Successful treatment of plantar warts using topical Zijinding, a traditional Chinese medicine preparation: A case series.

INTRODUCTION: Plantar warts are associated with high transmissibility and morbidity. Among the available therapeutic options, none is uniformly effective or virucidal. Salicylic acid is the first-line therapy but approximately one-third of lesions could not resolve and become recalcitrant despite repeated treatment. Cryotherapy is widely accessible with low cost but may be complicated by pain, blister formation, hemorrhage, infection, excessive granulation tissue formation, and hyper-/hypo-pigmentation. Hence, alternative treatment modalities are essential. METHODS: Three patients with debilitating plantar warts refractory or intolerant to cryotherapy were treated with a course of Zijinding (a traditional Chinese medicine preparation) paste prepared with white vinegar. RESULTS: All three patients showed excellent clinical response with Zijinding application with evolution of lesions to scabs and subsequently healthy skin within 1.5 to 5 months of treatment. Treatment was well tolerated and had no significant side effects with excellent compliance recorded for all three patients. There was no relapse for at least 10 months after stopping the treatment. CONCLUSION: Topical Zijinding could be a promising alternative modality for the treatment of plantar warts. Further clinical trials on the comparison of Zijinding and other treatment modalities of plantar warts are warranted. Further studies are required to investigate the mechanism of action of Zijinding and to isolate the active ingredient.

Real versus sham proximal biofield therapy in the treatment of warts of the hands and feet in adults: study protocol for a randomized controlled trial (MAGNETIK study).

BACKGROUND: Despite the lack of scientific studies on biofield therapies, they are widely acclaimed by patients. The mechanisms of action are not explained by current allopathic medical approaches. Warts are common and contagious viral lesions that may be refractory to standard dermatologic treatments such as cryotherapy, laser therapy, and keratolytic ointments. Biofield therapies are efficient in various pathologies. Their ability to treat warts has never been demonstrated in a scientific study with a robust methodology. Patients with refractory warts often place their trust in these alternative therapies because of the poor results obtained from traditional medicine. We propose a prospective, randomized, single-blind, assessor-blind trial to evaluate the efficacy of treatment of warts by biofield therapy. METHODS/DESIGN: Subjects with warts on their feet or hands will be randomized into two groups: real biofield therapy versus sham therapy. The diagnosis will be made at the time of inclusion, and follow-up will take place in week 3. Comparison of pictures of the warts at baseline and after 3 weeks will be used as the primary outcome measure. The hypothesis is that the extent of the disappearance of the original wart in the group treated by real biofield therapy will be 70% and that it will be 30% in the group treated by sham therapy. Using 90% power and an alpha risk of 5%, 31 subjects are required in each group for a two-tailed proportion comparison test. DISCUSSION: To our knowledge, this is the first study to evaluate the efficacy of biofield therapy on warts. Therefore, the aim of this study is to extend knowledge of biofield therapy to another area of medicine such as dermatology and to propose complementary or alternative practices to improve patient well-being. The main strength of the study is that it is a randomized, single-blind, assessor-blind, placebo-controlled study. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02773719 . Registered on 22 April 2016.

The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.

Viral warts or verruca pedis (plantar warts) are common skin conditions seen in both children and adults. Human papilloma virus (HPV), a DNA virus, is responsible for plantar verrucae. It needs an epidermal abrasion and a transiently impaired immune system to inoculate a keratinocyte. These entities are a therapeutic conundrum for many practitioners. This article discusses HPV infiltration and its subtypes involved in plantar warts; the evaluation of patients with plantar warts; and subsequent treatment options, such as laser, Candida albicans immunotherapy, topical therapy such as phytotherapy, and surgical excision.

Intensive local thermotherapy cleared extensive viral warts in a patient with systemic lupus erythematosus.

PURPOSE: A variety of medications and procedures are available for the treatment of warts, but it appeared the treatment response in systemic lupus erythematosus (SLE) patients is poor. It is necessary to investigate the feasibility, safety and efficacy of local thermotherapy for extensive viral warts. MATERIALS AND METHODS: A SLE patient on systemic steroid developed extensive viral warts on both her hands and feet for months. She had a high score of SLE Disease Activity Index (SLEDAI), up to 30, and was extensively treated with high and prolonged dosage of corticosteroid and intermittent use of cyclophosphamide. We applied local hyperthermia at 44 °C on a target lesion for 30 min on days 1, 2, 3, 17, 18, a protocol which has been successfully used in treating viral warts. There was no sign of clinical response in a 3-month follow-up. Then we treated the patient on a once-a-week protocol. RESULT: All the lesions cleared in ten weeks and there was no sign of recurrence. CONCLUSION: This observation suggests that more intensive local hyperthermia is required for clearing viral warts in SLE.

One stone, two birds: managing multiple common warts on hands and face by local hyperthermia.

