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Background: Pulsed dye laser (PDL) has revolutionized treatment of vascular dermatoses. It has been successfully employed to treat several non-vascular conditions in fair skinned individuals without producing significant pigmentary and textural complications. Aim: A preliminary study was undertaken to assess its efficacy in cosmetically distressing facial, vascular and non-vascular dermatoses in Indian patients with skin types IV and V. Materials and Methods: Nine patients of ages 7 to 55 years, with facial verruca plana (VP- 4 cases), angiofibromas (AF- 4 cases) and multiple pyogenic granulomas (PG- one case) were recruited. They had no systemic complaints. Laser parameters used were (spot size/fluence/wavelength/pulse duration):VP- 5mm/5.5-7.5J/585nm/0.45ms; AF-5mm/6-8.5J/585nm/0.45ms;PG- 5mm/7J/585 and 595nm alternately/1.5ms. Response was assessed clinically and photographically. Results and Conclusions: All VP lesions completely resolved after 2-4 sessions (mean 3.25 sessions), AF showed 50% regression in all cases after 2-3 sessions (mean 2.5 sessions) and ≥75% subsidence after 3-7 sessions (mean 5.5 sessions) and in PG, after 3 sessions, there was complete subsidence of small satellite lesions with moderate shrinkage of larger papules and complete resolution after 5 sessions. Complications included transient hyperpigmentation/hypopigmentation only. There was no recurrence during next 6 months. PDL offers significant cosmetic improvement in facial dermatoses in Indian patients.

INTRODUCTION Topical tretinoin (Retin-A), although currently recommended for the treatment of acne, has also been reported to be of benefit in a wide range of skin diseases including plane warts, i...

Epidermodysplasia verruciformis (EV) is a rare skin disease due to persistent human papilloma virus (HPV) infection. Multiple cancerous lesions develop after middle age. EV lesions are resistant to interferon and immunotherapy, and require surgical treatment with skin grafts. The numbers of cancerous lesions increase annually, while donor sites for normal skin diminish. Banking of cultured epidermal sheets may resolve this problem. A 50-year-old woman with EV complained of enlargement of Bowenoid cancer lesions on her face and forehead. Multiple lesions did not respond to intralesional interferon, interferon, or bleomycin. Because she had had multiple surgical treatments, areas with normal skin suitable for grafting were limited. Two cm of clinically normal skin distant from the Bowenoid cancers and warts was harvested after obtaining informed consent. Keratinocytes were cultured from the specimen and prepared as epidermal sheets. Multiple facial cancerous lesions were removed surgically. The raw surfaces where the tumours had been excised and split thickness skin graft donor site were covered with the cultured epidermal sheets using a fibrin adhesive. The sheets had adapted completely within a week. Grafted skin was amelanotic but there was no apparent recurrence of verrucous lesion observed during a 3year follow-up. To eliminate HPV infection in cultured epidermal sheets, HPV DNA was analysed by a PCR protocol specifically detecting tumorigenic HPV. DNA samples were prepared from a verruca plana lesion, two different BC lesions excised from the same patient and the cultured epidermal sheets. EV-related HPV DNA specific bands were amplified in both of the samples from the BC lesions and verruca plana lesion the same as HPV-47 DNA control; no EV-related HPV DNA was detected in the cultured epidermal sheets. There was no relapse of the verruca for 3 years, which also supports the results of PCR analysis. Since there is no established curative treatment, a self-skin banking system may contribute to the treatment of EV.

Background Several case reports have been published in the dermatologic literature demonstrating resolution of verruca plana, otherwise knows as “common warts”, with the use of oral Cimetidine.(Orlow et al. J Am Acad Dermat, 1993;28(5)) The mechanism of this effect has not been fully elucidated. We report complete disappearance of extensive vulvar/introital condyloma acuminata in an adolescent. Case An 18 y.o. female with congenital adrenal hyperplasia presented with multiple recurrent genital warts only 1 month after complete laser ablation. (Photo #1) Cimetidine, 400 mg P.O. Q.I.D. was prescribed and, when evaluated after 5 weeks of therapy, all condyloma had completely disappeared.(Photo #2) No untoward side-effects were noted. Conclusions We propose that there may be a role for Cimetidine in the treatment of extensive genital warts.

