Plantar warts successfully treated with bee venom: A case report.

BACKGROUND: Plantar warts, or verruca plantaris, are common cutaneous lesions of the plantar surface caused by the human papilloma virus (HPV) infection. Current treatments include salicylic acid, cryotherapy, bleomycin, and immunotherapy; however, they have limitations of low-cure rates or side effects. Plantar warts treated with bee venom (BV) have not been reported. Here we present a case of a patient who showed complete remission of multiple plantar warts after BV treatment. CASE PRESENTATION: A 13-year-old boy experienced total of 16 plantar warts and visited department of dermatology of Korean Medicine. BV was injected into wart sites. Warts were completely removed at the end of the 8-week treatment with no adverse event recorded. There was improvement during the follow-up after 4 weeks. CONCLUSION: This is the first case of plantar warts that improved with BV injection. This study suggests that BV may be a therapeutic option for individuals who cannot receive cryotherapy due to pain during and after treatment or who have refractory or relapsed warts.

Nowarta110 Topical Versus Placebo for the Treatment of Plantar Warts: A Phase I/II Randomized Controlled Clinical Trial.

BACKGROUND/AIM: Plantar warts are cutaneous lesions on the plantar aspect of the foot caused by the infection of keratinocytes with the human papillomavirus (HPV). The severity and magnitude of warts can vary, but they cause pain and discomfort for all age groups. The treatment for plantar warts remains a continuing challenge. The purpose of this research was to compare the efficacy and safety of naturally derived Nowarta110 topical formula versus a matching placebo in treating plantar warts. PATIENTS AND METHODS: The study is a randomized, double-blind, parallel assignment control interventional phase I/II clinical trial. This study included 54 patients with plantar warts. Patients were randomized to two groups: the placebo group, which included 26 patients treated with a matching placebo and the Nowarta110 group, which included 28 patients who received topical Nowarta110. The diagnosis of plantar warts was made by clinical examination. The treatment's efficacy and safety were assessed every week and after 6 weeks from the initiation of the intervention. RESULTS: In the Nowata110 group, 18 patients (64.3%) were completely cleared of their warts, and 10 patients (35.7%) partially responded to the therapy with a 20% to 80% decrease in warts dimensions. In the placebo group, only 2 patients (7.7%) were completely cleared of their warts, and 3 patients (11.5%) partially responded to the intervention with a 10% to 35% decrease in warts dimensions. The difference was highly significant between the two groups. There was 1 event with minor pain as a side effect in the Nowarta110 group and 9 events of non-serious local side effects in the placebo group, which included 2 patients who dropped out. CONCLUSION: Topical Nowarta110 is a safe, well-tolerated, and highly effective therapeutic modality in treating refractory and recurrent plantar warts. The breakthrough findings of the study encourage further extensive clinical trials to fully explore the prospect of Nowarta110 in managing all types of warts and HPV-related diseases.

Effectiveness and safety of topical application of diphenylcyclopropenone versus podophyllin in treatment of genital warts.

BACKGROUND: Many therapeutic modalities are available for treating genital warts; however, the effectiveness of both diphenylcyclopropenone and podophyllin is still controversial. AIM: To evaluate the effectiveness and safety of diphenylcyclopropenone and podophyllin in treating genital warts. METHODS: This study included 57 patients, divided randomly into two groups. Group (A): diphenylcyclopropenone (n = 29). Group (B): podophyllin 25% (n = 28). In group (A), sensitization was done with 2% diphenylcyclopropenone. Then, after 1 or 2 weeks, treatment started with a weekly application of diphenylcyclopropenone solutions ranging between 0.001 and 1% until clearance, or for a maximum of 10 sessions. In group (B), podophyllin 25% was applied weekly until clearance or for a maximum of 6 weeks. RESULTS: Higher clearance was achieved in group A, with 19 of 29 (65.5%) patients, than in group B, with 9 of 28 (32.1%) (p-value = 0.004). Also, effectiveness increases with young age in group A. Shorter wart duration was associated with better response in both groups (p-value = 0.005). No serious adverse effects occurred in either group. No recurrence was detected in group A, while seven patients (77.8%) had recurrence in group B after 1 year of follow up. CONCLUSION: Diphenylcyclopropenone shows a higher success rate than podophyllin in treating genital warts and a lower recurrence rate.

