Effectiveness of 100% tea tree oil (Melaleuca alternifolia) versus salicylic acid + lactic acid solution in the treatment of common warts: A randomized controlled trial

Background@#Common warts are a common malady among patients. Not only does it affect the person physically but also mentally and socially. Several treatment modalities are available; however, the major concerns are the treatment cost and adverse effect profile. Salicylic + lactic acid (SLA) solution is one of the standard treatment modalities owing to its strong keratolytic properties; however, its cost and adverse effects limit its use among patients. A cost-effective and safe alternative treatment is ideal to bring about a more favorable clinical outcome and better patient satisfaction. 100% tea tree oil (TTO) solution was used in this study due to its natural antiviral and anti-inflammatory properties.@*Objective@#The study aimed to compare the safety and effectiveness of 100% TTO versus SLA solution in the treatment of common warts.@*Methods@#A total of 17 patients with a total of 74 warts were included in the study. Each wart was assigned to either of the two treatment groups. the SLA group and the 100% TTO group. A treatment period of 6 weeks was used to assess the effectiveness of both treatment groups.@*Results@#The study showed no significant difference between the SLA solution and 100% TTO in the treatment of common warts. The 100% tea tree group reported lesser adverse effects. Both treatment groups reported favorable treatment satisfaction.@*Conclusion@#100% TTO is a potentially safe and cost-effective alternative in the treatment of common warts.

A cross-sectional study on the risk factors and prevalence of common warts / The Health Sciences Journal

INTRODUCTION@#Common warts are frequent benign cutaneous and mucosal infections. However, recommendations from previous studies have focused on personal and public factors to prevent warts and reduce its transmission. This study aimed to determine the prevalence of common warts and its relation to individual, family, school, public, and occupational factors.@*METHODS@#This is a cross-sectional study wherein the cutaneous surfaces (except the mucosa and genitalia) of residents of Barangay Doña Imelda, Quezon City were examined for the presence of warts. Information on individual, family, school, public, and occupational risk factors was obtained from the respondents themselves, parents or guardian using a data extraction sheet. A PRR of > 1.0 was interpreted as a positive association. Chi-square and Fisher’s exact tests were used to test for significance. A p-value of < 0.05 was considered significant.@*RESULTS@#The prevalence of common warts among 315 residents was 7.6 %. The presence of family (PRR = 6.41, 1.91), school (PRR = 1.68), and occupational (PRR = 1.50) factors increased the risk of developing warts. In contrast, a personal history of warts and public factors were not associated with the development of warts.@*CONCLUSION@#The prevalence of common warts is 7.6%, compatible with the results of previous studies. Having a family member with warts, large family size (more than five family members), having at least one closest school friend with warts, and occupation (fish or meat or poultry vendor) increase the risk of developing warts.

A double-blind, randomized controlled trial on the efficacy and safety of intralesional 2% zinc sulfate in the treatment of verruca vulgaris in a tertiary hospital

Background@#Verruca vulgaris ranked 10th in the top 10 diseases in 2019 seen among the Philippine Dermatological Society training institutions. The efficacy of immunotherapy, such as intralesional zinc sulfate (ZS), for warts were reported. Considering the limited studies with promising results on verruca, a study on the efficacy and safety of intralesional zinc in the treatment of verruca was considered.@*Objective@#This study aims to determine the efficacy and safety of intralesional 2% ZS in comparison to intralesional purified protein derivative (PPD) among adult patients with verruca vulgaris.@*Methods@#This is a double-blind, randomized, controlled trial involving 44 patients allocated to group ZS (n=22) and PPD (n=22). Intralesional injections of ZS or PPD to the largest wart were done at weeks 0, 2, 4, 6, 8, 10. Clearance and size reduction of the target and distant wart at 12th week and recurrence at 14th week were assessed. Adverse effects were checked.@*Results@#At the 12th week of treatment, higher proportion in group ZS patients achieved total resolution of the target lesion compared to PPD, but results were not statistically significant (29% vs. 19%). Both groups showed decline in the target lesion size. The median size reduction between the two groups showed no significant differences. Three patients from group ZS showed clearance of distant warts while none in group PPD. There was no recurrence of all previously resolved warts. Adverse reactions were pain, edema, and erythema.@*Conclusion@#Intralesional 2% zinc sulfate (29%) was efficacious and safe compared to Intralesional PPD (19%) but the difference was not statistically significant. There was clearance of distant warts in 5% of group ZS patients. The mild adverse events did not warrant discontinuation of treatment.

