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Mousa HAL. Autoinoculation Therapy for the Treatment of Widespread Cutaneous Warts. Dermatol Surg 2024; 50:341-344. [PMID: 38261749 DOI: 10.1097/dss.0000000000004083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND Cutaneous warts are common lesions that are often unresponsive to various therapeutic modalities. OBJECTIVE To assess the role of autoinoculation therapy in the treatment of widespread cutaneous warts. MATERIALS AND METHODS This interventional study included patients with widespread skin warts who did not respond to conventional treatments. Two methods were used to perform the autoinoculation therapy. The first procedure was performed by obtaining a small piece of the wart and inoculating it into a subcutaneous pocket. The second method was developed by the investigator and was performed by inserting a needle into the center of the wart toward the nearby subcutaneous tissue, with multiple forward and backward movements in several directions around the lesion. RESULTS The prospective study included 23 patients. The illness duration ranged from 3 months to 5 years. Autoinoculation interventions revealed full recovery of all warts in 20 cases (87%) within 20 to 90 days (mean: 40.7 days). CONCLUSION Autoinoculation procedures demonstrated effectiveness, less cost, lesser pain, less invasiveness, without leaving skin scars in comparison with other conventional therapies.
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A randomized controlled pilot study of autoinoculation versus 35% trichloroacetic acid for the treatment of molluscum contagiosum. J Am Acad Dermatol 2022; 87:1207-1209. [PMID: 35304165 DOI: 10.1016/j.jaad.2022.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/26/2022] [Accepted: 02/02/2022] [Indexed: 10/31/2022]
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Baveja S, Bhatt S, Vashisht S, Vashisht D, Joshi R, Pathania V, Venugopal R. Falkner's needling technique for the treatment of warts: Minimum investment, maximum benefit. Med J Armed Forces India 2022; 78:S75-S81. [PMID: 36147396 PMCID: PMC9485768 DOI: 10.1016/j.mjafi.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 07/22/2020] [Indexed: 11/28/2022] Open
Abstract
Background Verruca vulgaris is a viral infection with high recurrence rates and is very difficult to treat. It occurs due to the ability of the virus to evade immune recognition. This immune evasion by the human papillomavirus (HPV) can be circumvented by injecting HPV antigens subcutaneously and inducing inflammation and a systemic immune response. Falkner technique is an approved technique for the treatment of warts. In this observational study, we analyzed the recovery rate among patients undergoing this technique as part of their routine treatment. The aim of this study is to study the clinical outcome of Falkner's needling technique that is being used for the treatment of verruca vulgaris. Methods Under local anaesthesia, only a single wart was vertically punctured using a 26-gauge needle up till the subcutis multiple times till bleeding was observed. No treatment was done for other warts. Patients were advised not to take any anti-inflammatory medications for pain and were observed for responses after 1 week as well as 1 and 3 months. Results Of 41 patients included in this study, the total resolution of both the punctured and distant warts occurred in 28 patients (68.29%) and partial response in 7 patients (17.1%) by the end of 3 months. Interestingly, individual warts that were subjected to needling showed complete resolution in 35 patients (85.4%). Conclusion Falkner's needling method provides a high rate of complete resolution of multiple warts at both the needled and distant sites after a single treatment session of only a single lesion. This modality has a high cure rate, is easy to perform, requires minimal infrastructure support, is cost-effective, and can be undertaken at most peripheral settings with minimal training.
