Effectiveness of 100% tea tree oil (Melaleuca alternifolia) versus salicylic acid + lactic acid solution in the treatment of common warts: A randomized controlled trial

Background@#Common warts are a common malady among patients. Not only does it affect the person physically but also mentally and socially. Several treatment modalities are available; however, the major concerns are the treatment cost and adverse effect profile. Salicylic + lactic acid (SLA) solution is one of the standard treatment modalities owing to its strong keratolytic properties; however, its cost and adverse effects limit its use among patients. A cost-effective and safe alternative treatment is ideal to bring about a more favorable clinical outcome and better patient satisfaction. 100% tea tree oil (TTO) solution was used in this study due to its natural antiviral and anti-inflammatory properties.@*Objective@#The study aimed to compare the safety and effectiveness of 100% TTO versus SLA solution in the treatment of common warts.@*Methods@#A total of 17 patients with a total of 74 warts were included in the study. Each wart was assigned to either of the two treatment groups. the SLA group and the 100% TTO group. A treatment period of 6 weeks was used to assess the effectiveness of both treatment groups.@*Results@#The study showed no significant difference between the SLA solution and 100% TTO in the treatment of common warts. The 100% tea tree group reported lesser adverse effects. Both treatment groups reported favorable treatment satisfaction.@*Conclusion@#100% TTO is a potentially safe and cost-effective alternative in the treatment of common warts.

A cross-sectional study on the risk factors and prevalence of common warts / The Health Sciences Journal

INTRODUCTION@#Common warts are frequent benign cutaneous and mucosal infections. However, recommendations from previous studies have focused on personal and public factors to prevent warts and reduce its transmission. This study aimed to determine the prevalence of common warts and its relation to individual, family, school, public, and occupational factors.@*METHODS@#This is a cross-sectional study wherein the cutaneous surfaces (except the mucosa and genitalia) of residents of Barangay Doña Imelda, Quezon City were examined for the presence of warts. Information on individual, family, school, public, and occupational risk factors was obtained from the respondents themselves, parents or guardian using a data extraction sheet. A PRR of > 1.0 was interpreted as a positive association. Chi-square and Fisher’s exact tests were used to test for significance. A p-value of < 0.05 was considered significant.@*RESULTS@#The prevalence of common warts among 315 residents was 7.6 %. The presence of family (PRR = 6.41, 1.91), school (PRR = 1.68), and occupational (PRR = 1.50) factors increased the risk of developing warts. In contrast, a personal history of warts and public factors were not associated with the development of warts.@*CONCLUSION@#The prevalence of common warts is 7.6%, compatible with the results of previous studies. Having a family member with warts, large family size (more than five family members), having at least one closest school friend with warts, and occupation (fish or meat or poultry vendor) increase the risk of developing warts.

A double-blind, randomized controlled trial on the efficacy and safety of intralesional 2% zinc sulfate in the treatment of verruca vulgaris in a tertiary hospital

Background@#Verruca vulgaris ranked 10th in the top 10 diseases in 2019 seen among the Philippine Dermatological Society training institutions. The efficacy of immunotherapy, such as intralesional zinc sulfate (ZS), for warts were reported. Considering the limited studies with promising results on verruca, a study on the efficacy and safety of intralesional zinc in the treatment of verruca was considered.@*Objective@#This study aims to determine the efficacy and safety of intralesional 2% ZS in comparison to intralesional purified protein derivative (PPD) among adult patients with verruca vulgaris.@*Methods@#This is a double-blind, randomized, controlled trial involving 44 patients allocated to group ZS (n=22) and PPD (n=22). Intralesional injections of ZS or PPD to the largest wart were done at weeks 0, 2, 4, 6, 8, 10. Clearance and size reduction of the target and distant wart at 12th week and recurrence at 14th week were assessed. Adverse effects were checked.@*Results@#At the 12th week of treatment, higher proportion in group ZS patients achieved total resolution of the target lesion compared to PPD, but results were not statistically significant (29% vs. 19%). Both groups showed decline in the target lesion size. The median size reduction between the two groups showed no significant differences. Three patients from group ZS showed clearance of distant warts while none in group PPD. There was no recurrence of all previously resolved warts. Adverse reactions were pain, edema, and erythema.@*Conclusion@#Intralesional 2% zinc sulfate (29%) was efficacious and safe compared to Intralesional PPD (19%) but the difference was not statistically significant. There was clearance of distant warts in 5% of group ZS patients. The mild adverse events did not warrant discontinuation of treatment.