Arsenic poisoning (AP) was once common. Arsenic's easy availability and organoleptic characteristics (tasteless and odorless) made it the most commonly employed element in criminal poisonings. As well, arsenic was frequently used in medicine to treat many diseases, such as psoriasis, syphilis, verruca plana, lichen planus, and epilepsy. Although its use is presently much more restricted, arsenic still remains a problem, and many cases of poisoning, whether accidental, industrial, or intentional are reported yearly. However, the clinical manifestations may appear unrecognized for clinicians who are not familiar with AP. Dermatologic manifestations are prominent in most cases of AP, and its knowledge may provide us the key to the diagnosis of AP. Mees' lines are true transverse bands of leukonychia seen during AP. However, they are seldom demonstrated in these patients. In the last 8 years, we have seen four cases of AP, three of them with prominent Mees' lines, which constituted

Human papillomavirus-induced plane warts most often occur in the second decade of age. Afterward, they either spontaneously regress or are eradicated in the course of various treatments. As proved by in vivo and in vitro tests as well as clinical observations, they most often affect and persist longer in immunocompromised hosts. In this work it was confirmed that specific—ie, anti-HPV-directed, cell-mediated immunologic response plays a role in spontaneous regression of plane warts and that preservation of nonspecific immunity is prerequisite for spontaneous regression of plane warts.

A Statistical survey of viral disease in Department of Dermatology, Tokushima University, for the last 14 years from 1964 to 1977 was reported. The proportion of viral disease to the outpatients was 4.40% and the ratio between male and female was 1 to 1.45. Viral disease were classified to herpes zoster (25.98%), verruca vulgaris (25.74%), verruca plana juvenilis (17.21%), herpes simplex (11.71%), molluscum contagiosum (9.59%), varicella (3.56%), condyloma accuminatum (1.78%), rubeolla (1.54%) and others (2.84%).

Solcoderm was used in the management of various epidermal growths in 372 patients with 1,002 lesions, including condyloma acuminatum, verruca plana, basal cell epithelioma, intradermal nevus, seborrheic and solar keratosis. No antiseptic precautions or local anesthesia were used during the treatment. The results seem promising and suggest that Solcoderm is a simple, safe, and efficient method for the management of these tumors. Cosmetic results were excellent. It is especially recommended when the lesions are in difficult to manage locations for surgical or other known chemical or physical methods, when the patient is not fit for surgical procedures, and when local anesthesia is contraindicated.

Frigipoint, a new handheld dipstick cryoprobe, will be introduced. This apparatus has three components: (1) a thermal conductive housing chamber (reservoir) tapered to tips with diameters of 2-10 mm (applicator); (2) a cryogen absorbent member within the housing chamber; and (3) a low-thermal conductivity handle, which is threaded onto the housing chamber. Laboratory experiments employing a gelatin medium showed that the delivery of the cryogen is uniform over the area of application, producing a flat-bottom ice ball. In animal studies, liquid nitrogen spray produced greater depth of destruction and inflammation than Frigipoint. In preliminary clinical studies, 68 lesions, including actinic keratosis, molluscum contagiosum, verruca plana, solar lentigo, seborrheic keratosis, and verruca vulgaris, were treated in 16 patients. All but one resolved after cryosurgery with Frigipoint. Frigipoint is an effective, safe, and easily portable cryosurgical instrument that has a wide spectrum of dermatologic applications. It provides efficient, well-controlled focal cryosurgical treatment of multiple lesions with one immersion of the probe in liquid nitrogen. In addition, its simple operation is met with high patient and physician acceptance.

11 patients with verruca plana were treated with 5% 5-Fluorouracil ointment as a twice daily topical application with open dressing. The patients were chosen among those who failed to be cured with various topical agents such as salicylic acid, vitamin A acid and dinitrochlorobenzene (DNCB), or even with carbon dioxide cryotherapy, oral administration of methotrexate and intramuscular injection of sodium cacodylate. In 9 patients, all the treated warts completely disappeared within 3–5 weeks. 2 of these patients had recurrence after 3 weeks and 2 months, respectively. In 2 patients, some lesions disppeared while others failed to be healed. The major clinical adverse reactions were hyperpigmentation (8 cases), erythema (5 cases) and erosion (5 cases).