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Affiliation(s)
- Sukriti Baveja
- Professor (Dermatology), Command Hospital (Southern Command), Pune, India
| | - Siddharth Bhatt
- Resident (Dermatology), Command Hospital (Southern Command), Pune, India
| | - Surbhi Vashisht
- Associate Professor, Department of Physiology, Armed Forces Medical College, Pune, India
| | - Deepak Vashisht
- Professor (Dermatology), Command Hospital (Southern Command), Pune, India
| | - Rajneesh Joshi
- Professor, Department of Community Medicine, Armed Forces Medical College, Pune, India
| | - Vikas Pathania
- Associate Professor (Dermatology), Command Hospital (Southern Command), Pune, India
| | - Ruby Venugopal
- Assistant Professor (Dermatology), Command Hospital (Southern Command), Pune, India
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Oh BH. Cidofovir Intralesional Injection for Recalcitrant Common Warts: A Comparison with Sodium Tetradecyl Sulfate Intralesional Injection. Ann Dermatol 2021; 32:273-279. [PMID: 33911754 PMCID: PMC7992651 DOI: 10.5021/ad.2020.32.4.273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/18/2020] [Accepted: 03/09/2020] [Indexed: 11/09/2022] Open
Abstract
Background A novel treatment method is required for recalcitrant common warts. Objective This study aimed to compare the complete wart removal rate of cidofovir, a broad-spectrum antiviral agent, intralesional injection and sodium tetradecyl sulfate intralesional injection. Methods This retrospective study included 45 patients with recalcitrant common warts on the hands and/or feet, treated with cidofovir or sodium tetradecyl sulfate intralesional injection. Results The treatment results were evaluated in three groups as follows: (1) failure - recalcitrant common warts remaining despite three or more injections, (2) success - free from warts for more than 6 months after the injection, and (3) recurrence. The cidofovir group (n=22) showed significantly higher treatment success rates than the sodium tetradecyl sulfate group (n=23) (90.91% vs. 26.09%, p<0.001). Two immunosuppressed patients in the cidofovir group had recurrent lesions after 2 months of being declared free from warts. Considering adverse effects, two patients in the cidofovir group complained of bulla formation with severe pain requiring narcotic painkillers. Conclusion Although this study has the limitations of a small sample size and retrospective design, patients with recalcitrant common warts showed a dramatic response to the treatment with cidofovir intralesional injection, with minimal complications.
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Affiliation(s)
- Byung Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Autoimplantation – An Immunological Treatment For Multiple Warts. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2021. [DOI: 10.2478/sjdv-2020-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction. Warts are benign epithelial lesions that involve skin and mucosa. Successful management depends on the patient’s immunity, site and type of wart. In spite of huge therapeutic armory available, no treatment has been found to be effective so far.
Objective. To evaluate the effectiveness of autoimplantation in the management of multiple warts.
Material and Methods. This is a hospital based prospective study of forty patients with multiple warts. A prospective, hospital-based study included forty cases of multiple warts for autoimplantation. Resolution of warts within three months was taken as complete clearance; the follow up of any recurrence lasted six months.
Results. The majority of patients were males (69.7%), belonging to 21–30 years age group (57.6%). Complete resolution was observed in 25 patients, partial response was achieved in 5 patients and there was no response in 3 patients. The majority of patients did not have any complication or recurrence
Conclusion. Autoimplantation is a simple, daycare, effective procedure. It provides resistance by inducing cell mediated immunity and also prevents recurrence to a great extent.
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Ralph J, O'Grady C, Boggs J, Barry R. Remission of verruca vulgaris following incisional punch biopsy. Clin Exp Dermatol 2021; 46:1163-1165. [PMID: 33734465 DOI: 10.1111/ced.14613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/18/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- J Ralph
- Department of Dermatology, St James's University Hospital, Dublin, Ireland
| | - C O'Grady
- Department of Dermatology, St James's University Hospital, Dublin, Ireland
| | - J Boggs
- Department of Dermatology, St James's University Hospital, Dublin, Ireland
| | - R Barry
- Department of Dermatology, St James's University Hospital, Dublin, Ireland
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Abdelmonaem NA, Shaheen MA, Mohsen Mohamed Foad T, El-Husseiny R. Efficacy and safety of homologous autoinoculation in treatment of multiple recalcitrant warts of different types. J Cosmet Dermatol 2020; 20:2240-2246. [PMID: 33176040 DOI: 10.1111/jocd.13831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/29/2020] [Accepted: 10/30/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Homologous autoinoculation is a novel minimally invasive procedure that treats warts by stimulating specific immune response. AIM To evaluate the efficacy and safety of autoinoculation in treatment of multiple recalcitrant warts of different types in relation to patient's age, gender, type, number, size, and duration of warts. PATIENTS AND METHODS Two hundred patients with multiple recalcitrant warts of different types were treated with one autoinoculation session. Each patient was subjected to history taking, general and dermatological examination, and photographic documentation before and after treatment. Patients were followed up after 1 week, 2, 12, and 16 weeks to assess possible side effects, treatment response, and recurrence rate, respectively. Evaluation of treatment response was done through physician assessment according to change in size or number of warts or both. RESULTS After 12 weeks of procedure, 66% of patients showed complete clearance, 26% showed moderate clearance, and 4% showed mild clearance while only 1.5% of patients showed treatment failure, with negligible side effects and no recurrence. There was negative correlation between treatment response and wart duration (P < .001). CONCLUSION Autoinoculation is effective in treating multiple recalcitrant warts irrespective of their type, number or size, with minimal complications and no recurrence. The longer wart duration is, the less treatment response will be achieved.
