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Introduction: Plantar warts are associated with high transmissibility and morbidity. Among the available therapeutic options, none is uniformly effective or virucidal. Salicylic acid is the first-line therapy but approximately one-third of lesions could not resolve and become recalcitrant despite repeated treatment. Cryotherapy is widely accessible with low cost but may be complicated by pain, blister formation, hemorrhage, infection, excessive granulation tissue formation, and hyper-/hypo-pigmentation. Hence, alternative treatment modalities are essential., Methods: Three patients with debilitating plantar warts refractory or intolerant to cryotherapy were treated with a course of Zijinding (a traditional Chinese medicine preparation) paste prepared with white vinegar., Results: All three patients showed excellent clinical response with Zijinding application with evolution of lesions to scabs and subsequently healthy skin within 1.5 to 5 months of treatment. Treatment was well tolerated and had no significant side effects with excellent compliance recorded for all three patients. There was no relapse for at least 10 months after stopping the treatment., Conclusion: Topical Zijinding could be a promising alternative modality for the treatment of plantar warts. Further clinical trials on the comparison of Zijinding and other treatment modalities of plantar warts are warranted. Further studies are required to investigate the mechanism of action of Zijinding and to isolate the active ingredient., (© 2019 The Authors. Journal of Cosmetic Dermatology Published by Wiley Periodicals, Inc.)

Background: Despite the lack of scientific studies on biofield therapies, they are widely acclaimed by patients. The mechanisms of action are not explained by current allopathic medical approaches. Warts are common and contagious viral lesions that may be refractory to standard dermatologic treatments such as cryotherapy, laser therapy, and keratolytic ointments. Biofield therapies are efficient in various pathologies. Their ability to treat warts has never been demonstrated in a scientific study with a robust methodology. Patients with refractory warts often place their trust in these alternative therapies because of the poor results obtained from traditional medicine. We propose a prospective, randomized, single-blind, assessor-blind trial to evaluate the efficacy of treatment of warts by biofield therapy., Methods/design: Subjects with warts on their feet or hands will be randomized into two groups: real biofield therapy versus sham therapy. The diagnosis will be made at the time of inclusion, and follow-up will take place in week 3. Comparison of pictures of the warts at baseline and after 3 weeks will be used as the primary outcome measure. The hypothesis is that the extent of the disappearance of the original wart in the group treated by real biofield therapy will be 70% and that it will be 30% in the group treated by sham therapy. Using 90% power and an alpha risk of 5%, 31 subjects are required in each group for a two-tailed proportion comparison test., Discussion: To our knowledge, this is the first study to evaluate the efficacy of biofield therapy on warts. Therefore, the aim of this study is to extend knowledge of biofield therapy to another area of medicine such as dermatology and to propose complementary or alternative practices to improve patient well-being. The main strength of the study is that it is a randomized, single-blind, assessor-blind, placebo-controlled study., Trial Registration: ClinicalTrials.gov identifier: NCT02773719 . Registered on 22 April 2016.

Treating plantar, periungual, and external genital warts can be challenging. A prospective study from four centers in Italy evaluated 37 immunocompetent patients with single or multiple warts and treated each lesion with a nitric-zinc topical solution composed of organic and inorganic acids meant to devitalize tissue and destroy HPV DNA in infected keratinocytes. Thirty of the 37 patients had external genital warts, two had plantar warts, two had palm and finger warts, and three had subungual warts for a total of 55 lesions treated. Nitric-zinc aqueous solution was applied over each wart utilizing a 30 µL capillary tube until a whitening response was observed. Additional applications as needed were accomplished at 2-week intervals until the wart was gone. In those with hand, plantar, and subungual warts, there was a 100% clearance after two to three sessions. Three with external genital warts had only a partial response and one no benefit after four applications. Thus, this approach was effective in external genital and other "difficult-to-treat" warts in 90% of patients after one to four applications. It also was easy to use with no adverse events noted., (© 2016 Wiley Periodicals, Inc.)