A man developed with multiple warts on his hands and the inner canthus of his left eye. We applied local hyperthermia on a single target lesion on his hand at a surface temperature of 44 °C for 30 minutes on Days 1, 2, 3, 17, and 18. All the lesions treated with or without heat cleared 8 weeks after the last treatment. Treatment of a target lesion resolved all other untreated lesions, a fact suggestive that local hyperthermia could induce activation of specific immunity against human papillomavirus on the lesional skin, which lead to resolution of all the warts.

[Verruca planae Chinese medicine treatment].

OBJECTIVE: Flat wart on the effectiveness of TCM treatment. METHODS: Outpatients will be by the "People's Republic of China Chinese medicine industry standards, TCM diagnosis of dermatological diseases efficacy standards, Chen Hou State Administration of Traditional Chinese Medicine 1994-06-28 approved, 1995-01-01 implementation". Randomly divided into two groups. Treatment and control groups. Treatment groups treated with Chinese herbs. The control group were treated with WM. Since the preparation of the unification formula ointment, cuboiling method. Chinese herbal medicine preparation by my hospital room Producer. 5 g pre pack, after treatment for 30 days, clinical observation. RESULTS: The group of Chinese medicine is better than western medicine (86.7% vs 71.7% , P < 0.05). CONCLUSION: Chinese medicine has some effect flat wart.

Pulsed dye laser treatment is effective in the treatment of recalcitrant viral warts.

BACKGROUND: Verrucae vulgaris can be removed in a variety of ways but a specific therapy of choice has not yet been developed. Doctors are faced with a challenge, especially in the treatment of recalcitrant warts. It has been suggested that the success of pulsed dye laser treatment lies in the fact that warts contain an increased number of dilated blood vessels. METHODS: Seventy-three patients (42 female, 31 male) with verrucae vulgaris on their hands or feet (1:1.5) were given a maximum of 12 treatments with a flashlamp-pumped pulsed dye laser every 2 weeks over a period of 24 weeks until complete clearance had been achieved. A laser energy density of 8 to 12 J/cm2 with a spot size of 5 mm and a pulse duration of 450 microsec were used. The minimum follow-up period was 6 months. RESULTS: A total of 15.1% patients achieved complete clearance after 1 session and 47.9% after 2 to 5 sessions, resulting in a remission of 63.0% patients after a maximum of 5 treatment sessions. A remission of 23.3% patients was seen after 6 to 9 treatments and a total of 89.0% of patients showed remission after a maximum of 10 sessions. Only three patients (4.1%) failed and five patients (6.9%) stopped the treatment on account of pain/noncompliance. Only one patient, from a group of patients treated between January 2003 and April 2004, has relapsed. CONCLUSION: Pulsed dye laser treatment is effective and safe in the treatment of recalcitrant viral warts.

Psychotherapeutic intervention for numerous and large viral warts with adjunctive hypnosis: a case study.

Psychotherapy with adjunctive hypnosis is known to be an effective approach for the treatment of viral warts. There is an increasing clinical and scientific literature that illustrates the successful use of psychotherapeutic treatment with and without hypnosis in the reduction or elimination of viral warts (Bloch, 1927; Chandrasena, 1982; Clawson & Swade, 1975; Dreaper, 1978; Ewin, 1992; Ewin, 1995; and Goldstein, 2005; Obermayer & Greenson, 1949; McDowell, 1949; Reid, 1989; Scott, 1960; Spanos, Stenstrom & Johnston, 1988; Spanos, Williams & Gwynn, 1990; Surman et al., 1973; Morris, 1985; Noll, 1994; Noll, 1988; O'Laughlan, 1995; Tasini & Hackett, 1977; Vollmer, 1946; Yalom, 1964). In this case study the veracious area experienced a 100% reduction in five treatment sessions spanning a total of seven weeks. In this case, psychotherapy with hypnotic treatment relied upon an emphasis on two interventions: reduction of wart area with guided imagery and suggestions for the optimization of the client's immune system functioning. Photos illustrate the client's pre-treatment, mid-treatment, and post-treatment state. Causal factors in the client's recovery cannot be easily isolated but the startling results attest to the efficacy of the overall interventions and treatment context compared to prior medical interventions.

What's new in human papillomavirus infection.

Warts continue to be a therapeutic challenge, especially widespread warts on children. A single, most effective treatment has not been defined. Conventional methods attempt to nonspecifically destroy infected tissue. Most of these procedures are painful, poorly tolerated by children, and often require multiple treatments. The efficacy of destructive techniques is impossible to verify in controlled clinical trials. Uncontrolled success rates are suboptimal and often no better than that seen with placebos. Alternative pharmacologic approaches have been designed to stimulate immunologic responses or provide anti-viral activity. Further study is needed to establish efficacy of these treatments.

Topical effects of cidofovir on cutaneous rabbit warts: treatment regimen and inoculum dependence.