A randomized controlled study on the efficacy and safety of zinc oxide 20% ointment versus salicylic acid 15% + lactic acid 15% ointment in the treatment of patients with Verruca vulgaris in a tertiary hospital

Background@#Verruca vulgaris are scaly, rough papules or nodules caused by the human papilloma virus.@*Objective@#To determine the efficacy and safety of topical zinc oxide ointment versus topical salicylic acid + lactic acid ointment as treatment among patients with verruca vulgaris.@*Methods@#This randomized, double-blind, 6-week study involved 29 patients with verruca vulgaris in a tertiary center who received zinc oxide 20% ointment or salicylic acid 15% + lactic acid 15% ointment applied daily and occluded with LeukoplastTM tape. Evaluation was done every two weeks.@*Results@#There was significant decrease in number of warts in the zinc oxide group (p=0.004), while it was not significant in the salicylic acid+lactic acid group (p=0.392). Comparison between the two groups was not significant (p>0.05). Both zinc oxide (P=0.000) and salicylic acid+lactic acid groups (P=0.025) had significant decrease in size of warts from baseline to 6th week of observation. No significant differences were observed between the two groups in terms of adverse events such as erythema (P>0.05), edema (P>0.05), tenderness (P>0.05), and scaling (P>0.05); however, itching was significantly higher at 4th week in the salicylic acid+lactic acid group B (16.7%). Among the zinc oxide group, 100% would recommend the treatment, while only 71.4% would recommend salicylic acid+lactic acid. The satisfaction levels of zinc oxide group were also statistically higher than salicylic acid+lactic acid group (p=0.000).@*Conclusion@#Zinc oxide 20% ointment is a safe and effective option for the treatment of verruca vulgaris especially among patients that would prefer non-traumatic measures in the removal of their warts.

Fire needling stripping after local anesthesia for verruca vulgaris: a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris.@*METHODS@#A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group (300 cases, 2 cases dropped off), a fire needling group (300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group (300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte (CD@*RESULTS@#Compared before treatment, the skin lesion scores were decreased (@*CONCLUSION@#Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.

Efficacy of auto-implantation therapy in the treatment of extensive and recalcitrant verruca vulgaris

Background: Verrucae are benign tumors involving skin and mucous membrane that are caused by human papillomavirus (HPV). Several treatment modalities are available for treating extensive warts, but no single treatment is 100% effective. An ideal treatment should be effective, safe, with less morbidity and provide long-lasting immunity against HPV. This can only be achieved by stimulation of the immune system against the virus. The auto-implantation of warts is one such simple technique where the wart tissue is harvested as a donor and implanted into the uninvolved skin, thereby causing immune stimulation against the virus and resulting in the resolution of extensive and recalcitrant verrucae. Aim: The aim of the study was to evaluate the safety and efficacy of auto-implantation therapy in the treatment of extensiveand recalcitrant verruca vulgaris. Materials and methods: A hospital-based prospective interventional study was carried out on 50 clinically diagnosed patients of extensive verruca vulgaris. Homologous auto-implantation was done over the uninvolved flexor aspect of the forearm skin after harvesting wart tissue up to the level of the papillary dermis. Patients were assessed monthly and resolution after 3 months was considered as complete clearance. Results were analyzed using SPSS version 20.0. Results: Out of 50 patients, 41 patients came for regular follow up whereas 9 patients didn’t turn up for the follow-up. Out of 41 verrucavulgaris patients, 34 showed resolution within 3 months, accounting for a total clearance rate of 82.9%.