A modified direct method of the macrophage migration inhibition test (MMIT) was attempted on a large number of patients with malignant or benign tumors. Results of the MMIT in almost all patients with benign tumors were negative except for those with hydatidiform moles, dermoid cysts and viral benign tumors such as verruca plana which were positive. The number of cases determined as false positives were exceptionally few. Conversely, about the half of the patients with malignant tumors were positive. The majority of negative cancer patients were confirmed pathologically to be advanced cases and, therefore, were postulated to have been immunologically unresponsive. The remaining false negative patients were diagnosed to be very early cases with their malignant foci too small to be effective antigenic stimuli. The MMIT was also performed postoperatively on some of the patients using autologous antigens, which had been preserved by freezing, for examination of changes in the per cent migration index. The results led the authors to conclude that postoperative repetitions of the test permitted them to tell that cancer cells had been completely eradicated or that a relapse might occur in the near future. Examinations of cross reactivity between tumor antigens revealed that such reactivity exists between cancer antigens and antigens originating in hydatidiform moles and that there is also a very strong cross reactivity between allogeneic cancer antigens regardless of differences in the organs of origin. This fact suggests that the present test is effective for the screening of preoperative patients with early cancer.

Although tumors may be resolved due to host immune response, it is difficult to obtain direct evidence of this in man. Numerous flat warts, human papilloma virus type 3-induced papillomas, disappear systemically and simultaneously after showing inflammatory changes. Histologically, there is a dense cellular infiltration composed of lymphocytes and mononuclear phagocytes as identified by alpha-naphthyl acetate esterase staining in situ, the former being predominant in most cases. The primary tissue culture of such inflamed flat warts from ten cases revealed a proliferation of wart-derived keratinocytes as is the case with ordinary flat warts. However, in nine of the ten cases, massive mononuclear cells, most of which were T-lymphocytes, migrated out of the explants and began to attack these keratinocytes, inducing degenerative changes. These findings indicate that cell-mediated tumor cell destruction rather than antiviral reaction induces systemic spontaneous regression of multiple papillomas in man.

Fifty-nine patients with verrucae (45 with verrucae plana and 14 with verrucae vulgaris) were treated with dinitrochlorobenzene (DNCB) as a topical application on the normal uninvolved skin of the shoulder for sensitization and challenge. The patients were sensitized with 0.5 ml of 0.4% DNCB solution and then challenged with 0.1% DNCB ointment twice a week. Six cases of verrucae plana and 1 case of verrucae vulgaris were completely cured by sensitization only and 32 cases of verrucae plana and 7 cases of verrucae vulgaris were completely resolved by repeated challenges. The therapeutic effect was better in verrucae plana (84.4%) than in verrucae vulgaris (57.1%), and the verrucae were completely resolved within 10 weeks in more than 90% of the patients cured by challenge. The side effects of DNCB were mild allergic contact dermatitis and slight transitory hyperpigmentation at the site of application.

Two cases are presented of the nephrotic syndrome caused by protiodide of mercury used in the treatment of verruca plana or flat wart. This paper is presented to record the first two such cases and to discourage the future use of this drug.

In 1955 when 2 of us (S.J. and J.T.) saw a patient with cutaneous eruption which clinically suggested verruca plana but which had a pathologic picture that had not been seen previously by several dermatopathologists to whom sections were sent, we did not think too much of it until one of us (H. M.), who was one of the dermatopathologists who had studied the histopathologic sections from our case, found another person with the same pathologic picture. Report of Cases Case 1.— This 27-year-old male student from Bagdad, Iraq, was seen by us (S.J. and J.T.) in February, 1955, at the University of Wisconsin Hospitals and Clinics for a skin condition which had been present for at least 17 years. The patient described the early lesions as being oval, slightly pigmented, and localized to the dorsum of the hands. Throughout pubescence new lesions appeared on the neck, face, arms, and

Keratosis follicularis, commonly referred to as Darier's disease, is a rare, persistent, cutaneous disorder characterized by malodorous, greasy, crusted, sometimes pustular, hyperkeratotic brownish-red papules located primarily on the scalp, face, retroauricular areas and the trunk. The disease occurs most commonly in males and usually begins in childhood. Sporadic cases are common but many instances of familial occurrence have been noted which were transmitted as a simple Mendelian dominant. 1 Observations A few months ago three patients with keratosis follicularis were seen almost simultaneously at the University of Oklahoma Medical Center. At that time the observation was made that there were lesions, which appeared to be verruca plana, on the hands of all three of these patients with keratosis follicularis (Fig. 1). It was thought that this association was probably not coincidental. Biopsies were performed of several of these verruca-plana-like lesions. The histopathologic characteristics include hyperkeratosis without parakeratosis or vacuolization of