Trends of genital wart in Korea according to treatment method classification: Big data analysis of health care in 2010-2019.

PURPOSE: The purpose of this study is to investigate disease trend of genital wart through changes in each treatment method over the past 10 years in Korea. MATERIALS AND METHODS: From 2010 to 2019, surgical treatment including cauterization, excision, cryotherapy, and laser therapy, non-surgical treatment such as podophyllin, and surgical treatment for anorectal lesion were extracted and analyzed from 2010 to 2019. For each treatment method, characteristics such as sex, age, region, medical cost and average number of procedures were analyzed. RESULTS: The number of patients following all treatment modalities increased every year. Surgical treatment of genital wart and anorectal wart showed a significant increase in male patients. Number of non-surgical treatment decreased in males but increased in females. Surgical removal of the anorectal wart increased more than 250% in over 10 years, and males underwent surgery 4 times more than females. In both surgery and non-surgery, the mean session was higher in males. Most of them were carried out in primary medical institutions. In Seoul and Gyeonggi-do, the largest number of patients received treatment regardless of treatment method. CONCLUSIONS: Treatment for genital warts has increased rapidly over the past 10 years, and the increase in males is remarkable. The main treatment was surgery, and males mainly received surgical treatment, and females mainly received drug treatment. The primary medical institution was in charge of the most treatment. As the number of patients and related medical expenses are increasing rapidly, more attention and response to diseases are needed.

A multi center real world observation to evaluate the efficacy of cryotherapy versus local hyperthermia for the treatment of plane warts.

Most plane warts are recalcitrant to treatment. Both cryotherapy and local hyperthermia have been applied to treat plane warts. However, no direct comparative study on their respective efficacy and safety has ever been performed. To assess the efficacy and safety of local hyperthermia at 43 ± 1°C versus liquid nitrogen cryotherapy for plane warts. Sequential patients with plane warts entered the study, either receiving cryotherapy or local hyperthermia therapy at the discretion of the patients and the recommendations of consultants. Cryotherapy with liquid nitrogen was delivered in two sessions 2 weeks apart, while local hyperthermia was delivered on three consecutive days, plus two similar treatments 10 ± 3 days later. The temperature over the treated skin surface was set at 43 ± 1°C for 30 min in each session. The primary outcome was the clearance rates of the lesions 6 months after treatment. Among the 194 participants enrolled, 183 were included in the analysis at 6 months. Local hyperthermia and cryotherapy achieved clearance rates of 35.56% (48/135) and 31.25% (15/48), respectively (p = 0.724); recurrence rates of 16.67% (8/48) and 53.33% (8/15) (p = 0.01); and adverse events rates of 20.74% (28/135) and 83.33% (40/48), respectively (p < 0.001). Cryotherapy had a higher pain score (p < 0.001) and a longer healing time (p < 0.001). Local hyperthermia at 43°C and cryotherapy had similar efficacy for plane warts. Local hyperthermia had a safer profile than cryotherapy but it required more treatment visits during a treatment course. More patients preferred local hyperthermia due to its treatment friendly nature.

An Alternative Treatment for Vaginal Cuff Wart: a Case Report.

Human papillomavirus (HPV) has been directly related to acuminate warts and cervical cancer, the second most common neoplasia among women. Given the lack of treatment against the virus itself, many medications have been utilised, mainly aiming in modifying the host's immunological response. We present the case of a 54 years old postmenopausal patient with a history of vaginal cuff wart and HPV persistence that we managed in our clinic for 6 months with a mix of curcumin, aloe vera, amla and other natural ingredients. As the patient was found to be intolerant to imiquimod (one of the most common conservative methods of treatment) we attempted the use of curcumin, which was applied to the area of the wart three times per week for 6 months. Both clinical and colposcopical improvement was noted in regular clinic visits with regression of the lesion. The outcome of this case encourages our view that curcumin should be considered as a significant treatment modality against HPV infection and acuminate warts.