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Affiliation(s)
- Nsreen A Abdelmonaem
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - M A Shaheen
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Mohsen Mohamed Foad
- Dermatology, Venereology and Andrology Department, Misr University for Science and Technology, 6th of October City, Egypt
| | - Rania El-Husseiny
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Taneja G, Hazarika N, Bhatia R. Effectiveness of autoinoculation in viral warts: A single arm, open-label, and clinical trial. Dermatol Ther 2020; 33:e14122. [PMID: 32748544 DOI: 10.1111/dth.14122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 11/27/2022]
Abstract
Viral warts are well-defined, hyperkeratotic mucocutaneous lesions caused by human papilloma virus infection, that can occur anywhere on the body. Various medical and surgical modalities are required for treatment of warts as spontaneous regression is rarely seen. Despite the availability of multiple treatment options, warts are often recurrent and resistant to treatment. The effectiveness of autoinoculation in the treatment of multiple or recurrent verruca was evaluated. Consecutive cases with at least five warts or recurrent warts were included. A treatment-free washout period of 1 month was ensured. Patients with verruca vulgaris (n = 13), palmoplantar (n = 4), periungual (n = 5) were included in the study. The warty tissue was excised, minced and homogenous tissue implanted in a small dermal pocket in the left forearm. Patients were evaluated every 4 weeks. The procedure was repeated at 4th and 8th week. Response was assessed at each visit and at 12th week. Fifteen cases were recruited. Majority of the patients were diagnosed with verruca vulgaris (87%, n = 13) followed by periungual warts (33%, n = 5) and palmoplantar warts (27%, n = 4). Recurrent warts were present in 73% (n = 11) patients. Average improvement at the end of 12 weeks was seen in 65% cases. Ten (67%) patients showed complete resolution of warts. In two patients, warts increased in number while on treatment. Local site infection was seen in two patients. The study is limited by its small sample size. Autoinoculation is an effective modality of treatment for multiple and recurrent warts. Furthermore, it is an effective treatment modality for periungual and plantar warts, which are usually resistant to other modalities.
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Affiliation(s)
- Gargi Taneja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Neirita Hazarika
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Riti Bhatia
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Agarwal P, Bodar P, Saikia S, Dalal T, Jagati A. Evaluating the efficacy of 100% trichloroacetic acid needling in the treatment of palmoplantar warts. INDIAN JOURNAL OF DRUGS IN DERMATOLOGY 2020. [DOI: 10.4103/ijdd.ijdd_38_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zulauf EE, Sahli H, Alexander K, DeMore M, Ehredt DJ, Kawalec J. Does implantation of verruca plantaris into the abductor hallucis muscle belly in conjunction with CO 2 laser ablation prevent recurrence? Foot (Edinb) 2019; 39:45-49. [PMID: 30965226 DOI: 10.1016/j.foot.2019.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 02/05/2019] [Accepted: 02/19/2019] [Indexed: 02/04/2023]
Abstract
Often times, conservative treatment is unsuccessful in long-term resolution of recalcitrant verrucae plantaris lesions. In addition to being aesthetically displeasing, severe cases that are left untreated can be debilitating, often leading to chronic pain, gait abnormalities, and further cutaneous spread. Inoculation through implantation of verrucae plantaris into a muscle was previously postulated to provoke an immune response against the human papilloma virus, resulting in auto-immunization. The purpose of this study was to determine the rate of recurrence following two methods of treatment: A) Surgical removal and subsequent implantation of verruca plantaris into the contralateral abductor hallucis muscle belly and B) Surgical excision of verrucae plantaris. A retrospective chart review of 43 consecutive patients was performed. Group A was comprised of 25 patients who underwent surgical removal of verrucae plantaris followed by implantation of a biopsied specimen into the contralateral abductor hallucis muscle belly. Group B was comprised of 18 patients who underwent only surgical removal of the verrucae. The presence or absence of verrucous lesions was recorded at a post-operative follow-up at an average of 27.5 months. Correlations between recurrence of disease and age, sex, and medical comorbidities were evaluated. Our results suggest that implantation of verruca plantaris into the abductor hallucis muscle belly yields no significant difference in clinical recurrence rates when compared to surgical removal.