Purpose: A variety of medications and procedures are available for the treatment of warts, but it appeared the treatment response in systemic lupus erythematosus (SLE) patients is poor. It is necessary to investigate the feasibility, safety and efficacy of local thermotherapy for extensive viral warts., Materials and Methods: A SLE patient on systemic steroid developed extensive viral warts on both her hands and feet for months. She had a high score of SLE Disease Activity Index (SLEDAI), up to 30, and was extensively treated with high and prolonged dosage of corticosteroid and intermittent use of cyclophosphamide. We applied local hyperthermia at 44 °C on a target lesion for 30 min on days 1, 2, 3, 17, 18, a protocol which has been successfully used in treating viral warts. There was no sign of clinical response in a 3-month follow-up. Then we treated the patient on a once-a-week protocol., Result: All the lesions cleared in ten weeks and there was no sign of recurrence., Conclusion: This observation suggests that more intensive local hyperthermia is required for clearing viral warts in SLE.

Background: One-third of Dutch primary school children have cutaneous warts; each year around 20% of them seek medical treatment. However, little is known about the epidemiology of the types of human papillomavirus (HPV) causing these warts., Objectives: To investigate the distribution of cutaneous wart-associated HPV types in three primary school classes by analysing skin swabs taken from warts, and the forehead, hand dorsum and sole of the foot of included children., Methods: Using the hyperkeratotic skin lesion polymerase chain reaction/multiplex genotyping assay, each swab sample was used to genotype for 23 cutaneous wart-associated HPV types., Results: Thirty-one (44%) of the 71 children had a total of 69 warts, with a maximum of six warts per child. In the wart swabs, HPV2, HPV27 and HPV57, members of Alphapapillomavirus species 4, were most frequently detected (27%, 32% and 14%, respectively), whereas HPV1 was only found in two plantar warts. The prevalence of HPV carriage, detected in swabs of clinically normal skin of the forehead, left hand and left sole was 80%, with the most prevalent types being HPV1 (59%), HPV2 (42%), HPV63 (25%) and HPV27 (21%)., Conclusions: Cutaneous wart-associated HPV types were highly prevalent in primary school children, but did not correlate with the HPV types in warts. In contrast to the existing literature, HPV1 was frequently detected on clinically normal skin but was much less frequent in warts., (© 2014 British Association of Dermatologists.)

Plantar warts are a common reason for dermatological consultations and their treatment can occasionally be a challenge. Plantar warts are benign lesions produced by the human papillomavirus (HPV) that often fail to respond to habitual treatment. Cidofovir is a potent antiviral drug that acts competitively, inhibiting viral DNA polymerase. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral plantar warts. We undertook a retrospective observational study of patients with plantar warts who received treatment with topical cidofovir between July 2008 and July 2011 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data about the rate of treatment response, the adverse effects, and recurrences, as well as the characteristics of the patient cohort, were recorded. We identified 35 patients who had received some previous treatment. The usual concentration was 3% (in 33 of 35 cases), applied twice a day (in 31 of 35 cases). A greater or lesser response was noted in 28 cases. There were two recurrences. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant plantar common warts that fail to respond to usual treatment., (© 2013 Wiley Periodicals, Inc.)

Background: Various laser therapies have been used to treat viral warts, and numerous successful results have been reported, but plantar warts are notoriously difficult to treat and eradicate., Materials & Methods: This study included 35 lesions in 31 patients (17 female, 14 male) with plantar warts. We used a carbon dioxide (CO₂) laser for incisions, and the defect was covered with artificial dermis. Follow-up periods ranged from 3 to 12 months. Overall, we examined the presence or absence of human papillomaviruses (HPVs) DNA in the lesional skin of all cases and at the excisional site after treatment in 20 cases., Results: Thirty-one of 35 lesions (88.6%) achieved complete clearance after one treatment session. We observed local recurrence in four lesions (11.4%). The application of salicylic acid was effective in treating minor recurrent cases. After complete remission, HPV DNA was not detected in the upper epidermis of the postoperative site. No significant scars or severe pain were seen in any patients., Conclusion: A combination of CO₂ laser therapy and artificial dermis application effectively treated the majority of plantar warts after one treatment, with complete and rapid clearance and no persistent pain. The authors have indicated no significant interest with commercial supporters., (© 2010 by the American Society for Dermatologic Surgery, Inc.)

