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Recent studies that examined the treatment efficacy of Candida antigen injection for both non-genital and genital warts yield inconsistent results. To address this, a systematic review and meta-analysis was conducted, comparing the treatment response between Candida antigen injection therapy and other intralesional immunotherapies across all types of warts. PubMed, Cochrane Library, and Embase were searched for relevant randomized controlled trials (RCTs) from inception to 16 September 2023, and 24 eligible RCTs were identified. A protocol was developed using the PRISM A-P checklist. In terms of complete clearance, intralesional Candida injection therapy demonstrated a significant improvement compared with saline (risk ratio [RR] 5.39; 95% confidence interval [CI] 3.49–8.33; I2=0%). However, no statistically significant differences were observed when compared with other therapies such as mumps–measles–rubella vaccines, purified protein derivative, vitamin D3, bivalent human papillomavirus vaccine, and zinc sulphate. Adverse effects associated with intralesional Candida therapy were generally reported as mild and manageable. In conclusion, intralesional Candida injection therapy for cutaneous warts may exhibit a superior complete and distant response rate. Nevertheless, owing to a limited sample size and other limitations, future research should aim for larger studies to provide more conclusive evidence.

Introduction: Recalcirant warts are resistant to conventional therapeutic option with high recurrence rate. In recent year, treatment of warts with different immunotherapeutic agent has shown good results, as it regulate epidermal cell proliferation and are involved in the formation of anti microbial peptides. Hence, this study was undertaken to evaluate the efficacy of immunotherapy with intralesional vitamin D in wart. Methods: A descriptive cross-sectional study was conducted from 1 January 2021 to 2 February 2023 at Kathmandu Medical College after approval from the Institutional Review Committee (Reference number: 0110202002). Ninety - two patients with recalcitrant wart of varying sizes and duration were included in the study. Injection vitamin D ( 600000 IU, 15mg/ ml) was injected about (0.2-0.5 ml) to the base of the wart. Maximum of five warts were injected per month, and was repeated after 4 weeks for 3 sessions. Results: Among 92 patient, complete response was seen in 70 patient (76.08%), partial response was seen in 17 patients ( 18.47%) and 5 patient(5.43%)showed no response. Mild pain as observed at the time of injection. Signs of hypervitaminosis D was not observed. Conclusions: Intralesional administration of Vitamin D is an effective treatment option for reclacitrant warts and is, highly effective, cost-efficient, with minimal adverse effects, and can be perfomed in our clinical set up

Intralesional therapies are used for recalcitrant warts, but no Food and Drug Administration–approved treatment exists nor is there consensus regarding the most efficacious therapy. Therefore, this systematic review aims to summarize efficacy and adverse events reported in 62 randomized controlled trials (RCTs) of intralesional therapies for cutaneous warts. The most studied intralesional therapies included measles, mumps, rubella (MMR) vaccine (n = 24 studies), purified protein derivative (PPD) (n = 19 studies), vitamin D3 (n = 15 studies), and Candida antigen (n = 14 studies). Most studies included adult and pediatric patients or adults alone, with only 4 studies on pediatric patients alone. MMR vaccine was the most studied treatment (n = 853 patients). MMR had a complete response rate of 27–90%. The next most common treatment, PPD, had a complete response rate of 45–87%. Other treatments included Candida antigen and vitamin D3, with complete response rates of 25–84% and 40–96%, respectively. The most frequent side effects were injection-site reactions and flu-like symptoms. This systematic review represents a useful summary of intralesional therapy RCTs for clinician reference. This study also highlights the lack of large multi-institutional RCTs, despite many patients being treated for this widespread problem.

Human Papillomavirus (HPV) are non enveloped Deoxyribonucleic Acid (DNA) viruses, sized between 50-55 nm, that form two distinct groups to cause epithelial proliferation at cutaneous and mucosal surfaces, which are mostly benign. With more than 100 different HPV types, estimated 30-40 strains affect human genital tract. Of which, 16, 18, 31, 33, 35, 39, 45, 51, 52, and 5 are the oncogenic (high-risk) types associated with cervical, vulvar, vaginal, and anal cancers, and 6, 11, 40, 42, 43, 44, and 54 are non oncogenic (low-risk) types and are associated with genital warts. HPV 6 and 11 are more commonly associated with genital warts and are also responsible for approximately 90% of these lesions. Despite a series of modalities available to treat HPV, that range from topical to immunotherapeutic modalities to surgically destructive procedures, there is no promising, stand-alone modality which still is a cause of dilemma for Dermatologists while treating warts. The present article reviews all the treatment modalities commonly applied in practice and also the areas less explored by their level of evidences.