Two Cases of Intractable Warts and A Case of Intractable Vaginal Condyloma That Were Cured by Coix-seed Reactive Derivatives (CRD) and Vitamin Combination Therapy / 日本補完代替医療学会誌

We reported 2 cases of intractable warts and a case of intractable vaginal condyloma that were cured by Coix-seed Reactive Derivatives (CRD) and vitamin (folic acid・B1・B6・B12）combination therapy. Further studies are needed to define the efficacy of this treatment.

Unusual presentation of Erythema Elevatum Diutinum mimicking a giant wart on the heels of a Filipino male : A case report

@#Erythema elevatum diutinum (EED) is a rare condition believed to be a form of chronic recurrent leukocytoclastic vasculitis possibly secondary to vascular immune complex deposition. The disease is characterized by symmetrical, red, brownish-purple, and yellow papules, plaques, and nodules distributed mainly over the extensor surfaces of the extremities. We report a 61-year-old male with an atypical presentation of such disease as a giant warty lesion on the heels. Histologically, a spectrum from leukocytoclastic vasculitis to vessel occlusion and dermal fibrosis is seen in EED. These histological findings were present in the histopathological reading of the patient which established its diagnosis and further ruled out verruca vulgaris. The disease is associated with many disease entities, which include human immunodeficiency virus, malignant conditions, chronic infection, and autoimmune and connective tissue disorders. None of these conditions was present in the patient as manifested in the history, physical, and laboratory examinations. However, the patient has a low hemoglobin and a G6PD deficiency which makes him a bad candidate for dapsone therapy which is the main treatment for EED. Tetracycline, niacinamide and plain vaseline + salicylic acid were given initially for 4 weeks but no improvement was noticed. It was then shifted to 10mg intralesional corticosteroid and urea paste 40%. Niacinamide still was given. There was a marked thinning of the lesions. The medications were continued and were slowly tapered. More improvement of the lesions was observed.

Pilomatrixoma quístico con verruga vulgar intraquística: reporte de un caso / Cystic pilomatrixoma with intracystic vulgar wart: case report

El pilomatrixoma es una neoplasia anexial benigna, que habitualmente se presenta como pápula o nódulo subcutáneo, de crecimiento lento y asintomático. Es más frecuente en niños. El diagnóstico se basa en hallazgos clínicos, y la ecografía es útil como examen complementario. El tratamiento es su resección quirúrgica. Se presenta un caso infrecuente de pilomatrixoma quístico con verruga vulgar intraquística en un paciente adulto.

Pilomatricoma is a benign adnexal tumor, usually presenting as a slow growing asymptomatic subcutaneous papule or nodule. It is more common in children. The diagnosis is based on clinical findings, and ultrasound is useful as a complementary workup tool. Its treatment is surgical excision. We present a rare case of a cystic pilomatricoma with an intracystic verruca vulgaris in an adult patient.

Expresión de E-cadherina y células de Langerhans en verruga vulgar y papiloma bucal / Expression of E-cadherin and Langerhans cells in verruca vulgaris and oral papilloma

Introducción: la verruga vulgar y el papiloma bucal son lesiones provocadas por el virus papiloma humano se pueden encontrar presentes en la mayoría de las superfi cies cutáneas y mucosas, su comportamiento biológico es benigno. Las proteínas de adhesión como la E-cadherina, se encargan de mantener la organización y morfología celular, disminuyen su expresión epitelial en ciertas lesiones potencialmente cancerizables, y favorecen la migración e invasión celular ocasionando posiblesmetástasis. Las células de Langerhans, son células presentadoras deantígeno que activan el sistema inmunológico para proteger al organismocontra patógenos o sustancias extrañas. Objetivo: Determinar el grado de expresión de E-cadherina y de células de Langerhans en verruga vulgar y papiloma bucal. Material y métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se incluyeron 16 bloques con tejido incluido en parafi na con diagnóstico de verruga vulgar, ycuatro diagnosticados como papiloma bucal, todos los casos fueron corroborados con la tinción de hematoxilina y eosina. La determinacióndel grado de expresión de las células de Langerhans y E-cadherina se realizó por medio de la técnica de inmunohistoquímica, la valoraciónse llevó a cabo de manera semicuantitativa, y se realizó estadísticadescriptiva. Resultados: La expresión de E-cadherina en verruga vulgar fue intensa tanto en cantidad como intensidad, mientras que en papiloma bucal fue moderada también en ambos casos; las células de Langerhans mostraron una inmunotinción moderada en las lesiones de verruga vulgar en intensidad y cantidad; en el caso de papiloma bucal esta inmunotinción en intensidad y cantidad fue leve. . Conclusiones:Los resultados mostraron que las proteínas de adhesión E-cadherinano pierden su expresión en la verruga vulgar y papiloma bucal, lo cualconfi rma su benignidad...

