Five Cases of Onychatrophy Following Bleomycin Intralesional Injections for Periungual Warts / 대한피부과학회지

Onychatrophy is the processes in which the nail has initially formed satisfactorily and then shows total or partial regression. The causes of onychatrophy with pterygium include lichen planus, acrosclerosis, Stevens-Johnson syndrome, and cicatrical pemphigoid, and those without pterygium include severe paronychia, Stevens-Johnson syndrome, epidermolysis bullosa, and drugs. Bleomycin is an antitumor, antibacterial, and antiviral agent used in many dermatologic diseases such as warts, vascular anomalies, hemangioma, and cutaneous malignancies. Cutaneous adverse effects of bleomycin strongly depend on the route of administration and dosage. Bleomycin intralesional injection for periungual warts could result in permanent Raynaud phenomenon, nail dystrophy, and nail loss. We report five cases of onychatrophy following bleomycin intralesional injections for periungual warts. We remind that if bleomycin intralesional injection near the nail matrix is inevitable in recalcitrant periungual warts, the performer must manipulate precisely to avoid adverse effects.

Therapeutic Effects of High Fluence Pulsed Dye Laser for Periungual Warts / 대한피부과학회지

BACKGROUND: Viral warts are benign epithelial proliferations induced by the human papillomavirus (HPV) and they affect 7~10% of the population. Some warts such as periungual warts are resistant to various treatment modalities, including cryotherapy, surgical excision, carbon dioxide laser therapy and immune therapy. Thus, some studies have reported that pulsed dye laser has been effectively used for treating recalcitrant warts. OBJECTIVE: The purpose of this study was to evaluate the therapeutic response and safety of pulsed dye laser using high fluence for the treatment of periungual warts. METHODS: 66 periungual warts on 28 patients were treated with pulsed dye laser. The treatment parameters were a spot size of 5.0 mm, a pulse duration of 0.45~1.5 ms and a fluence of 14.0~15.0 J/cm2. The warts were evaluated at 2~3 week intervals to assess the clearance rate and side effects. RESULTS: Complete clearance was achieved for 47 out of 66 periungual warts (71.2%). The average number of treatment sessions was 2 (range: 1~6). After the first session, complete clearance was achieved for 24 out of 66 warts (36.4%). No significant side effects were observed except for pain during and after the procedure. During a median follow up period of 7 months (range: 3~15 months), 10 periungual warts on 3 patients recurred. CONCLUSION: Pulsed dye laser using high fluence could be used as a safe and successful treatment for recalcitrant periungual warts.

The Safety and Efficacy of Cimetidine Therapy for Periungual Warts / 대한피부과학회지

BACKGROUND: Variable effectiveness of high dose cimetidine therapy for multiple warts, verruca plana and molluscum contagiosum has been reported. The immunomodulatory actions of cimetidine, an H2-receptor antagonist, and its use in the treatment of viral warts have been described previously but its effectiveness is still debated. OBJECTIVE: The purpose of this study is to evaluate the efficacy and safety of high dose cimetidine therapy for periungual warts. METHODS: Twenty seven patients with periungual warts were treated with high dose oral cimetidine (30~40 mg/kg/ day). RESULTS: Evaluable data was obtained in 20 (male 10, female 10) of the 27 patients enrolled in the study. 19 patients (95% of 20 patients) showed either complete resolution (50% of 20 patients) or partial resolution (45% of 20 patients) of their periungual warts without any side effect. CONCLUSION: Unlike aggressive therapies, oral high dose cimetidine administration is simple and cost effective and does not usually interfere with the patient's work activity or affect his or her social life. Though we can consider that high dose cimetidine therapy is one of the effective therapy for periungual warts, complete remission rate is not so high. Combined therapy with other topical therapy using liquid nitrogen, formic acid, silver nitrate or imiquimod, etc. would also be considered and evaluated for more effective treatment of periungual warts.

Study of Pulsed Dye Laser Followed by Intralesional Bleomycin Treatment Compared to Lone Intralesional Bleomycin Treatment for Recalcitrant Periungual Warts / 대한피부과학회지

BACKGROUND: Viral warts affect 7~10% of the population and are a major burden on time and resources for all dermatology departments. There are currently various treatment modalities available, including cryotherapy, laser therapy, immune therapy, and topical keratolytics. However, some warts have proven to be resistant to these multiple therapies. Bleomycin has shown to be effective on these warts, but its injection can be difficult because of risk of local complications. OBJECTIVE: We compared the cure rate, efficacy, tolerability, side effects, and practicality of pulsed dye laser immediately followed by intralesional bleomycin treatment compared to treatment by intralesional bleomycin alone. METHODS: This study is a randomized controlled trial. Twenty-four patients, all with recalcitrant viral periungual warts of at least 2 years duration, were recruited. Twelve patients were treated with pulsed dye laser followed by intralesional bleomycin injection, and the other 12 patients were treated with intralesional bleomycin injection alone. RESULTS: All warts were cleared in all patients. There was no significant difference in the mean treatment number and the mean number of nail changes between the two groups. However, there was a significant decrease in the VAS score and the size of hemorrhagic blistering, involving the surrounding normal skin, in the combined pulsed dye laser and intralesional bleomycin group. In addition, the combined therapy enabled physicians to inject bleomycin more easily and safely. CONCLUSION: The combined method of pulsed dye laser and intralesional bleomycin appears to be a safe, effective and well tolerated treatment for recalcitrant periungual warts.

Combination Therapy with Intralesional Interferon α-2b and Pulsed Dye Laser for the Treatment of Periungual Warts

BACKGROUND: Periungual warts are a therapeutic challenge. Many studies have revealed that intralesional interferon α-2b therapy and pulsed dye laser therapy have numerous advantages over other modalities of theratment. OBJECTIVE: The purpose of this study was to determine if combination therapy with intralesional interferon α-2b and pulsed dye laser might offer an effective treatment for periungual warts. METHODS: Thirty-three patients were randomly assigned to one of three study groups. In group A, the patients received both intralesional interferon α-2b treatment and pulsed dye laser(PDL) therapy (n=13). Group B patients were treated wit intralesional interferon α-2b alone (n=10) and group C was done with PDL therapy only (n=10). RESULTS: The clearance rate was 92.3% for the patients treated with the combination therapy of intralesional interferon α-2b treatment and pulsed dye laser (PDL) therapy. It was 50% for the patients with the intralesional interferon α-2b treatment alone, and 0% for the group with the PDL therpy only. No significant side effects were observed. At 6 months after cessation of the therapy, total 2 cases (one from group A and the other from group B) were recurred. CONCLUSION: The combination therapy with intralesional interferon α-2b treatment and pulsed dye laser therapy was highly effective for the treatment of recalcitrant periungual warts.