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Na Zhang,1,* Xinru Chen,1,* Tianhui Ye,1 Hongping Ge,1 Xiaoli Zhai,2 Jun Wu,1 Min Zhang,1 Meiyan Wang1 1Department of Dermatology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China; 2Department of Pathology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, People’s Republic of China*These authors contributed equally to this workCorrespondence: Na Zhang, Department of Dermatology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, No. 365 Renmin East Road, Jinhua, 321000, People’s Republic of China, Tel +86 18757806099, Email sallyzhang1986@163.comAbstract: Verrucae vulgaris are highly contagious keratotic lesions occurring on the skin caused by human papillomavirus. Generally, verrucae vulgaris are harmless to the body, but when they occur in specific areas such as the face or soles of the feet, they can profoundly impact an individual’s quality of life and necessitate therapeutic intervention. Although several pharmacological and physical topical treatments are available, the results are often unsatisfactory in terms of efficacy and cosmetic outcome. Verrucae which typically occur widely on the face are usually Verrucae Planae. When Verrucae vulgaris does occur, it usually presents as single or occasional multiple lesions, rather than covering almost the entire face. In immunocompromised situations, verruca vulgaris can exhibit rare proliferative behavior. In this report, we present a 17-year-old male adolescent who was successfully treated for generalized facial verrucae vulgaris by using a combination of curettage and photodynamic therapy (PDT). The patient’s prolonged use of topical corticosteroids and tacrolimus ointment on the face for eczema over several years is believed to have led to a localized immunosuppressive state of the facial skin, which is considered a significant factor in the outbreak of verrucae vulgaris. Additionally, the patient has a history of acne and frequently scratched face. The appearance of the Koebner phenomenon following scratching is considered another potential reason. This treatment achieved complete resolution and improved the patient’s pre-existing acne problem, resulting in a satisfactory cosmetic outcome without any notable adverse effects or recurrence during the follow-up period. This highlighted that pre-treatment with curettage before PDT enhanced the efficiency of verrucae vulgaris treatment and reduced the cost.Keywords: photodynamic therapy, curettage, verruca vulgaris, adolescent, cosmetic

Cutaneous warts also known as verruca vulgaris are common benign epithelial proliferation caused by human papilloma virus (HPV). For the eradication of warts, several therapeutic techniques have been suggested. However, complete eradication of cutaneous wart is not always achieved with standard therapy. Although there is still a scarcity of data, the use of Light Amplification by Stimulated Emission of Radiation (LASER) may be a useful treatment option to manage cutaneous warts. We present a case of a 19-year-old male teenager with asymptomatic brownish to greyish verrucous papules and plaques over the upper and lower extremities for almost 2 years. Diagnosis of cutaneous warts was established with clinical findings and dermoscopy of the lesions which revealed pinpoint dots of papillary capillaries. The patient was treated with combination of Er:YAG (erbium-doped yttrium aluminium garnet) and Nd:YAG (neodymium-doped yttrium aluminium garnet) LASER under local anesthesia. All cutaneous warts were completely removed with no noted serious adverse events. The Er:YAG laser is perfectly suited for rapid and precise warts removal without thermal harm to surrounding tissue. Combining with the Nd:YAG laser, which affects the nearby blood vessels and removes the remaining wart tissue, has produced favorable outcome. Combining Er:YAG with Nd:YAG in a LASER is a promising and effective way to eliminate cutaneous warts. [ABSTRACT FROM AUTHOR]

Verruca vulgaris is a benign skin tumor that caused by Human papillomavirus (HPV) which a DNA virus that has more than 100 genotypes that being known. Verruca vulgaris commonly affects the hands, arms, legs, and feet, particularly in areas where there has been minor trauma, like the knuckles or the area around the nails. A 38-year-old man came in with chief complaints of lumps on his left thumb and right index finger since 1 month ago. Any histories of being trauma or scratched was denied. The patient had the same chief complaint approximately 2 months ago. The patient was undergoing physical and supportive examination using dermoscopy and he was diagnosed with recurrent verruca vulgaris. The patient was given the combination therapy using electrosurgery and 90% trichloroacetate (TCA) and five months later he went back for the follow up and there was no new lesion was found. [ABSTRACT FROM AUTHOR]