Introduction: verruca vulgaris and oral papilloma are lesions causedby the human papillomavirus. They can be found on most skin and mucosalsurfaces, and their biological behavior is benign. Adhesion proteinssuch as E-cadherins are responsible for maintaining cell morphologyand organization; they decrease the expression in certain potentiallycancerous epithelial lesions and promote cell migration and invasion,causing possible metastasis. Langerhans cells are antigen-presentingcells that activate the immune system to protect the body againstpathogens or foreign substances. Objective: To determine the degreeof expression of E-cadherin and Langerhans cells in verruca vulgarisand oral papilloma. Material and methods: We performed a descriptiveand retrospective study involving 16 paraffi n-embedded tissue blocksof diagnosed cases of verruca vulgaris and 4 paraffi n-embedded tissueblocks identifi ed as oral papilloma. The diagnosis was previouslyconfi rmed by hematoxylin and eosin staining. The degree of expressionof Langerhans cells and E-Cadherin was determined by immunohistochemistry,while the evaluation was carried out semiquantitatively,with descriptive statistics being performed. Results: The expression ofE-cadherin in verruca vulgaris was strong in terms of both quantityand intensity, whereas in the case of oral papilloma it was moderatefor both. Langerhans cells showed moderate immunostaining for bothintensity and quantity in verruca vulgaris-type lesions, while for oralpapilloma, the immunostaining was also mild in both cases. Conclusions:The results suggest that the expression of E-cadherin adhesionproteins does not diminish in verruca vulgaris and oral papilloma,which confi rms their benignity...

Verruga vulgar bucal, en comisura labial

Se reporta el caso de un paciente masculino de nueve años de edad, el cual presenta neo formación con 6 meses de evolución en comisura labial izquierda, asintomático, quien es referido por su médico del centro de salud al área de estomatología del Hospital Infantil del Estado de Sonora (HIES), para ser valorado por el cirujano maxilofacial. A la exploración clínica, presenta caries múltiples y absceso periapical, además de la neoformación localizada en comisura labial izquierda de aproximadamente 5 cm, sin lesiones semejantes en ninguna otra zona del cuerpo. El paciente se rehabilitó oralmente, en el consultorio y se realizó biopsia excisional de dicha formación. El diagnóstico clínico fue posible virus de papiloma humano. El informe de la biopsia precisó: verruga vulgar bucal.

It has been reported a case of a male patient nine years old, attending IMSS clinic, who was referred from Hospital Infantil del Estado Sonora (HIES) to be evaluated by a maxillofacial surgeon. The patient presents a neomorph with 6 months of evolution in left labial commissure, being asymptomatic. At clinical examination he presented a caries and abscess, also a neomorph in labial commissure of approximately .5cm in diameter and did not presented a similar injury in any part of the body. The patient was rehabilitated and had surgical excision of the injury and subsequent histological analysis of the sample. The clinical presumptive diagnose was Human papillomavirus. Result : oral verruca vulgaris.

Laryngeal Verruca Vulgaris: A Case Report and Review of Literature

Verruca vulgaris of the larynx (VVL) is an extremely rare disease that can be easily misdiagnosed as papillary keratosis, squamous papilloma or verrucous carcinoma, which would have led to needless operation. We experienced a case of VVL in a 66-year-old man with 1-year history of progressive hoarseness. Whitish lesions in both vocal cords were observed by using indirect laryngoscopy and completely removed via microlaryngeal surgery with CO2 laser.