A randomized controlled study on the efficacy and safety of zinc oxide 20% ointment versus salicylic acid 15% + lactic acid 15% ointment in the treatment of patients with Verruca vulgaris in a tertiary hospital

Background@#Verruca vulgaris are scaly, rough papules or nodules caused by the human papilloma virus.@*Objective@#To determine the efficacy and safety of topical zinc oxide ointment versus topical salicylic acid + lactic acid ointment as treatment among patients with verruca vulgaris.@*Methods@#This randomized, double-blind, 6-week study involved 29 patients with verruca vulgaris in a tertiary center who received zinc oxide 20% ointment or salicylic acid 15% + lactic acid 15% ointment applied daily and occluded with LeukoplastTM tape. Evaluation was done every two weeks.@*Results@#There was significant decrease in number of warts in the zinc oxide group (p=0.004), while it was not significant in the salicylic acid+lactic acid group (p=0.392). Comparison between the two groups was not significant (p>0.05). Both zinc oxide (P=0.000) and salicylic acid+lactic acid groups (P=0.025) had significant decrease in size of warts from baseline to 6th week of observation. No significant differences were observed between the two groups in terms of adverse events such as erythema (P>0.05), edema (P>0.05), tenderness (P>0.05), and scaling (P>0.05); however, itching was significantly higher at 4th week in the salicylic acid+lactic acid group B (16.7%). Among the zinc oxide group, 100% would recommend the treatment, while only 71.4% would recommend salicylic acid+lactic acid. The satisfaction levels of zinc oxide group were also statistically higher than salicylic acid+lactic acid group (p=0.000).@*Conclusion@#Zinc oxide 20% ointment is a safe and effective option for the treatment of verruca vulgaris especially among patients that would prefer non-traumatic measures in the removal of their warts.

Fire needling stripping after local anesthesia for verruca vulgaris: a multi-center randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical therapeutic effect of fire needling stripping after local anesthesia, simple fire needling and liquid nitrogen cryotherapy on verruca vulgaris.@*METHODS@#A total of 900 patients with verruca vulgaris were randomized into a fire needling stripping group (300 cases, 2 cases dropped off), a fire needling group (300 cases, 4 cases dropped off) and a liquid nitrogen cryotherapy group (300 cases, 5 cases dropped off). After local anesthesia of compound lidocaine cream, fire needling therapy was adopted, and the necrotic tissue of verruca was stripped in the fire needling stripping group. Simple fire needling therapy was adopted in the fire needling group, without local anesthesia and stripping. Liquid nitrogen cryotherapy was adopted in the liquid nitrogen cryotherapy group. The treatment was given once a week, and totally 3 weeks were required in the 3 groups. The skin lesion scores of number, area, thickness, color, pruritus, isomorphism and the level of T lymphocyte (CD@*RESULTS@#Compared before treatment, the skin lesion scores were decreased (@*CONCLUSION@#Fire needling stripping after local anesthesia can effectively treat the verruca vulgaris, improve the skin lesion and immunity, its therapeutic effect is superior to simple fire needling and liquid nitrogen cryotherapy.

Efficacy of auto-implantation therapy in the treatment of extensive and recalcitrant verruca vulgaris

Background: Verrucae are benign tumors involving skin and mucous membrane that are caused by human papillomavirus (HPV). Several treatment modalities are available for treating extensive warts, but no single treatment is 100% effective. An ideal treatment should be effective, safe, with less morbidity and provide long-lasting immunity against HPV. This can only be achieved by stimulation of the immune system against the virus. The auto-implantation of warts is one such simple technique where the wart tissue is harvested as a donor and implanted into the uninvolved skin, thereby causing immune stimulation against the virus and resulting in the resolution of extensive and recalcitrant verrucae. Aim: The aim of the study was to evaluate the safety and efficacy of auto-implantation therapy in the treatment of extensiveand recalcitrant verruca vulgaris. Materials and methods: A hospital-based prospective interventional study was carried out on 50 clinically diagnosed patients of extensive verruca vulgaris. Homologous auto-implantation was done over the uninvolved flexor aspect of the forearm skin after harvesting wart tissue up to the level of the papillary dermis. Patients were assessed monthly and resolution after 3 months was considered as complete clearance. Results were analyzed using SPSS version 20.0. Results: Out of 50 patients, 41 patients came for regular follow up whereas 9 patients didn’t turn up for the follow-up. Out of 41 verrucavulgaris patients, 34 showed resolution within 3 months, accounting for a total clearance rate of 82.9%.