Recent patents in anti-wart treatment.

Warts, small skin protuberances caused by human papillomavirus, are not life-threatening, but can be unsightly, embarrassing, uncomfortable and potentially contagious. They may regress naturally but over a prolonged time. Hence wart-afflicted people seek prescribed or over-the-counter therapies. Out of the innumerable marketable anti-wart medications, only a few are effective. Besides, frequent applications over months and certain undesirable side effects limit their success rates. Recurrences are also known. Hence the search for an effective, safe, cheap and quick medicine that is easy to apply continues. A number of patents for anti-wart therapies have been filed in the last few years. In this article, we enlist the recent anti-wart patents and find out those holding promise in the future.

Comparative proteomic analysis of resistant and susceptible potato cultivars during Synchytrium endobioticum infestation.

MAIN CONCLUSION: We report the first comparative study of protein expression profiles in tuber sprouts between Katahdin-derived potato cultivars resistant and susceptible to Synchytrium endobioticum. Synchytrium endobioticum causes wart disease in potato (Solanum tuberosum L.) and is considered as the most important quarantine pathogen in almost all countries where potatoes are grown. We performed a comparative analysis of differentially expressed proteins in the tuber sprouts of potato cultivars differing in resistance to pathotype 1(D1) of S. endobioticum using two-dimensional electrophoresis (2-DE) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) approaches. Bulks prepared from two resistant (Calrose and Humalda) and three susceptible (Sebago, Seneca and Wauseon) potato cultivars were studied. When protein profiles were compared between mock- and S. endobioticum-inoculated sprouts, 35 and 63 protein spots, indicating qualitative or quantitative differences, were detected in the resistant and susceptible cultivars, respectively. In turn, 24 proteins associated with resistance to S. endobioticum were revealed by comparison of the resistant and susceptible bulks. These proteins were changed in a constitutive or induced manner and were grouped into four categories: stress and defence, cell structure, protein turnover, and metabolism. Among the 13 proteins classified into the stress and defence group, seven proteins were related to heat-shock proteins (HSPs)/chaperone factors. In addition, four proteins, S-adenosyl-L-homocysteine hydrolase-like, superoxide dismutase [Mn], inactive patatin-3-Kuras 1 and patatin-15, were induced in the resistant bulk; whereas two proteins, patatin-01 and nucleoredoxin 1, showed significant differences in expression between the S. endobioticum-inoculated resistant and susceptible bulks. The detection of such a large number of S. endobioticum-mediated proteins representing the HSP70, HSP60 and HSP20 families suggests their significant role in restricting wart disease in potato tubers.

Low dose isotretinoin as an adjuvant therapy for treatment of different clinical variants of warts: A case series.

Warts constitute the most frequently observed dermatological manifestations of human papillomavirus (HPV). Although an extensive range of treatments exist for local warts, there is no specific therapy based on high-quality evidence of notable treatment success or high cure rate, or minimal adverse effects. Recalcitrant warts are, therefore, a common therapeutic problem. This case series refer to 14 immunocompetent patients with recalcitrant warts, who experienced full resolution of their warty lesions when treated with addition of low dose isotretinoin, in a dose of 0.1-0.2 mg/kg/day, for a 3-month course, with no significant adverse effects. Long-term remission was noted for up to 3 years with no signs of active lesions. Low dose isotretinoin should be in the priority of the treatment options of recalcitrant warts, alone or in combination.

The efficacy of vaginal suppository based on myrtle in patients with cervicovaginal human papillomavirus infection: A randomized, double-blind, placebo trial.