Oral verruca vulgaris: report of two rare cases and review.

Varieties of verrucous and papillary lesions affect skin as well as oral mucosa. These are either benign or reactive. Verruca vulgaris is one of the most commonly observed skin growths, widely known as “wart” and a lesion of childhood. Intraoral warts can occur at any age but are most commonly seen in age group of 30-50 years with equal incidence in both genders. It is found commonly on the palate followed by lip, tongue, buccal mucosa and rarely seen on gingiva. Conservative surgical excision with safe margins is the treatment of choice. Two rare case reports of Verruca vulgaris present on very rare intra oral site, gingiva have been discussed in this article. Key message: Papillary and verrucous lesions are not uncommon in oral cavity but reported cases of oral Verruca vulgaris are very rare. Gingiva is again a very rare site for oral warts.

An assessor-blind, randomized controlled trial on the efficacy and safety of apple cider vinegar vs. salicylic-lactic acid solution in the treatment of common warts (verruca vulgaris)

BACKGROUND: Common warts are among the top causes of dermatologic consultations. Apple cider vinegar is an old time home remedy for various ailments including common warts.Objectives: To compare the safety and efficacy of apple cider vinegar with salicylic-lactic acid solution in the treatment of common warts.METHODS: Twenty-seven patients clinically diagnosed with a total of 88 common warts were assigned randomly for topical application of either apple cider vinegar or salicylic-lactic acid solution which were applied and occluded for 3 consecutive days. Clinical evaluation and curettage were conducted on day 3 and every 3 days thereafter until complete resolution of the lesion for a maximum of 4 weeks. The primary outcome measured in this study was complete clinical cure of the treated wart. One week post-treatment evaluation assessment was also graded as clinical cure, clinical improvement, clinical failure and side effect failure. Adverse events were monitored.RESULTS: In the ACV group, 33 out of 44 (75%) common warts were completely cleared while in the salicylic-lactic acid (SA/LA) group, 26 common warts were completely cleared (59%). There was no significant difference in the cure rates between the two groups (p=0.112, chi-square test). There was no significant difference in the mean time to cure between the two groups, 11 days and 12 days in the apple cider vinegar and salicylic-lactic acid groups, respectively (p=0.090; log rank test). There was no significant difference in the incidence of adverse reactions between the two groups (p=0.676; Fisher's exact test).CONCLUSION: Apple cider vinegar is a safe and effective topical treatment that was comparable to salicylic-lactic acid solution in the treatment of common warts.

Verruca Vulgaris on Top of a Melanocytic Nevus Simulating Melanoma / 대한피부과학회지

No abstract available.

Verrugas vulgares bucales múltiples. Reporte de un caso.

Los virus de papiloma humano son un grupo de virus con genoma de ácido dexosiribonucleico, los cuales necesitan una célula hospedera para reproducirse y multiplicarse. La infección por el virus papiloma humano se ha asociado con lesiones epiteliales hiperplasicas, papilomatosas y carcinomas verrugosos en la piel y en diferentes tipos de mucosas, incluyendo el tracto anogenital, uretra y las mucosas traqueobronquial, nasal, de la laringe y de la cavidad bucal. En la actualidad se han descrito alrededor de 100 tipos de virus papiloma humano. Las verrugas comunes o verrugas vulgares son lesiones de la infancia producidas por los virus papiloma humano 2, 4, y 40, se presentan como nodulos benignos elevados y firmes con proyecciones papilomatosas características en la superficie. El sitio más común de aparición es en la piel de los dedos. Las lesiones orales son relativamente raras y usualmente causadas por autoinoculación a partir de las lesiones de dedos y manos. Nosotros reportamos un caso de múltiples verrugas vulgares bucales, en una niña de 12 años sin lesiones semejantes en ninguna otra zona del cuerpo.