Pilomatrixoma quístico con verruga vulgar intraquística: reporte de un caso / Cystic pilomatrixoma with intracystic vulgar wart: case report

El pilomatrixoma es una neoplasia anexial benigna, que habitualmente se presenta como pápula o nódulo subcutáneo, de crecimiento lento y asintomático. Es más frecuente en niños. El diagnóstico se basa en hallazgos clínicos, y la ecografía es útil como examen complementario. El tratamiento es su resección quirúrgica. Se presenta un caso infrecuente de pilomatrixoma quístico con verruga vulgar intraquística en un paciente adulto.

Pilomatricoma is a benign adnexal tumor, usually presenting as a slow growing asymptomatic subcutaneous papule or nodule. It is more common in children. The diagnosis is based on clinical findings, and ultrasound is useful as a complementary workup tool. Its treatment is surgical excision. We present a rare case of a cystic pilomatricoma with an intracystic verruca vulgaris in an adult patient.

Unusual presentation of Erythema Elevatum Diutinum mimicking a giant wart on the heels of a Filipino male : A case report

@#Erythema elevatum diutinum (EED) is a rare condition believed to be a form of chronic recurrent leukocytoclastic vasculitis possibly secondary to vascular immune complex deposition. The disease is characterized by symmetrical, red, brownish-purple, and yellow papules, plaques, and nodules distributed mainly over the extensor surfaces of the extremities. We report a 61-year-old male with an atypical presentation of such disease as a giant warty lesion on the heels. Histologically, a spectrum from leukocytoclastic vasculitis to vessel occlusion and dermal fibrosis is seen in EED. These histological findings were present in the histopathological reading of the patient which established its diagnosis and further ruled out verruca vulgaris. The disease is associated with many disease entities, which include human immunodeficiency virus, malignant conditions, chronic infection, and autoimmune and connective tissue disorders. None of these conditions was present in the patient as manifested in the history, physical, and laboratory examinations. However, the patient has a low hemoglobin and a G6PD deficiency which makes him a bad candidate for dapsone therapy which is the main treatment for EED. Tetracycline, niacinamide and plain vaseline + salicylic acid were given initially for 4 weeks but no improvement was noticed. It was then shifted to 10mg intralesional corticosteroid and urea paste 40%. Niacinamide still was given. There was a marked thinning of the lesions. The medications were continued and were slowly tapered. More improvement of the lesions was observed.

Two Cases of Intractable Warts and A Case of Intractable Vaginal Condyloma That Were Cured by Coix-seed Reactive Derivatives (CRD) and Vitamin Combination Therapy / 日本補完代替医療学会誌

We reported 2 cases of intractable warts and a case of intractable vaginal condyloma that were cured by Coix-seed Reactive Derivatives (CRD) and vitamin (folic acid・B1・B6・B12）combination therapy. Further studies are needed to define the efficacy of this treatment.

Combined ablative fractional Er ∶ YAG laser and 10％ ALA-PDT in treatment of refractory verruca plana / 中华医学美学美容杂志

Objective To evaluate the efficacy of combined therapies of ablative fractional Er ∶YAG laser (2,940 nm) and ALA-PDT on refractory verruca plana.Methods 120 cases of refractory verruca plana patients were randomly divided into two groups:60 cases in the control group and 60 cases in the experimental group.The control group used 10％ ALA-PDT with LED irradiation of a power density 70 of mW/cm2 at a distance of 20 cm,which lasted for 20 min each time.The experimental group was treated with ablative fractional Er ∶ YAG laser (2,940 nm) first with the fluence of 500P/cm2 and short pulse duration,and then treated 10％ ALA-PDT as mentioned before.Every patient was treated twice at two-week intervals.Three independent investigators evaluated subject outcomes at 3 months post-treatment including efficacy and side-effects.Results The effective rate of the experimental group was 86.44 ％ at 3 months post-treatment after one to two times.Meanwhile,the control group was 59.65 ％.The clinical outcome of experimental group was better than the control group.There was significant difference between the two groups (P＜0.05).The recurrent rate of experimental group was 3.39％ and 12.30％ in control group.There was significant difference between the two groups (P＜0.05).There were no obvious side-effects in both groups.Conclusions Ablative fractional laser with low fluence promotes the transdermal absorption of ALA and enhances the efficacy of PDT.