Human papillomavirus (HPV) can be detected in most of cervical cancers. Due to antiviral, antimutagenic, and proapoptotic activities of myrtle, this study was designed to investigate the effect of a herbal suppository based on myrtle in cervicovaginal HPV infections. This study was performed as a double-blind randomized trial at the Clinic of Traditional Medicine in Mashhad University of Medical Sciences between 2016 and 2017. Sixty women, 18 to 50 years old, with cervicovaginal HPV infection, were included and randomly allocated to two groups. Sixty placebo or herbal vaginal suppositories were prescribed for 3 months (20 suppositories at each menstrual cycle). Each herbal vaginal suppository contained 10% of myrtle aqueous extract and 0.5% of myrtle essential oil. The HPV test and colposcopic findings were evaluated after treatment. There was no difference between two groups as regards lesion site, diagnosis time of disease, and HPV type before intervention (p ≥ 0.05). At the end of the study, the HPV test was negative in 92.6% and 62.6% of the intervention and placebo groups, respectively (p = 0.036). The change in cervical lesion size was 71.4% and 30.4% in the intervention and placebo groups, respectively, based on colposcopic findings (p = 0.015). It seems that herbal suppository can speed up virus clearance and can be effective in treating HPV infection.

Comparison of clinical efficacy and safety of thermotherapy versus cryotherapy in treatment of skin warts: A randomized controlled trial.

The effect of thermotherapy in the treatment of skin warts in comparison to cryotherapy, as the standard conventional method, has remained uncertain. This study aimed to assess the clinical efficacy and safety of thermotherapy and cryotherapy in removing skin warts. This randomized controlled trial was conducted on 52 patients aged 18 years and over with ≤ 10 skin warts. The participants were randomly assigned into two groups to receive cryotherapy (every 2 to 3 weeks up to six sessions if required) or thermotherapy (one session). The patients in both groups were followed every 2 to 3 weeks for the first three months, and then three months after the last treatment session. The clearance rate was 79.2% in the thermotherapy group and 58.3% in the cryotherapy group with no significant difference (p = 0.212). The rate of scarring in the thermotherapy group was 20% (p = .018). A higher clearance rate was achieved in the thermotherapy group. However, this result was not statistically significant. There were some minimal post-treatment complications. Patients needed only one session of thermotherapy. Due to the risk of scarring, we suggest thermotherapy only as a suitable treatment method for palmoplantar warts.

Small cryotherapy devices for the treatment of skin warts.

STUDY PURPOSE: Effectiveness of cryotherapy on skin wart models. MATERIALS AND METHODS: Two small cryotherapy devices, Wartner and Wortie, were administered for 10″-60″ on tomatoes and potatoes used as skin wart models. Frozen surface and depth were evaluated by standardized photography and computer analysis. Tissue temperature at depths of 0.1-10 mm was assessed by an electronic thermometer during treatment. RESULTS: Cryotherapy induced a transient freezing of the tomato surface. The devices produced similar tomato tissue temperature reduction at all depths examined. At 5 mm, Wortie induced lower tissue temperatures than Wartner. Both devices induced potato tissue destruction to a depth of 0.5-1.2 mm at 40″ and 50″. Wartner induced a maximum destruction at 40″, Wortie led to a partially linear destruction depth with freezing time. The devices produced similar reduction of potato tissue temperature at all depths tested. Wartner induced more rapidly lower temperatures (1.5 mm, 10″, p = .001). Wortie induced lower tissue temperatures with time (0.1 mm, 50″, p = .025; 60″, p = .039; 5 mm, 60″, p = .05). None of the devices reached the lethal temperature of -22 °C. CONCLUSIONS: Both cryotherapy devices produced sufficient tissue damage, at least in the potatoes, to a depth of 0.5-1.2 mm when applied for 40″ (commercially proposed time).

A comparative study of pulsed dye laser versus long pulsed Nd:YAG laser treatment in recalcitrant viral warts.