The present study examined topical effects of cidofovir on cutaneous rabbit warts. Based on an inoculum-dependency study, each New Zealand White rabbit was inoculated with a high and low titer of cottontail rabbit papillomavirus (CRPV) at four sites on each dorsolateral area. Inoculation with 50 ID(50) induced papillomas at 100% of the inoculation sites within 16+/-1 days, and the wart growth curve plateaued within approximately 7 weeks. With an inoculum of 5 ID(50), 80% of the inoculated sites developed papillomas within 21+/-1 days and their size plateaued at a later time. Cidofovir was applied topically twice daily on the inoculated sites at a concentration of 1% for 18 days, starting at three different time points. In the first experiment, treatment was initiated 7 days post-inoculation. One of the inoculated sides received cidofovir or the vehicle, PBS, while the other side was left untreated. With this treatment regimen, cidofovir significantly delayed the time of onset and the growth rate of papillomas induced with the high titer of inoculum. It completely prevented papilloma-induction on the sites inoculated with the low titer of CRPV. Reversible side-effects of cidofovir were observed on the directly treated area including erythema, necrosis, and flaking. Both therapeutic and side-effects were limited to the sites of direct exposure. In the second experiment, one of the two sides in each group of rabbits received cidofovir or vehicle starting on day 29 post-inoculation. With this treatment regimen, cidofovir significantly reduced wart growth against the low titer only. Topical treatment initiated on day 49 post-inoculation was not effective on warts initiated with either viral titer. These results demonstrated that topical cidofovir could be very effective against papillomavirus-induced wart growth if it is initiated early during the infection, especially against low titers of inoculum.

Density of viral particles in pre and post Nd: YAG laser hyperthermia therapy and cryotherapy in plantar warts.

BACKGROUND: Warts often present a difficult treatment problem for clinicians because of the lack of specific antipapillomavirus agents. Plantar warts, in particular, represent a therapeutic challenge. METHODS: Twenty-five patients with plantar warts were treated with Nd:YAG hyperthermia and another 25 were treated with cryotherapy. Biopsies were taken before and after treatment in both groups and were examined for the presence of human papillomavirus deoxyribonucleic acid (HPV DNA) using in situ hybridization (ISH). RESULTS: HPV DNA was detected in 100% of untreated warts and in 96% of cryotreated warts, but was not detected in any of the hyperthermia-treated warts. CONCLUSIONS: HPV is more vulnerable to hyperthermia than to cryotherapy.

Resolution of recalcitrant hand warts in an HIV-infected patient treated with potent antiretroviral therapy.

Human papilloma virus (HPV)-related cutaneous manifestations occur with increased frequency and severity among HIV-infected persons. In this report, we describe an HIV-infected man with persistent, severe cutaneous hand warts that did not respond to multiple therapies, including liquid nitrogen cryotherapy, topical dinitrochlorobenzene, topical podophyllin, and intralesional interferon-alfa injections. Approximately 1 year after starting a potent protease inhibitor-containing antiretroviral regimen, the patient's recalcitrant cutaneous warts markedly diminished in size, even though the patient did not receive any specific therapy for the warts after starting aggressive antiretroviral therapy. The patient continued on a potent protease inhibitor-containing antiretroviral regimen and, approximately 2 years later, the warts completely resolved. Our patient's dramatic clinical improvement of cutaneous HPV infection that followed protease inhibitor-containing antiretroviral therapy provides a clear-cut example that protease inhibitor-containing combination antiretroviral therapy can produce significant clinical benefit.

Hyperthermia therapy for warts utilizing a self-administered exothermic patch. Review of two cases.

BACKGROUND: Hyperthermia therapy was described previously to be effective for treating warts using a hot water technique as well as an ultrasound hyperthermia technique. Recently, two other papers described controlled localized heat therapy for cutaneous warts. A new heat-generated application system and method has been developed for treating warts using a self-administered, self-adhesive disposable exothermic patch. OBJECTIVE: The objective of this study was to describe our clinical experience in using the exothermic patch to successfully treat patients with cutaneous recalcitrant warts who failed to respond to multiple antiwart therapy. METHODS: Two patients with recalcitrant warts that did not respond to other therapeutic modalities were treated with the exothermic patch with complete remission of their warts. Exothermic patches were used in this study that were specially constructed to provide long-lasting, continuous, and reproducible heating of the skin surface for at least 2 hours at a temperature level of 42-43 degrees C, which will not burn or otherwise injure the skin. CONCLUSIONS: Warts are difficult to treat in part because there are no specific anti-Papillomavirus drugs or methods available. We describe our clinical experience in successfully treating two patients with recalcitrant warts using the exothermic patch.

Primary care treatment approach to nongenital verruca.

Nongenital verruca is a common ailment frequently encountered in the primary care setting. Although greater than half of verruca resolve spontaneously within a 2-year period, many have a propensity to spread and cause considerable discomfort if untreated. This characteristic makes it vital for the clinician to become competent in assessment and treatment of verruca. This article discusses etiologic and epidemiologic factors, diagnosis and prevention considerations, folk remedies, and common treatment options for the management of verruca. Included is a patient-teaching handout to offer the patient when dual office and home therapy is chosen. This article also reviews the newest treatment option, Cimetidine (Tagamet). Current research with this H2 antagonist offers hope for easier and less costly management of recalcitrant verruca.