Background: There have been no studies on the prevalence of types of human papillomavirus (HPV) in cutaneous warts that focus on warts in toe webs (WTW). There is no documented association between HPV 7 and WTW., Objectives: To explore the clinical and histopathological features of WTW, and the distribution of HPV genotypes in patients with WTW., Methods: The study group consisted of 20 patients with WTW; 31 patients with typical verruca vulgaris (VV) were enrolled as the disease control group, and 53 patients with tinea pedis and 48 healthy volunteers were enrolled as the disease-negative control group. Tissue specimens were analysed for clinical and histological features and distribution of HPV genotypes. Polymerase chain reaction (PCR)-based direct sequencing, TA cloning and type-specific PCR (TS-PCR) were performed in the WTW and VV groups. Interdigital scale specimens from patients with tinea pedis and from healthy volunteers were analysed for HPV DNA by nested PCR and TS-PCR (HPV 7)., Results: All the patients with WTW were male and nearly all were immunocompetent; their mean age was 41 +/- 10 years. The lesions presented mainly as soft, friable and vegetating clusters. HPV 7 was the predominant genotype in WTW with a frequency of 80% (16/20). Fourteen specimens were taken for histopathological examination. The most frequent histological results (seven out of 14) revealed characteristics of HPV 7 infections such as heavily stained cells containing medium-sized keratohyaline granules and a pronounced hyperkeratosis with parakeratosis. TA cloning showed that the sequence shared 90% or more homology with the HPV genotype in direct sequencing. No HPV 7 DNA was found in the scales taken from toe webs without warts., Conclusions: This is the first study evaluating the prevalence of HPV types in WTW and the first report of the association between HPV 7 and specific subgroups of patients with warts.

Plantar warts are a common problem frequently seen by dermatologists and other practitioners with an interest in skin disease management. The diagnosis is often straightforward, but the treatment is difficult and lengthy. The available treatment options are reviewed.

Introduction: Pulse dye laser (PDL) appears an attractive method to treat warts. However, data concerning the efficacy of this approach are based chiefly upon open clinical studies or case reports and results vary widely from one study to another. The purpose of this study was to compare the efficacy and safety of PDL with a placebo in the treatment of a homogeneous group of patients presenting palmoplantar warts., Methods: This was a randomized, prospective, placebo-controlled, single-blind study conducted between December 2004 and July 2005 in patients consulting for palmoplantar warts at the Dermatology Department of the University Teaching Hospital of Nice. The treatment settings used for the 595-nm PDL were as follows: spot diameter 5 mm, pulse duration 0.45 ms, fluence 9 J/cm2 with 5 passes at a frequency of 1 Hz. Cryogen spray cooling (system incorporated in the machine) was given at a rate of 50 spurts of 40 ms prior to each laser pulse. In patients in the placebo group, cooling pulses alone were given. For the plantar warts (in both groups), hyperkeratosis was removed manually with a scalpel before each session. A maximum of three sessions was administered at 3-week intervals. The type and number of warts was counted and recorded in a treatment schedule before the start of therapy, at each session and 5 weeks after the final session. The global safety of the treatment was evaluated using a visual analog scale between 0 (intolerable) and 10 (completely safe)., Results: Nineteen patients were included in the laser group and 16 were included in the placebo group. Sixty-four per cent (48/75) of warts in the laser group resolved completely compared with 13% (4/30) in the placebo group (p<0.001). In the PDL group, 6 of 19 patients (31.5%) no longer had warts by the end of the study compared with 3 of 16 patients (18.75%) in the placebo group (p=0.46). The global safety score of the treatment as assessed by the patients themselves was 8.31 in the laser group and 9.81 in the placebo group., Discussion: Pulse dye laser appears to be an effective treatment in palmoplantar warts but the efficacy of this method seems to be only equivalent to that of standard treatments (cryotherapy or salicylic acid preparations). Safety is excellent and constitutes one of the major advantages of this technique. The absence of any proven superiority over the standard treatments in terms of efficacy, coupled with the high costs involved, means that PDL should only be used second-line therapy in patients wishing to avoid constraints affecting their professional activity.