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Affiliation(s)
- Emily E Zulauf
- Kent State University College of Podiatric Medicine, Independence, OH, USA
| | - Hannah Sahli
- Kent State University College of Podiatric Medicine, Independence, OH, USA
| | - Kevin Alexander
- Kent State University College of Podiatric Medicine, Independence, OH, USA
| | | | - Duane J Ehredt
- Division of Foot/Ankle Surgery and Biomechanics, Kent State University College of Podiatric Medicine, Independence, OH, USA.
| | - Jill Kawalec
- Kent State University College of Podiatric Medicine, Independence, OH, USA
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Evaluation of topical potassium hydroxide in the treatment of nongenital warts. JOURNAL OF THE EGYPTIAN WOMEN’S DERMATOLOGIC SOCIETY 2016. [DOI: 10.1097/01.ewx.0000484540.81926.b7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J 2016; 7:364-370. [PMID: 27730031 PMCID: PMC5038096 DOI: 10.4103/2229-5178.190487] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
- Devinder M Thappa
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Minu J Chiramel
- Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Kumar S, Mahajan BB, Kaur S, Singh A. Autologous therapies in dermatology. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2014; 7:38-45. [PMID: 25584137 PMCID: PMC4285449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Autologous therapy is a therapeutic intervention that uses an individual's cells or tissues, which are processed outside the body, and reintroduced into the donor. This emerging field presently represents a mere tip of the iceberg with much knowledge and applications yet to be discovered. It, being free from risks of hypersensitivity reactions and transmission of infectious agents, has been explored in various fields, such as plastic surgery, orthopedics, and dermatology. This review article focuses on various forms of autologous therapies used in dermatology along with their applications and mechanisms of action.
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Affiliation(s)
- Sumir Kumar
- GGS Medical College & Hospital, Department of Dermatology, Venereology & Leprology, Faridkot, Punjab, India
| | - Bharat Bhushan Mahajan
- GGS Medical College & Hospital, Department of Dermatology, Venereology & Leprology, Faridkot, Punjab, India
| | - Sandeep Kaur
- GGS Medical College & Hospital, Department of Dermatology, Venereology & Leprology, Faridkot, Punjab, India
| | - Amarbir Singh
- GGS Medical College & Hospital, Department of Dermatology, Venereology & Leprology, Faridkot, Punjab, India
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Longhurst B, Bristow I. The Treatment of Verrucae Pedis Using Falknor's Needling Method: A Review of 46 Cases. J Clin Med 2013; 2:13-21. [PMID: 26236985 PMCID: PMC4470114 DOI: 10.3390/jcm2020013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 03/14/2013] [Accepted: 03/19/2013] [Indexed: 12/21/2022] Open
Abstract
Human Papilloma Virus (HPV) related verrucae pedis persist, seemingly evading host immune surveillance, yet sometimes disappear with inflammation. The absence, or reduction, of a cellular immune response may explain why verrucae treatments are not uniformly successful and treatment can be difficult even in immune-competent individuals. Little investigation has been undertaken into the potential benefit and efficacy of needling verrucae, a treatment modality causing HPV infected keratinocyte destruction in addition to inducing an assumed enhanced immune response. A review of clinical practice is presented, reporting the treatment method and results of data collected from a retrospective review of 45 patients. Thirty-one (69%) cases demonstrated complete resolution of verrucae following needling treatment. Three patients demonstrated reduction in size and pain whilst 11 showed no improvement. No adverse events were noted. Needling may have a place in the management of verrucae pedis in an adult population but a large scale study utilising objective measures and a control intervention would provide more detailed efficacy data along with a greater understanding of the effects of this treatment on long term immunity.
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Affiliation(s)
| | - Ivan Bristow
- Faculty of Health Sciences, University of Southampton, Hampshire, SO17 1BJ, UK.
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