From the Cochrane Library: Topical Treatments for Cutaneous Warts (Preprint)

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Intralesional Measles Mumps Rubella vaccine versus BCG in the treatment of multiple cutaneous warts: a comparative study

Background: Verrucae or warts are benign epithelial proliferations that occur due to accumulation of keratinocytes induced by HPV. Immunotherapy is a new promising modality which uses the principle of activation of one’s own immunity against the disease. Materials and methods: The study included 40 patients with multiple cutaneous warts in two groups of 20 each. Assigned treatment was injected into the single largest wart at an interval of 3 weeks until complete clearance or for a maximum of 3 times. Results: A statistically significant difference (p=0.018) was seen in the therapeutic response when compared to that of the BCG. All 20(100%) patients in the MMR group showed >50% clearance while in the BCG group 14(70%) patients showed >50% clearance according to Physician’s Global Assessment scores. Conclusions: Intralesional immunotherapy with MMR and BCG vaccines are both safe and promising whereas the therapy with MMR stands out with statistically significant results.

A Combination of Herbal Medicine and Moxibustion Treatment is Effective for a Recalcitrant Cutaneous Warts in a Pediatric Patient: A Case Report

Although warts are a common skin condition/disease that recurs in childhood, treatment completion is difficult owing to the pain associated with conventional therapies. In this case, Korean herbal medicine, Guijakjihwang-Tang, and indirect moxibustion was used to treat a recalcitrant cutaneous wart without pain and recurrence. A 7-year-old boy presented with recurrent cutaneous warts on his right hand and received cryotherapy 3 times in the previous year. The wart recurred during the course of cryotherapy treatment, and the patient did not want to suffer any more pain from the previous treatment. Therefore, parents sought an efficient and painless therapy. The patient was treated for 2 months using Guijakjihwang-Tang combined with indirect moxibustion. The prominent lesion separated in the 2nd month of treatment and completely recovered without adverse events in the 3rd month. There was no recurrence over 12 months of follow-up. This report provides meaningful insights into the use of Korean medicine as a safe, painless and efficient treatment for warts in pediatric patients.

Intralesional Acyclovir: A Potential Therapeutic Option for Cutaneous Warts

Background The treatment of warts is challenging and the development of an antiviral drug that can eradicate the human papilloma virus (HPV) is difficult. The viral origin of warts suggests that acyclovir, an antiviral drug with a proven efficacy in DNA viruses, may be a potential therapeutic option. Aim To evaluate the efficacy and safety of intralesional acyclovir in the treatment of cutaneous warts. Methods Thirty-one patients with cutaneous warts were allocated into 2 groups. Group A (19 patients) had intralesional acyclovir (70 mg/ml) injected into the warts, while group B (12 patients) received intralesional saline as control. The treatment was repeated at 2 week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 52.6%, partial response in 36.8%, and no response in 10.5% of the patients in the acyclovir group. Partial response was reported in 16.7%, and no response in 83.3% of the patients in the control group. A high statistically significant difference was found between the treatment and control groups ( P < .01). Adverse effects included pain during injection in 89.5%, blistering in 52.6% and erythema in5.3% of the patients. No recurrence was detected during the follow-up period. Conclusion Intralesional acyclovir can be an effective and well-tolerated treatment modality for cutaneous warts.

Role of Erbium: YAG Laser in Management of Cutaneous Warts

Cutaneous warts are one of the commonest presenting complaints of patients reporting to Dermatology OPD. Most of the warts are viral in origin and they can be either single or multiple. Their morphology varies from flat-topped, angulated, filiform etc. Nowadays, various options are available for management of warts which include topical application of medications, surgical excision and laser treatment. Conventionally, CO2 laser has been used for treatment of warts but Erbium: yttrium aluminium-garnet (YAG) laser is one of the lasers which has recently come into the literature for treatment of warts. This study highlights our experience of using of Erbium: YAG laser in the management of cutaneous warts.

Nonavalent Human Papillomavirus Vaccine as a Treatment for Recalcitrant Warts in an Adult with HIV

To the Editor: Cutaneous warts are seen in as many as a quarter of immunosuppressed patients. 1 Cell-mediated immunodeficiency, as seen in HIV, is correlated with increased rates of palmoplantar warts. 2 These warts often cause discomfort, and can progress to verrucous carcinoma. As they can be resistant to traditional treatments like cryotherapy, patients must resort to more aggressive and invasive measures like intralesional bleomycin. In this case report, we present an immunocompromised patient with HIV successfully treated for his palmoplantar human papilloma virus (HPV) warts using the nonavalent HPV vaccine (Gardasil 9TM, Merck Inc, Kenilworth, NJ, USA) after only marginal improvement with six treatments of bleomycin.