Analysis of dermoscopy and reflectance confocal microscopy features of verruca plana / 中华皮肤科杂志

Objective To evaluate imaging features of verruca plana by dermoscopy and reflectance confocal microscopy (RCM).Methods Totally,88 untreated patients with verruca plana were enrolled into this study.One typical skin lesion was chosen from each patient and subjected to dermoscopy and RCM separately,and imaging features were recorded and analyzed.Results Dermoscopy revealed a light red background in 48 cases (54.55％),a light yellow background in 40 cases (45.45％),and a various number of punctate hemorrhages in 84 cases (95.45％).RCM showed concentric onion-skin-like structures in 48 patients (54.55％).Among 57 patients with disease duration ＞ 1 year,44 (77.19％) had the concentric onion-skin-like pattern,while only 4 (12.90％) patients had similar structures among 31 patients with disease duration ＜ 1 year.A significant difference in the prevalence of concentric onion-skin-like structures was observed between patients with disease duration ＞ 1 year and those with disease duration ＜ 1 year (x2 =33.47,P ＜ 0.05).Of 88 patients,86 (97.73％) had hyperpigmentation in the basal layer at the dermo-epidermal junction,intact dermal papillary rings,vasodilatation,hyperemia and 1-2 dilated capillaries in the dermal papillae.Eight patients were treated for 2 weeks,and the above features disappeared after the treatment under dermoscopy and RCM.Conclusion Based on clinical manifestations,dermoscopy and RCM features may be helpful for the diagnosis of verruca plana.

A Case of Subungual Verruca in All Fingers / 대한피부과학회지

No abstract available.

A Case of Combination Treatment with Oral Acitretin and Topical 5% Imiquimod Cream in an Immunosuppressive Patient with Widespread Verruca Plana / 대한피부과학회지

Verruca plana is a subtype of warts, which are one of the most common dermatological diseases. A 37-year-old man presented with multiple asymptomatic skin-colored, 1∼2-mm, flat-topped papules on both arms, neck, and face. The patient had ulcerative colitis, which had been treated with immunosuppressants for 15 years. After skin biopsy, verruca plana was confirmed. The patient was treated with 5% imiquimod cream for 6 months. However, only mild improvement was observed. Acitretin was then added to the treatment regimen. After 44 weeks of treatment, acitretin was stopped. Dramatic and rapid clinical improvement was achieved after 3 weeks of treatment, and no sign of recurrence after treatment cessation has been reported for 60 weeks. Consequently, the combination of oral acitretin and topical 5% imiquimod cream should be recommended for the effective and safe treatment of recalcitrant verruca plana in immunosuppressed patients.

Expresión de E-cadherina y células de Langerhans en verruga vulgar y papiloma bucal / Expression of E-cadherin and Langerhans cells in verruca vulgaris and oral papilloma

