.6%), cantharidin-podophyllin-salicylic acid formulation (97.82%), laser (79.36%), topical antivirals (72.45%), intralesional bleomycin (83.37%), and intralesional immunotherapy (68.14%). Twenty-two studies (50%) had a level of evidence 1b and grade of recommendation A, five studies (11.4%) had a level of evidence 2b and grade of recommendation B, two studies (4.5%) had a level of evidence 3b and grade of recommendation B, and 15 studies (34,1%) with a level of evidence 4 and grade of recommendation C. First-choice treatments for common warts, such as cryotherapy and salicylic acid, have low-cure rates for plantar warts. Other treatments, such as CPA formulation, immunotherapy, and intralesional bleomycin, which have compassionate use, have higher cure rates. This review should stimulate future high-quality research to evaluate these specialized treatments.
Topics: Cryotherapy; Humans; Prospective Studies; Retrospective Studies; Salicylic Acid; Warts
PubMed: 33263934
DOI: 10.1111/dth.14621 -
American Journal of Clinical Dermatology Dec 2018Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety...
BACKGROUND AND OBJECTIVE
Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts.
METHODS
We performed a systematic review of studies assessing topical cantharidin treatment of molluscum contagiosum or warts. We searched the databases of Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus. Two authors performed the study selection and data extraction.
RESULTS
Twenty studies (1958-2018) met inclusion/exclusion criteria. Twelve studies assessed warts, and eight studies assessed molluscum contagiosum. Overall, 1752 patients were included (range 0.3-62 years; specified in 15 studies). Clearance rates with topical cantharidin for molluscum contagiosum were variable (range 15.4-100%). Significant clearance of warts with maintenance of clearance was demonstrated with topical cantharidin alone. Topical cantharidin in combination with podophyllotoxin and salicylic acid demonstrated efficacy for plantar warts (pediatric and adult; clearance rate range 81-100%; four studies had 100% clearance), with the majority clearing after a single treatment. Satisfaction with cantharidin therapy was high, especially in molluscum contagiosum. Pain (7-85.7%), blistering (10-100%), and hyper-/hypopigmentation (1.8-53.3%) were the most commonly occurring adverse effects with cantharidin treatment.
CONCLUSION
Topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety.
Topics: Administration, Cutaneous; Blister; Cantharidin; Drug Therapy, Combination; Humans; Incidence; Irritants; Keratolytic Agents; Molluscum Contagiosum; Pain; Patient Satisfaction; Podophyllotoxin; Salicylic Acid; Skin Pigmentation; Treatment Outcome; Warts
PubMed: 30097988
DOI: 10.1007/s40257-018-0375-4 -
Journal Der Deutschen Dermatologischen... Mar 2004(1) Salicylic acid (SA) and 5-Fluorouracil (5-FU) are effective drugs in wart therapy. (2) In Germany, increasing data on the benefit and the economic efficiency of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
(1) Salicylic acid (SA) and 5-Fluorouracil (5-FU) are effective drugs in wart therapy. (2) In Germany, increasing data on the benefit and the economic efficiency of drugs at Level I of evidence-based medicine are needed.
METHODS
Evaluation of the effectiveness and benefits of a drug combination containing 0.5 % 5-FU and 10% SA in the therapy of (a) common and (b) plantar warts in form of a two-step procedure--(1) Systematic literature analysis, (2) Meta-analysis of the randomised-controlled studies (RCTs).
RESULTS
(1) The efficacy of 5-FU/SA therapy was tested in a total of 625 patients (n=8 RCTs) with common warts and 101 patients (n=4 RCTs) with plantar warts. The therapeutic effect across all studies in common warts was 63.4% response (complete healing) for 5-FU/SA vs. 23.1% for the 5-FU-free controls, respectively. In plantar warts, the response was 63.0% vs. 11.0%. (2) A meta-analysis of n=7 RCTs on common warts (n=325 patients) showed a mean risk difference of 0.42 (CI 0.34-0.50, p < 0.05), thus a significant superiority of 5-FU/SA over SA. A comparable result was also found for plantar warts.
CONCLUSION
The combination of 5-FU and SA is an effective and beneficial therapy for common and plantar warts.
Topics: Aspirin; Drug Combinations; Fluorouracil; Foot; Humans; Internationality; Prognosis; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Treatment Outcome; Warts
PubMed: 16281635
DOI: 10.1046/j.1439-0353.2004.04703.x