Cutaneous warts are caused by human papillomavirus (HPV). Prevalence studies of the types of HPV present in cutaneous warts have been carried out more frequently in immunosuppressed patients. The present study was designed to study the association of high-risk HPV in cutaneous warts of immunocompetent patients. A total of 45 cases of cutaneous warts from various sites in immunocompetent subjects were analyzed for HPV. Samples included both archival material i.e., paraffin embedded and fresh tissue. Highly sensitive and comprehensive polymerase chain reaction (PCR) methodology for detection of HPV of high oncogenic potential, HPV 16/18, was employed. Human papillomavirus 16 was detected in 3 (6.6%) patients. None of the lesions demonstrated HPV 18. None of the cutaneous warts demonstrated histopathological features associated with dysplasia or neoplasia. The identification of HPV 16 in cutaneous warts, which are benign proliferations of the skin, further expands the spectrum of HPV-linked lesions. It remains of critical interest to determine whether these types are specifically associated with the development of malignant lesions analogous to those seen in anogenital cancer.

Background: The primary target cell of human papillomaviruses (HPVs) is an unsettled issue. Recent studies have suggested that the hair follicle is an important candidate as the reservoir of certain HPV types. However, little is known about the cells which serve as the target or the reservoir of HPVs in nonhairy palmoplantar skin., Objectives: To investigate whether the eccrine sweat gland, the only skin appendage in nonhairy palmoplantar skin, also serves as the target or the reservoir of HPVs., Methods: HPV 63-induced warts were employed in this study, because the virus induces tiny warty lesions of a punctuate appearance in the plantar skin and shows peculiar intracytoplasmic inclusion bodies as a diagnostic histopathological marker of infection: this seemed to provide a useful model for the present study. Serial sections were obtained from the entire body of each biopsy specimen and were investigated histologically, immunohistochemically and using DNA-DNA in situ hybridization (ISH) for the histological localization of HPV 63 infection., Results: On microscopy, HPV 63 histopathological changes were seen closely associated with eccrine ducts. Using ISH, HPV 63 DNA was detected not only in keratinocytes resident around acrosyringia but also in the uppermost portion of the eccrine dermal duct. A few keratinocytes harbouring HPV 63 DNA were also identified in acrosyringeal areas in the normal plantar skin adjacent to the wart lesions., Conclusions: On the basis of our results, it seems likely that HPV 63 targets keratinocytes resident in or around the eccrine ducts in the plantar skin. The results may also suggest that not only hair follicles but also eccrine ducts serve as reservoirs for certain HPV types, including HPV 63, especially in the nonhairy plantar skin.

Plantar epidermoid cysts with human papillomavirus (HPV) infection are not rare in Japan. Most of them show the cytopathic effect of HPV type 60 - homogeneous intracytoplasmic inclusion bodies. Our case presented a plantar epidermoid cyst with vacuolation around the granular cell layer without any features of HPV type 60. In situ hybridization and polymerase chain reaction followed by DNA sequencing analysis revealed an association with HPV type 57., (Copyright 2003 S. Karger AG, Basel)

Warts can be difficult to diagnose and to treat in the setting of human immunodeficiency virus (HIV) infection. A 37-year-old woman with a background of HIV presented with a large verrucous plaque involving her right foot. Human papillomavirus (HPV)-66 was identified in the lesional skin biopsy sample and in scrapings obtained from her cervix. The wart rapidly responded to topical cidofovir therapy. HPV-66 is a novel HPV type to be associated with verruca vulgaris. Topical cidofovir should be further investigated as an alternative treatment modality for verruca vulgaris.