Introducción: la verruga vulgar y el papiloma bucal son lesiones provocadas por el virus papiloma humano se pueden encontrar presentes en la mayoría de las superfi cies cutáneas y mucosas, su comportamiento biológico es benigno. Las proteínas de adhesión como la E-cadherina, se encargan de mantener la organización y morfología celular, disminuyen su expresión epitelial en ciertas lesiones potencialmente cancerizables, y favorecen la migración e invasión celular ocasionando posiblesmetástasis. Las células de Langerhans, son células presentadoras deantígeno que activan el sistema inmunológico para proteger al organismocontra patógenos o sustancias extrañas. Objetivo: Determinar el grado de expresión de E-cadherina y de células de Langerhans en verruga vulgar y papiloma bucal. Material y métodos: Se realizó un estudio descriptivo y retrospectivo, en el cual se incluyeron 16 bloques con tejido incluido en parafi na con diagnóstico de verruga vulgar, ycuatro diagnosticados como papiloma bucal, todos los casos fueron corroborados con la tinción de hematoxilina y eosina. La determinacióndel grado de expresión de las células de Langerhans y E-cadherina se realizó por medio de la técnica de inmunohistoquímica, la valoraciónse llevó a cabo de manera semicuantitativa, y se realizó estadísticadescriptiva. Resultados: La expresión de E-cadherina en verruga vulgar fue intensa tanto en cantidad como intensidad, mientras que en papiloma bucal fue moderada también en ambos casos; las células de Langerhans mostraron una inmunotinción moderada en las lesiones de verruga vulgar en intensidad y cantidad; en el caso de papiloma bucal esta inmunotinción en intensidad y cantidad fue leve. . Conclusiones:Los resultados mostraron que las proteínas de adhesión E-cadherinano pierden su expresión en la verruga vulgar y papiloma bucal, lo cualconfi rma su benignidad...

Introduction: verruca vulgaris and oral papilloma are lesions causedby the human papillomavirus. They can be found on most skin and mucosalsurfaces, and their biological behavior is benign. Adhesion proteinssuch as E-cadherins are responsible for maintaining cell morphologyand organization; they decrease the expression in certain potentiallycancerous epithelial lesions and promote cell migration and invasion,causing possible metastasis. Langerhans cells are antigen-presentingcells that activate the immune system to protect the body againstpathogens or foreign substances. Objective: To determine the degreeof expression of E-cadherin and Langerhans cells in verruca vulgarisand oral papilloma. Material and methods: We performed a descriptiveand retrospective study involving 16 paraffi n-embedded tissue blocksof diagnosed cases of verruca vulgaris and 4 paraffi n-embedded tissueblocks identifi ed as oral papilloma. The diagnosis was previouslyconfi rmed by hematoxylin and eosin staining. The degree of expressionof Langerhans cells and E-Cadherin was determined by immunohistochemistry,while the evaluation was carried out semiquantitatively,with descriptive statistics being performed. Results: The expression ofE-cadherin in verruca vulgaris was strong in terms of both quantityand intensity, whereas in the case of oral papilloma it was moderatefor both. Langerhans cells showed moderate immunostaining for bothintensity and quantity in verruca vulgaris-type lesions, while for oralpapilloma, the immunostaining was also mild in both cases. Conclusions:The results suggest that the expression of E-cadherin adhesionproteins does not diminish in verruca vulgaris and oral papilloma,which confi rms their benignity...

Verruga vulgar bucal, en comisura labial

Se reporta el caso de un paciente masculino de nueve años de edad, el cual presenta neo formación con 6 meses de evolución en comisura labial izquierda, asintomático, quien es referido por su médico del centro de salud al área de estomatología del Hospital Infantil del Estado de Sonora (HIES), para ser valorado por el cirujano maxilofacial. A la exploración clínica, presenta caries múltiples y absceso periapical, además de la neoformación localizada en comisura labial izquierda de aproximadamente 5 cm, sin lesiones semejantes en ninguna otra zona del cuerpo. El paciente se rehabilitó oralmente, en el consultorio y se realizó biopsia excisional de dicha formación. El diagnóstico clínico fue posible virus de papiloma humano. El informe de la biopsia precisó: verruga vulgar bucal.

It has been reported a case of a male patient nine years old, attending IMSS clinic, who was referred from Hospital Infantil del Estado Sonora (HIES) to be evaluated by a maxillofacial surgeon. The patient presents a neomorph with 6 months of evolution in left labial commissure, being asymptomatic. At clinical examination he presented a caries and abscess, also a neomorph in labial commissure of approximately .5cm in diameter and did not presented a similar injury in any part of the body. The patient was rehabilitated and had surgical excision of the injury and subsequent histological analysis of the sample. The clinical presumptive diagnose was Human papillomavirus. Result : oral verruca vulgaris.

Laryngeal Verruca Vulgaris: A Case Report and Review of Literature

Verruca vulgaris of the larynx (VVL) is an extremely rare disease that can be easily misdiagnosed as papillary keratosis, squamous papilloma or verrucous carcinoma, which would have led to needless operation. We experienced a case of VVL in a 66-year-old man with 1-year history of progressive hoarseness. Whitish lesions in both vocal cords were observed by using indirect laryngoscopy and completely removed via microlaryngeal surgery with CO2 laser.