BACKGROUND: Viral warts are common infectious skin disease induced by human papillomavirus (HPV). But the treatment of recalcitrant warts is still challenging. OBJECTIVE: In this study, we compared the effectiveness of pulsed dye laser (PDL) and long pulsed Nd:YAG (LPNY) laser in the treatment of recalcitrant viral warts. METHODS: We retrospectively analyzed the medical records of patients with recalcitrant warts treated with laser therapy between January 2013 and February 2016. RESULTS: Seventy-two patients with recalcitrant warts were evaluated. Thirty-nine patients were treated with pulsed dye laser and thirty-three patients were treated with LPNY laser. The following parameters were used: PDL (spot size, 7 mm; pulse duration, 1.5 ms; and fluence, 10-14 J/cm2) and LPNY (spot size, 5 mm; pulse duration, 20 ms; and fluence, 240-300 J/cm2). Complete clearance of two patients (5.1%) in PDL group, and three patients (9.1%) in LPNY group were observed without significant side effects. The patients who achieved at least 50% improvement from baseline were 20 (51.3%) in PDL and 22 (66.7%) in LPNY, respectively. CONCLUSION: This research is meaningful because we compared the effectiveness of the PDL and LPNY in the recalcitrant warts. Both PDL and LPNY laser could be used as a safe and alternative treatment for recalcitrant warts.

Professor WANG Yue Analyzed the Idea of Treating HT from Liver and Spleen / 浙江中医药大学学报

[Purpose]To summarize and discuss Professor WANG Yue's unique methods of using traditional Chinese medicine to treat HT.[Methed]In the process of diagnosing and treating HT with Prof.WANG in recent years, observing the method of seeking pathogenesis,treating with syndrome differentiation and selecting preferable medicine carefully, summarising Prof.WANG 's viewpoints about HT in the aspects of pathogenesis, treatment and medicine, to conclude Prof.Wang's some experience on HT. [Results]Prof. WANG treats HT from the liver and spleen. On the one hand, Prof. WANG distinguishes the etiology and pathogenesis ,on the other hand he observes the clinical manifestations.In the early stage,he smoothes and refreshes the liver or regulates the spleen with drugs,then nourishes and relaxes the liver or strengthens the spleen medicinally, together with the method of dissipating phlegm and removing blood stasis, tonifying qi and yin,embodying the law of pattern identification and treatment administration to treat the illness,which have made great effects.Modern pharmacology experiments have also confirmed the mechanism of some Chinese medicine in treating HT, providing further supports for the treatment of HT in Chinese medicine.[Conclusion] Prof. WANG treats HT from the liver and spleen and combines the actual and visual conditions together. He not only signifies the feature of traditional Chinese medicine,but also combines with modern pharmacology achievements about the Chinese medicine which has the effect of regulating immune.Prof. Wang follows the principle of integrating Chinese and western medicine,considerating both the illness itself and patients' symptoms to treat HT which is remarkable and worthy of promotion.

Evolving role of immunotherapy in the treatment of refractory warts.

Cutaneous and genital warts are common dermatological conditions caused by the human papilloma virus (HPV). Although it is a benign condition, it causes disfigurement, has a tendency to koebnerize, and can be transmitted to others. This makes adequate and timely treatment important. There are several conventional treatments available with variable response. Topical and systemic immunotherapy has now found a significant place in the treatment of warts because of its nondestructive action, ease of use, and promising results. Through this review, we would like to present a brief overview of the various immunotherapeutic agents used. These include more established agents such as imiquimod, Mycobacterium w vaccine, bacillus Calmette-Guérin vaccine, measles, mumps, and rubella vaccine, Candida antigen, trichophyton antigen, tuberculin, zinc, cimetidine, levamisole, HPV vaccine, and autoimplantation therapy. Other agents such as contact immunotherapy which is sparsely used now than before and newer agents such as Corynebacterium parvum, sinecatechins, echinacea, propolis, glycyrrizinic acid, and Vitamin D have also been discussed. The mechanism of action of these agents, along with their dosage, mode of administration, duration of use, expected outcomes and comparative efficacy, evidence for their use, and expected side effects, if any, are reviewed.

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.

Administration of Herbal Complexes, Dangguijakyak-san (TJ-23) and Coix Seeds, for Treating Verruca Planae: A Case Report.