A CLOSE clinical relationship between juvenile laryngeal papillomas and verrucas has been noted for many years. As early as 1871, Morrell MacKenzie 1 observed the frequent association of skin warts and laryngeal papillomas. Ullmann 2 in 1923 stated, "One cannot fail to observe the striking similarity between laryngeal papilloma, condyloma acuminatum, and the verruca plana." More recently, Bjork and Weber 3 reported that in their study of 45 patients, 32 (or 71%) had a history of skin warts. They concluded that "Warts were so frequent in our patients with laryngeal papillomas or in members of their families that evidently there is also a statistical correlation between these two conditions." The purpose of this paper is to report a case, somewhat similar to that of Hajek, 4 which lends support to the close relationship of warts and juvenile laryngeal papillomas. Report of a Case A woman gave birth to an apparently

A case of verruca plana juvenilis is reported in detail in view of the multiple therapeutic aspects of this rather uncommon lesion. The condition is of importance when located on exposed areas, such as the face—where it occurs most frequently—and when the patient is a woman. This case is also important because of its bearing on Herxheimer and Marx' advice as to the use of arsenic and because it demonstrates a peculiar fact already mentioned by other authors, the cause of which is unknown, namely, the spontaneous disappearance of some warts when others, situated at a distance, disappear under treatment. CASE REPORT A young woman, aged 26 years, presented at a session of the Spanish Society of Dermatology and Syphilology last year because of some flat warts on the back of both hands and on the face, was treated with calcined magnesia during a short period, receiving 0.5 gm. a

Lichen nitidus is a comparatively rare disease which was first described by Pinkus 1 in 1901. He reported nine cases, all in men. The eruption consisted of flat-topped, shiny, pinkish papules which were neither confluent nor grouped, and which were most frequent on the genitalia, breasts, abdomen and arms, in the order named. Histologic examination showed a hemispherical granuloma in the upper cutis, composed of epithelioid and giant cells. The basal cell layer was lacking under the overlying epithelium. The papillae were horny and partly hyperkeratotic. No bacteria were found. The picture was that of an infectious granuloma. Pinkus stated that the differential diagnosis lay between verruca plana, lichen planus and lichen scrofulosus. The penis was involved in all of the twelve cases reported by Arndt 2 (Berlin), and in one case the mucous membrane also. He believed that the disease was of tuberculous origin. The animal inoculations in Kyrle's

The suggestion of treating flat warts by the internal administration of mercury was first made by Dr. Charles J. White1in 1915. This method of treatment was tried on the supposition that warts were caused by some as yet undiscovered protozoon. In his first paper White reported seven cases and four additional cases were reported in a subsequent communication. All of the eleven cases, except one, showed a most favorable response at the end of a few weeks to the internal use of some form of mercury. Four of White's patients were adults, the ages of the others varying from 7 to 14 years. In addition to the internal medication, some of the patients were also treated locally by salicylic acid or other remedy. The disease in question is often spoken of as verruca plana juvenilis, though it is by no means confined to juvenile patients. It generally appears

Frequently in keratosis follicularis (Darier's disease) verruciform papules, resembling verruca plana, occupy the dorsal surfaces of the hands and feet, quite distinctive from the typical papules of keratosis follicularis disseminated elsewhere over the body. The extensive foreign literature on keratosis follicularis takes appropriate note of this peculiar association of unlike lesions, but little mention of it is carried in the dermatologic literature of the English language. This report will deal with the clinical and histopathologic characteristics of these verruciform manifestations and their relationship to keratosis follicularis. Also, because of their similarity to so-called hard nevi (Unna), attention will be given to the differentiation of the two verruciform conditions, and evidence will be presented indicating that hard nevi are simply atypical variants of seborrheic keratoses. Hopf1in 1931 reported a verruciform dermatosis affecting the distal portions of the extremities, to which he gave the name acrokeratosis verruciformis. Unaccompanied by lesions

With the introduction of the use of resin of podophyllum in the treatment of condyloma acuminatum by Kaplan, 1 it was natural that attempts were made to use this agent in the treatment of verruca vulgaris and verruca plana. Culp and Kaplan 2 stated that 25 per cent resin of podophyllum in liquid petrolatum was of no value in the treatment of "typical horny verrucae." With the exception of 1 instance of multiple warts of the face, which was treated by MacGregor 3 with 25 per cent resin of podophyllum in liquid petrolatum, there are no reports of any consistent success with this agent in the treatment of verruca vulgaris or verruca plana situated on the glabrous skin. Because it was considered possible that the failure of this method of treating warts was due to the lack of penetration of the resin of podophyllum through the thick horny surface when

Confluent and reticulated papillomatosis is a rarely reported dermatosis of unknown origin. It is similar to nummular and confluent papillomatosis; punctate, pigmented verrucose papillomatosis; acanthosis nigricans; pseudoacanthosis nigricans; benign acanthosis nigricans; pseudoatrophoderma colli; tinea versicolor; Darier's disease; epidermodysplasia verruciformis; and verruca plana. Treatment may be temporarily successful, but the lesions usually recur within a period of months.