Background and Design: Internalized stigma is the acceptance of negative stereotypes about the disease created by society and withdrawing of oneself from society with emotions such as worthlessness and shame. This study aimed to investigate the internalized stigma status of patients with verruca. Materials and Methods: A total of 58 patients with verruca were included in this study. The sociodemographic and clinical characteristics of these patients were recorded. The Internalized Stigma Scale (ISS) was used. In addition, patients answered the 12-Item General Health Questionnaire-12 (GHQ-12) and the Perceived Health Status question. Results: The mean ISS total score was 52.17+-14.73. Cronbach's alpha coefficient for the whole scale for patients with verruca was 0.92. Among the five ISS subscales in patients with verruca, the lowest internal consistency was found in the 'stigma resistance' subscale (Cronbach's alpha coefficient: 0.572), and the highest internal consistency was in the 'social withdrawal' subscale (Cronbach's alpha coefficient: 0.890). A significant correlation was found between the GHQ-12 and ISS total or ISS subscales, except for the 'stigma resistance' subscale (p

Background: In 2007, skin cancers were third most common malignancies in Indonesia. However, profile of cutaneous tumors in our institution has not been studied. Purpose: To evaluate profile of cutaneous tumors in Dermatology and Venerology Outpatient Clinic, Dr. Soetomo General Hospital, Surabaya, Indonesia. Methods: This is a descriptive retrospective study. Inclusion criteria was new cutaneous tumor patients. Exclusion criteria was incomplete data. Medical record and photograph database from 2019-2020 were assessed for demography, clinical features, histopathological examination and final diagnosis. Results: There were 379 (5,5%) cutaneous tumors among 6896 new patients at Dermatology and Venereology Outpatient Clinic. Overall, there were more female patients (53.7%) and age group of 0-45 years old (70.4%). Cutaneous tumors more commonly presented as papular (50.4%), multiple (56.5%), nonpigmented (58.3%), asymptomatic lesions (62.5%), with time from onset 0-24 months (66.2%) and location on head and face (61.2%). Benign cutaneous tumors showed similar findings. Malignant cutaneous tumors showed differences including predominantly male sex, age above 45 years old, nodular, solitary, pigmented and easily bleeding lesions. Malignant tumors were less common (6.9%). Most common malignant tumor was BCC. Most common benign and overall cutaneous tumor was seborrheic keratosis. Conclusion: Cutaneous tumors presented across gender and ages, showing heterogenous clinical manifestations. Malignant and benign cutaneous tumors showed similarity on time from onset and location of lesions. However, differences were seen in demographic profiles and majority of clinical features. BCC was the most common malignant cutaneous tumors, while seborrheic keratosis was the most common benign and overall cutaneous tumors.

Background: Verruca (non genital warts) is a quite common public health problem caused by viral infection of low risk Human Papilloma Virus (HPV) types, risking patients of all backgrounds. There is still no ideal treatment for verruca with little knowledge regarding the effectiveness of the available therapies, which results in the lack of therapeutic standard for patients. Purpose: To evaluate the incidence, management, and effectiveness of verruca treatment. Methods: This was a descriptive, retrospective study with a cross-sectional design. All patients diagnosed with verruca in Tumor and Skin Surgery Division of the Dermatology and Venereology Outpatient Unit at Dr. Soetomo General Academic Hospital Surabaya between January 2016 and December 2020 were included in the study. Result: The results of this study obtained a total of 113 verruca patients, consisting of 61 (53.98%) male patients and 52 (46.01%) female patients, mostly aged 20-60 years old (45 patients [39.82%]). The upper extremity was the most common location where the lesion was found (39 patients [34.5%]). Electrosurgery was the most performed method (38 patients [33.6%]). Thirty-one patients who were treated and returned to the clinic at least once during the month were evaluated for the resolution of the lesion after undergoing therapy. Among 31 patients, resolution was reported in 35.5% of cases. Conclusion: Verruca is a common condition in general practice with many treatment options available yet often neglected. Knowing the available evidence for efficacy of those treatments is critical for dermatologist when considering treatment and educate patients.