Verruca planae (VP) are warts caused by the human papillomavirus. Many patients develop resistance to the conventional therapy for these lesions. Therefore, alternative therapies are needed. We encountered a patient with VP who showed resistance to conventional therapy and was subsequently treated with Dangguijakyak-san (TJ-23; Tsumura, Japan; and Tokishakuyakusan in Japanese) and coix seed tablets with favorable outcomes. A 29-year-old woman had typical VP on her left upper extremity for >11 years. She had been receiving conventional therapies such as immunotherapy with diphenylcyclopropenone, and tretinoin and imiquimod ointments. However, her VP symptoms persisted. Therefore, she was given herbal medication therapy consisting of Dangguijakyak-san (TJ-23) and coix seeds (500mg coix seed extract; Kracie, Japan). At the four-month follow-up, the papules were found to have disappeared. Therefore, we stopped the TJ-23 + coix seed therapy. Until September 2014, the patient has had no recurrence. We believe that Dangguijakyak-san with coix seeds remedy can have an effect on the immune system and consequently treat VP.

A Clinical Study using Quadrivalent Human Papilloma Virus (HPV) Vaccine for Treatment of Recalcitrant Wart / 대한피부과학회지

BACKGROUND: Although several traditional treatments have been applied for recalcitrant viral warts, these treatments have rarely resulted in complete recovery. To treat the recalcitrant viral wart, alternative therapies are required. OBJECTIVE: This study aimed to evaluate the efficacy and safety of quadrivalent HPV vaccine for recalcitrant wart treatment. METHODS: From 2012 to 2014, 17 patients who provided informed consent were enrolled. All patients received 3 doses of quadrivalent HPV vaccine at 0, 2, and 6 months, respectively. During clinic visits, doctors checked the grade of improvement, patient satisfaction, and treatment side effects. After completion of the 3 doses, the patients were followed up for 5 months with outpatient visits and telephone inquiries. RESULTS: After the third dose, 58.8% of patients showed complete remission and 41.2% showed no response after 5 months. There were no statistically significant differences in sex, age, disease duration, number, anatomic site, and previous treatment between the complete remission group and the no-response group. An adverse effect (syncope) was observed in one patient. CONCLUSION: Compared with traditional aggressive therapies, quadrivalent HPV vaccine is a simple method and does not usually interfere with the patient's work or social life. Quadrivalent HPV vaccine is an effective and safe alternative treatment for recalcitrant warts.

Tratamiento de las verrugas genitales: una actualización / Genital wart treatment: an update

La infección por el Virus del Papiloma Humano es una afección altamente prevalente a nivel mundial y una de sus consecuencias es la verruga genital externa o condiloma genital. El tratamiento de estas lesiones ha sido tradicionalmente difícil, debido a la alta recurrencia de las lesiones. Se revisan los aspectos más novedosos del tratamiento de las verrugas genitales. Las sinecatequinas y una nueva formulación de Imiquimod al 3,75% resaltan como las terapéuticas más novedosas, mientras que la terapia fotodinámica carece de evidencia científica adecuada como para recomendar su uso rutinario. Las vacunas profilácticas y terapéuticas parecen poseer un gran potencial pero aún se encuentran en fases iniciales de investigación. Es deseable estudios con un mayor número de pacientes y un seguimiento más prolongado, que permita una comparación directa de la efectividad entre las diferentes técnicas terapéuticas a corto y largo plazo.

Human Papillomavirus infection is a highly prevalent condition worldwide whose frequent consequence is the external genital wart or genital condyloma. The treatment for this condition has been traditionally difficult due to the recurrence of the lesions. The most innovative aspects of the treatment of genital wart, are reviewed. The sinecatechins and a new formulation of Imiquimod 3.75% stand out as the most innovative therapeutic, while photodynamic therapy lacks adequate scientific evidence to recommend its routine use. The prophylactic and therapeutic vaccines seem to have great potential but are still in early stages of research. Studies should be conducted with larger patient samples and longer follow-ups to allow comparison of the effectiveness among the different therapeutic techniques in the short and long term.