Verrucae planae are considered by most authorities to be due to a filtrable virus. 1 A clinical note on treatment of molluscum contagiosum with aureomycin by Guy and associates 2 prompted my use of this antibiotic in an extensive case of verrucae planae of the face in a young child. The difficulty of handling an extensive case in children where cooperation is necessary in the painful procedures of solid carbon dioxide applications, curettage and application of trichloroacetic acid, for example, as reported in all dermatologic texts, makes a simple remedy, if efficacious, highly desirable. D. U., aged 6, was seen with approximately 80 lesions of typical flat discrete verrucae of the face and a few scattered lesions on the dorsa of both hands, of one year's duration. A 10 per cent solution of trichloroacetic acid was prescribed to be used at night in order to macerate superficially the keratin layer

Recent observation of three cases of hyperpigmentary lesions of verruca plana called attention to the differential diagnosis between lentigines, ephelides and these unusual pigmentary lesions of verruca plana. In one case there were none of the usual lesions of verruca plana, while in the other two, one or more typical lesions were seen in addition to the hyperpigmented lesions. Hyperpigmentary lesions vary in size from those that are scarcely perceptible to those that are 1 cm. in diameter. They are yellowish brown, have a smooth, nonverrucous surface, are nonelevated or are almost imperceptibly elevated and, according to Freudenthal and Spitzer,1are differentiated from ephelides and lentigines by the fact that they can be curetted, while the latter two lesions cannot. REPORT OF CASES Case1.—A married woman aged 24 years had for several months noticed on the right side of the face brown spots which had been growing more

Our interest in verruca plana and epithelial nevus was prompted by the observation that the vacuolar alterations of epidermal cells in both of these conditions suggested a possibly common pathologic anomaly. We were impressed particularly by the morphologic relations of verruca plana and epidermodysplasia verruciformis, and, in fact, this investigation was undertaken when we had the opportunity recently to examine patients suffering from epidermodysplasia verruciformis at the Mayo Clinic and sought to distinguish histologically between this disease and verruca plana, which it grossly simulates. Also, one of us (H. M.) 1 has recognized for many years the fact that apparently related epidermal abnormalities occur in some forms of linear nevus. It was the purpose of this study to determine whether the epidermal lesion in verruca plana is the same as the lesion in certain forms of epithelial nevus and also to appraise the nosologic status of epidermodysplasia verruciformis, which has

Verruca vulgaris and verruca plana juvenilis are classified by Jadassohn1among the benign epitheliomas of infectious origin. The filiform wart of the face and scalp is closely related, and there is good evidence for classifying condyloma acuminatum in this group. The plantar wart is probably of the same etiology, although this relationship has not been demonstrated experimentally. Experiments by Ullman,2not yet repeated by other observers, suggest that the papilloma of the larynx of childhood may fall in the same group. The relationship between the various types has been demonstrated by the production of verruca vulgaris and verruca plana juvenilis from condyloma acuminatum and from filiform warts,3and by the production of verruca plana juvenilis from material derived from a laryngeal papilloma.2 Frey3adiscussed the relationship between warts and condyloma acuminatum. Two thirds of the patients with condyloma that he observed were free from syphilis

Since 1949 γ-globulin has been used as therapeutic agent in divergent diseases of the skin 1-5 but not in the treatment of verruca plana, verruca vulgaris, and molluscum contagiosum. The authors have found γ-globulin efficacious when given intradermally in these conditions. In the present report results obtained in treatment of verruca plana are reported. "Globulin-BPCJ" prepared by the Blood Plasma Corporation of Japan was used in this study. The preparation is said to contain more than 100 mg/ml. of γ-globulin, 2.25% of glycine, and 0.01% of sodium ethylmercurithiosalicylate. Analysis of several samples in our laboratory revealed an average γ-globulin content of 95.4 mg/ml. The material was injected by three different methods. Intramuscular injections were given 2 to 12 times weekly in single doses of 0.5 to 1.5 gm., the total dose ranging from 2.1 gm. to 22.75 gm. of γ-globulin. Intralesionally, 1 cc. of the preparation was given two, three