The clinical observation of interferon -1b in the treatment of verruca planae / 中国基层医药

Objective To observe the clinical effect of interferon -1 b (Yundesu)in the treatment of verru-ca planae.Methods 1 1 0 patients with verruca pianae were randomly divided into observation group and control group,55 cases in each group.The observation group was given Yundesu injection 30 g once every day in first week, and once every other day in another three weeks.The control group was given orally mannatide 1 0ml two times every day.The leision changes of the two groups were observed after 4 weeks therapy.Results The total effective rate of the observation group was 92.7%(51 /55),which of the control group was 72.78%(40 /55),the difference between the two groups was statistically significant (χ2 =7.70,P <0.01 ).No adverse reactions in the two groups were observed.Conclusion The clinical effect of Yundesu is more prominently beneficial to patients with verruca planae.

Photodynamic Therapy Combined with TCM External Treatment for 40 Cases of Verruca Acuminata / 浙江中医药大学学报

[Objective] To observe the cure effect of photodynamic therapy(PDT) combined with TCM on verruca acuminata. [Method] Select 80 cases of verruca acuminata, divide them into control group and treatment group, n=40 for each; the control one only took LE D-IB PDT therapeutic apparatus, the treatment one added with TCM on the base of control one; Observe their cure effects and side effects. [Result] The effective rate was 97.5% for treatment group, and 88.5% for control one, the treatment one was better than other one; there ’re 2 cases in each group respectively who had slight red and swol en skin of the il umination part, without side effects of erosion, ulcer, infection or scar;the recurrence rates were respectively 2.5% and 12.5% for both groups, the difference had statistical meaning. [Conclusion] PDT combined with TCM treating verruca acuminata had high cure rate, low recurrence rate, little side effects and high safety, without influencing patients ’life quality, with good compliance, worth clinical broad popularization.

Cure Warts Capsules Combined with Burt's res-q Ointment in the Treatment of 40 Cases of Verruca Plana / 浙江中医药大学学报

[Purpose] To observe the clinical effects, relapse rate and security of treating the verruca plana with the cure warts capsules combined with Burt's res-q ointment. [Methods] Eighty patients with verruca plana were randomly divided into two groups. Forty patients in the combination group received cure warts capsules combined with Burt's res-q ointment; others in the control group received 0.1% al-transretinoic acid cream only. The courses of treatment of two groups was four weeks, then observe the number of verruca plana and bad reaction after the treatment, and record four weeks fol ow-up observation of relapse. [Results] The effective rate of treatment group was 92.50%which was significantly higher than the control group that the effective rate was 50.00% , and the former’s relapse rate was 3.40% which was significantly lower than that in the group which was 44.40% , the above showed significant difference(P<0.05).There was no significant side effects in the two groups. [Conclusion] Cure warts capsules combined with Burt's res-q ointment had better effect, low relapse rate and high safety.

Verruca Plana: Effect of Skin Care Behavior in Skin Care Clinics and Skin Care Shops / 대한피부과학회지

BACKGROUND: Verruca plana is a common viral disease that commonly affects the face. It can autoinoculate or autotransmit, as well as cause many cosmetic problems. Skin care material that had direct contact with the skin of an affected person during a skin care procedure can be a transmission route of verruca plana or a risk factor of autoinoculation of the virus. OBJECTIVE: The goal of this study is to compare skin care behavior between skin care clinics and skin care shops, and the effects on verruca plana transmission. METHODS: Seventy-four patients who visited local dermatology clinics in Daegu from January 2011 to January 2013 were selected randomly, and a questionnaire survey was done. RESULTS: The incidence of verruca plana in patients visiting the clinic to receive skin care was higher than in the normal population. There was a statistically significant correlation between the number of procedures and the incidence of verruca plana in both skin care clinics and skin care shops. Whereas the number of verruca plana cases increased with the increase in the number of procedures in skin care shops, there was no significant correlation between the number of procedures and the incidence of verruca plana in skin care clinics. CONCLUSION: The number of procedures was significantly correlated with the incidence of verruca plana. In persons receiving treatment in skin care shops, the incidence of verruca plana increased with the increase in the number of procedures.