Background: Various kinds of viral warts have their own typical clinical appearances and histologic properties. From each of them, a corresponding unique type of human papillomavirus (HPV) has been detected. More than 60 types of HPV have been identified from the warts and other squamous cell epithelial tumors. Human papillomavirus type 60 has been identified in an epidermal cyst on the sole. We present a case of a peculiar plantar wart infected with HPV type 60., Observations: A 21-year-old male student complained of yellowish hyperkeratotic slightly elevated nodules on the right plantar arch. The surface of the nodules was not papillary, but a normal ridge pattern of the sole could be traced. Histologic findings included moderate acanthosis, papillomatosis, and eosinophilic intracytoplasmic large granules with or without surrounded vacuoles. These were noted in the middle and upper epidermis, including the hypertrophic stratum corneum. Virologic findings included HPV antigen detected by anti-HPV polyclonal antibody. The DNA of HPV type 60 was detected by in situ hybridization., Conclusion: A new type of plantar wart infected with HPV type 60 is reported. It shows unique clinical and histologic findings that can be distinguished from those of ordinary verruca or myrmecia on the sole.

Background: We had recently cloned a new cutaneous human papillomavirus type 60 (HPV-60) from a plantar cyst with characteristic pathologic changes and identified it in additional cysts. However, it is not known whether or not HPV-60 infection causes the other cutaneous lesions., Observations: Six plantar warts were found in five patients. These warts were found either with concomitant plantar cysts (four patients) or without an accompanying cyst (one patient). All warts showed a similar clinical appearance, including a smooth and slightly elevated surface and the retained appearance of the dermal ridges. Their histopathologic features were identical to those found in the wall of the cysts reported previously, namely hyperkeratosis with vacuolated structure with or without nuclei in the horny layer and amorphous eosinophilic cytoplasmic inclusions in the cells with peripherally located nuclei in the granular and prickle cell layers. By Southern blot analysis, all warts were found to harbor HPV-60 DNA. In addition, immunohistochemistry and in situ hybridization analysis revealed the presence of viral capsid antigen and viral genome in these lesions, respectively., Conclusion: We conclude that HPV-60 infection on the plantar skin causes the warty lesion, designated as ridged wart, distinct from those infected with other cutaneous human papillomaviruses.

Background: Since 1987, many cases have been reported in which human papillomavirus (HPV) could be associated with epidermoid cysts of the palms and soles. In 1989, the HPV found in an induced epidermoid cyst was cloned and named HPV 60., Objective: Our purpose was to examine the relationship of HPV 60 to plantar cysts., Methods: Ten cases of plantar cysts and two cases of verruca plantaris containing single inclusion bodies were obtained by biopsy and examined by the in situ hybridization (ISH) method with a digoxigenin labeled HPV 60 DNA probe., Results: Six of ten cases were found to have cytopathic effect (CPE) in the cyst wall and inner contents of the cyst. HPV 60 was detected in these cases by ISH. Two cases of verruca plantaris showing CPE also demonstrated the presence of HPV 60. Of the six HPV type 60 positive cases, four cases also showed CPE in the overlying epidermis., Conclusion: At first, punctate keratotic lesions are induced by HPV 60. HPV 60 induces irregular elongation of the rete ridges into the dermis. Plantar cysts probably form as a result of the traumatic implantation of HPV 60 infected epidermis with irregularly long and narrow rete ridges into the dermis.

Two new types of intracytoplasmic inclusion bodies (ICBs) associated with distinct clinical features, and the presence of DNA of distinct types of human papillomaviruses (HPVs) are reported. One hundred and seven cutaneous warts containing ICBs were grouped into three categories according to distinct clinicopathological features: 67 were wart lesions with well-known granular (Gr)-ICB, 13 were punctate keratotic lesions with filamentous (Fl)-ICB and 31 were pigmented warts with homogeneous (Hg)-ICB. Molecular biological studies were performed in order to assess a specific association of each group of warts with distinct types of HPV. HPV-1 DNA sequences were detected in all the lesions with a Gr-ICB. Punctate keratotic lesions with Fl-ICB were associated with HPV-63, which was newly cloned from such a lesion. One of the samples also contained HPV-1 DNA. Pigmented warts with Hg-ICBs contained one of the related HPVs, i.e. HPV-4, HPV-60 or a novel type of HPV, HPV-65. Based on these associations, a classification of inclusion warts is proposed.