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Lv S, Fu X, Yue Z, Zhang H, Zhou G, Liu H, Zhang F. Photodynamic therapy and CO 2 fractional laser combination therapy for verruca vulgaris caused by Koebner phenomenon - Two case reports. Photodiagnosis Photodyn Ther 2024; 45:103946. [PMID: 38145774 DOI: 10.1016/j.pdpdt.2023.103946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/05/2023] [Accepted: 12/19/2023] [Indexed: 12/27/2023]
Abstract
Verruca vulgaris, caused by the human papillomavirus (HPV), can profoundly impact an individual's quality of life and necessitate therapeutic intervention. The challenges associated with treating verruca vulgaris are particularly noteworthy when they manifest as the Koebner phenomenon (KP). In this report, we present two cases of verruca vulgaris that developed KP following cryotherapy. Some studies have suggested that pretreatment with laser therapy enhances the efficacy of Photodynamic Therapy (PDT). Given the inefficacy of cryotherapy and the emergence of KP in our patients, we opted for a treatment approach that combined PDT with CO2 fractional laser (CO2FL), resulting in complete resolution without any notable adverse effects or recurrence during the follow-up period. Our cases underscore the importance of considering KP when verruca vulgaris exhibit enlargement and proliferation post-cryotherapy. Furthermore, this combined treatment modality demonstrates its effectiveness and safety. Additionally, our experience highlights the need for a large-scale study to determine the optimal photosensitizer concentration for the treatment of thick, enlarged verruca vulgaris.
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Affiliation(s)
- Shuang Lv
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Xi'an Fu
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Zhenhua Yue
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Huimin Zhang
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Guizhi Zhou
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Hong Liu
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
| | - Furen Zhang
- Hospital for Skin Diseases, Shandong First Medical University, Jingshi Lu, 27397, Jinan, Shandong Province, China; Shandong Provincial Institute of Dermatology and Venereology, Shandong Academy of Medical Sciences; Jingshi Lu, 27397, Jinan, Shandong Province, China.
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Lau WC, Lau CB, Frangos JE, Nambudiri VE. Intralesional cidofovir for the management of refractory cutaneous verrucae: a review of applications and opportunities. Ther Adv Infect Dis 2023; 10:20499361231165862. [PMID: 37056449 PMCID: PMC10088403 DOI: 10.1177/20499361231165862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/09/2023] [Indexed: 04/15/2023] Open
Abstract
Viral warts - manifestations of cutaneous infection by human papilloma virus - can be a significant physical and emotional burden for patients when common treatments fail, particularly for individuals who are immunocompromised or with multiple lesions. Cidofovir, an antiviral agent typically used for the treatment of cytomegalovirus infection, has emerged as an alternative treatment option for viral warts when administered topically or intralesionally. In this review, we highlight the scientific rationale, published evidence, and practical clinical uses of intralesional cidofovir for the management of cutaneous warts as well as ongoing questions requiring further research and exploration of this emerging therapy for refractory verrucae.
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Affiliation(s)
| | | | - Jason E. Frangos
- Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Iorizzo M, Pasch MC. Bacterial and viral infections of the nail unit: Tips for diagnosis and management. HAND SURGERY & REHABILITATION 2022:S2468-1229(22)00474-1. [PMID: 36427761 DOI: 10.1016/j.hansur.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/25/2022] [Accepted: 11/10/2022] [Indexed: 11/26/2022]
Abstract
The nail unit is the most commonly affected area in hand infections, which can be primary infection or superinfection complicating other nail or skin disorders. Trauma, mechanical or chemical, is usually the trigger enabling infiltration of infectious organisms. Artificial nails and nail polish are also a possible cause of bacterial infection, harboring microorganisms. In severe acute bacterial infection, surgical intervention is often needed to prevent morbidity and disability. Abscess should always be drained, but viral infection such as herpetic whitlow, may mimic an abscess and, in contrast, requires non-operative treatment; to prevent sequelae. A more conservative approach is also generally advisable in less severe bacterial infection, other viral infections and in subacute or chronic nail infection. The present review deals with acute, subacute and chronic bacterial and viral infections of the nail unit, with a focus on diagnostic and treatment options. LEVEL OF EVIDENCE: III, systematic review of level III studies.
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Affiliation(s)
- M Iorizzo
- Private Dermatology Practice, Viale Stazione 16, 6500 Bellinzona, Switzerland.
| | - M C Pasch
- Department of Dermatology, Radboud University Medical Center, Rene Descartesdreef 1, 6500 Nijmegen, The Netherlands
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Zoheir MGT, Almohsen AM, Amer MAEM, Seddeik Abdel‐Hameed AK. Intralesional full‐concentration (25 mg/ml) methotrexate in the treatment of plantar warts: A pilot study. Dermatol Ther 2022; 35:e15815. [DOI: 10.1111/dth.15815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/24/2022] [Accepted: 09/08/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Mohamed Gomaa Tolba Zoheir
- Department of Dermatology, Venereology and Andrology Al‐Azhar University Faculty of Medicine Cairo Egypt
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Sepaskhah M, Sarani MB, Bagheri Z. Comparison of the Efficacy of Intralesional 5-Fluorouracil/Lidocaine/Epinephrine Injection with Cryotherapy to Treat Common and Palmoplantar warts: a Randomized, Controlled Trial. Dermatol Ther 2022; 35:e15726. [PMID: 35864578 DOI: 10.1111/dth.15726] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/27/2022]
Abstract
Cutaneous warts are treated by different treatments with various efficacy. Intralesional injection of 5-fluorouracil (IL 5-FU) has been compared with placebo and a few other wart treatments. Our objective was to compare the efficacy of IL 5-FU injection with cryotherapy to treat common and palmoplantar warts. Forty-five patients with common and palmoplantar warts were treated with either IL 5-FU admixed with lidocaine and epinephrine (5-FU+LE) or cryotherapy, once weekly for six sessions. The patients were assessed for clinical response score, the thickness of warts, pain score, and quality of life in treatment sessions, two weeks and eight weeks after the last session. Nine patients (64.3%) in the 5-FU+LE group, and 5 patients (35.7%) in cryotherapy group experienced complete response (p=0.285). Both treatments caused improvement of clinical response score in the patients during the treatment time (p<0.001), but the efficacy of treatments was not significantly different (p=0.793). Changes in wart thickness were significantly more marked in the 5-FU+LE group compared to the cryotherapy group (p=0.021). The patients in the cryotherapy group experienced more severe pain compared to the 5-FU+LE group (p=0.011). The quality of life better improved in the 5-FU+LE group compared to the cryotherapy group (p = 0.02). To conclude, most of the patients that experienced complete clinical response had received 5-FU+LE injection, though the difference was not significant. However, 5-FU+LE injection accompanied less pain and caused more reduction in wart thickness and more improvement in quality of life compared to the cryotherapy.
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Affiliation(s)
- Mozhdeh Sepaskhah
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mina Bazyar Sarani
- Department of Dermatology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Shen S, Feng J, Song X, Xiang W. Efficacy of photodynamic therapy for warts induced by human papilloma virus infection: A systematic review and meta-analysis. Photodiagnosis Photodyn Ther 2022; 39:102913. [DOI: 10.1016/j.pdpdt.2022.102913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/14/2022] [Accepted: 05/16/2022] [Indexed: 12/21/2022]
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