Background: Multiple treatment options are available for verruca, however none is completely effective. Conventional modalities such as salicylic acid, cryotherapy have inconsistent treatment efficacies. Newer modalities such as immunotherapy, bleomycin and lasers have shown higher clearance rates of warts in recent studies. Immunotherapy is an innovative approach to treat warts which relies on the principle of enhancement of cell-mediated immunity. This study was done to evaluate the efficacy of immunotherapy with Tuberculin Purified Protein Derivative injection in palmoplantar verruca in our context. Materials and Methods: This is an open labelled, prospective interventional study. Patients with palmoplantar verruca enrolled in the study were injected with purified protein derivative intralesionally by an insulin syringe at a dose of 10 IU (0.1 mL) in the largest wart every 2 weeks until all lesions disappeared or for a maximum of six sessions. They were followed up for 3 months after final treatment session. Results: A total of 54 patients, 34 males and 20 females, were enrolled in the study. Commonest distribution of palmoplantar verruca was in plantar distribution (48.1%). Among them, 12 (22.2%) patients had periungual warts. Complete clearance of warts without any scarring was seen in 66.7% (36) patients with palmoplantar verruca at the end of 6th session whereas 33.3% (18) patients did not respond. Adverse effects noted were erythema, edema and pain at injection site. Conclusion: Intralesional injection of purified protein derivative is an effective and inexpensive treatment option for palmo-plantar verruca with good outcome.

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.

Los tumores benignos del esófago son raros, constituyendo solo el 0,5 al 0,8 % de todos los tumores esofágicos. Aproximadamente el 60 % de los tumores benignos del esófago son leiomiomas, el 20 % son quistes y el 5 % son pólipos. El resto de las lesiones ocurren con una frecuencia menor del 2 % y constituyen curiosidades y dentro de ellas tenemos al papiloma. Los papilomas son tumores benignos fibrosos y sésiles cubiertos por epitelio escamoso producidos por el papilomavirus humano (VPH), que tienen la capacidad de producir lesiones proliferativas en piel y/o mucosas. En el tubo digestivo se localizan más frecuentes hacia los extremos proximales (boca) y dístales (recto). El caso que se presentó se trata de una localización esofágica distal en un paciente de 49 años de edad, masculino, con sintomatología sugestiva de una enfermedad por reflujo gastroesofágico y/o un trastorno de la motilidad esofágica, diagnosticándosele -por endoscopia y biopsia- lesiones elevadas esofágicas y la presencia de coilocitos. Se le indicó tratamiento con interferón alfa 2 recombinante, quedando pendiente de evolución endoscópica e histológica post-tratamiento.The benign tumors of the esophagus are rare, being only the 0,5-0,8 % of all the esophageal tumors. Around the 60 % of the benign esophageal tumors are leiomyomas, 20 % are cists and 5 % are polyps. The rest of the lesions occur with a frequency less than 2 % being curiosities, and among them there is the papilloma. The papilloma are benign, fibrous and sessile tumors covered by a squamous epithelium produced by the human papilloma virus (HPV), having the capacity of producing proliferative lesions in the skin and/or mucosa. In the digestive tract they are more frequently located to the proximal (mouth) and distal (rectum) endings. In the case we present, it is a distal esophageal location in a male patient aged 49, with symptoms suggesting a disease by gastro-esophageal reflux and/or disturbances of the esophageal motility, arriving to the diagnosis by endoscopy and biopsy: elevated esophageal lesions and the presence of koilocytes. We indicated a treatment with Recombinant Alpha 2 Interferon, being pending the post-treatment endoscopic and histological evolution.

Placement of decorative tattoo on the skin may lead to various immunological, infective, and coincidental complications. Inoculation of human papillomavirus leading to development of verruca is an uncommon complication of tattoos. The present report highlights the development of verruca vulgaris, developing after 2 years of tattooing in a young male.