The human papilloma viruses with desoxyribonucleic acid genome which need a host cell for their reproduction and multiplication. The human papilloma virus infection has been associated to epithelium hyperplastic, papillomas and verrucous carcinoma lesions on the skin and differents kind of mucous. Including anogenital tract, uretra and tracheobronquial, nasal, lariyngeal and oral mucous. Currently, about 100 kinds of human papilloma viruses have been described. The common wart or verruca vulgaris are lesions of childhood caused by HPV 2, 4, and 40. These are benign, elevated, firm nodules with characteristic papillomatous surface projections. The most common site of occurrence is the finger. Oral lesions are relatively rare and are usually caused by auto inoculation from lesions on the fingers and hands. We here with report a case of oral verruca vulgaris that occurred in a middle-aged individual without any wart like lesions elsewhere in the body.

Expression of Toll-Like Receptors in Verruca and Molluscum Contagiosum

Recent studies indicate that several Toll-like receptors (TLRs) are implicated in recognizing viral structures and instigating immune responses against viral infections. The aim of this study is to examine the expression of TLRs and proinflammatory cytokines in viral skin diseases such as verruca vulgaris (VV) and molluscum contagiosum (MC). Reverse transcription-polymerase chain reaction and immunostaining of skin samples were performed to determine the expression of specific antiviral and proinflammatory cytokines as well as 5 TLRs (TLR2, 3, 4, 7, and 9). In normal human skin, TLR2, 4, and 7 mRNA was constitutively expressed, whereas little TLR3 and 9 mRNA was detected. Compared to normal skin (NS), TLR3 and 9 mRNA was clearly expressed in VV and MC specimens. Likewise, immunohistochemistry indicated that keratinocytes in NS constitutively expressed TLR2, 4, and 7; however, TLR3 was rarely detected and TLR9 was only weakly expressed, whereas 5 TLRs were all strongly expressed on the epidermal keratinocytes of VV and MC lesions. In addition, the mRNA expression of IFN-beta and TNF-alpha was upregulated in the VV and MC samples. Immunohistochemistry indicated that IFN-beta and TNF-alpha were predominately localized in the granular layer in the VV lesions and adjacent to the MC bodies. Our results indicated that VV and MC skin lesions expressed TLR3 and 9 in addition to IFN-beta and TNF-alpha. These viral-induced proinflammatory cytokines may play a pivotal role in cutaneous innate immune responses.

A Case of Verruca Vulgaris Treated with Imiquimod / 대한피부과학회지

Despite numerous therapeutic options the treatment of verruca vulgaris remains difficult and various treatment modalities are accompanied with substantial pain, tissue destruction and frequent recurrence. Recently imiquimod has been successfully used as topical immune response modifier for the treatment of external anogenital warts with less pain, destruction and fewer recurrent rate. We observed a case of verruca vulgaris on the left palm and the left second toe in a 57-year-old man. He had been treated with keratolytic agent and CO2 laser with little effect. So we tried to treat him with 5% imiquimod cream which was self-applied to the lesions and achieved complete clearance after 4 weeks of the therapy.

Experiences in the Use of Shiun-ko for Verruca Vulgaris / 日本東洋医学雑誌

Twenty-seven cases with verruca vulgaris were examined in which the treatment consisted of oral administration of biscoclaurin alkaloids and Kampo medicine (Jumi-haidoku-to) with Siun-ko ointment. Seven of these cases were cured within one month-12 cases were cured within three months; and 8 cases required more than 3 months for a cure to be effected. However, there were no regressions or ineffective cases. Histopathological features of 5 cases examined after two or four weeks usage of Siun-ko ointment showed swelling of keratinocytes with formation of lacunae or fissures. This combination is thought to be an effective and useful treatment.

Verruca Vulgaris Developed on the Skin Tag

Skin tags are very common skin tumors in middle age. In spite of their frequent occurrence, there was no reported cases of verruca vulgaris developing on the soft fibroma. We report a case of verruca vulgaris developing on the bag-like skin tag. We think that the incidence of HPV infection on the large skin tags may be higher than on normal skin due to their protrusion and repetitive irritation.