Background: Verruca vulgaris (VV) is caused by human papillomavirus affecting both keratinized and nonkeratinized epithelium. Different treatment modalities are available leading to scarring, pain, and ineffectiveness. Injection of measles, mumps, and rubella (MMR) not only clears treated warts but also distant warts by stimulating cell-mediated immunity. Objectives: The objective of this study was to study the efficacy of adjuvant zinc with injectable MMR vaccine in treatment with side effects of treatments, the pattern of regression, the number of injections required for clearance, and the recurrence of verruca. Materials and Methods: Fifty patients having verruca were divided into groups A and B with 25 patients each. Group A received an injection of MMR and tablet of zinc whereas group B only injection MMR. A total of five injections were given in the largest wart at intervals of 2 weeks i.e., 0, 2, 4, 6, and 8 weeks. Follow-up was done at 3rd month and 6th months following 1st dose. Improvement in warts and patient satisfaction were assessed using visual analog scale and Likert scale, respectively. Results: Mean age of patients in groups A and B was 30.36 and 32.68 with male-to-female ratio 5.28:1 (21:4) and 1.77:1 (16:9), respectively. Mean numbers and size of lesions in group A and B were 2.24 (±1.59), 1.84 (±1.40) and 5.52 mm, 5.08 mm, respectively. Eighty-four percentage of patients in both groups needed five injections for complete clearance. Pain was the most common side effect in all patients of both groups whereas gastritis, fever, and lymphadenopathy were observed only in one patient of Group A. Patients in both groups were strongly satisfied on Likert's scale. Conclusion: Oral zinc as an adjuvant with MMR vaccine for the treatment of VV was equally safe but did not prove to be of higher efficacy in our study.

Background: Immunocompromised patients, including those with human immunodeficiency virus (HIV), have been observed to have verrucae that are more extensive and treatment-resistant compared to those in immunocompetent patients. However, there is a critical lack of data in the current literature on the characteristics of verruca vulgaris in individuals with HIV.Methods: This retrospective chart review included a cohort of HIV-positive individuals and a control group of immunocompetent individuals presenting to an outpatient, county hospital-based dermatology clinic for evaluation of verruca vulgaris between the years of 2016 and 2018. Clinical characteristics, including gender, age, last CD4 count, viral load, antiretroviral therapy adherence, and total number and location of lesions were recorded.Results: A total of 66 patients (33 HIV-positive, 33 immunocompetent) were included in the study. HIV-positive status was significantly associated with a higher total number of lesions (42% of immunocompromised patients versus 21% of immunocompetent patients presented with four or more lesions, P=0.04) as well as location of lesions on the face, scalp, and neck (51.5% versus 9.1%, P

Verruca vulgaris is always stubborn to treat. We applied a new combined therapy of local recombinant human interferon alpha 1b (rhIFNα1b) injection plus acupuncture on verruca vulgaris recently to evaluate the efficacy and safety of the combined therapy. The retrospective study was conducted in The First Hospital of China Medical University from 2018 to 2020. Patients with verruca vulgaris were included. Combined therapy with local rhIFNα1b injection plus acupuncture was set as treatment group, rhIFNα1b injection and carbon dioxide (CO2) laser were set as control groups. A total of 2415 patients were included in the study. The cure rates were 81.85%, 85.93%, and 100% in combined group, rhIFNα1b group, and CO2 laser group, separately. All lesions cured in combined group were located on hands or feet, while majority of lesions cured in other groups were located on other sites. For patients with medium/big single lesion or 6–9 lesions, less treatment times were needed in combined group than rhIFNα1b group. For patients with small single, two to five or more than ten lesions, the treatment times of combined group and rhIFNα1b group were comparable. All patients complained of pain in varying degrees when local injection or laser irradiation. Compared with CO2 laser group, more fever, less swelling or scar was reported in combined group. In conclusion, combined therapy of local rhIFNα1b plus acupuncture was beneficial for verruca vulgaris with limited adverse effects. The therapy was more acceptable by younger female patients with verruca vulgaris. [ABSTRACT FROM AUTHOR]

Background: Pediatric oncology patients undergoing cancer treatment can often have numerous and recalcitrant cutaneous warts due to their underlying immunosuppression. There are little published data on the optimal management of warts in pediatric oncology patients undergoing active cancer treatment compared to patients having completed treatment. Our objective was to analyze the clinical course of warts treated within this patient population at Boston Children's Hospital over a 10‐year period. Methods: This was a single‐institution retrospective study of 72 pediatric oncology patients from 1 September 2011 to 1 September 2021 who were treated for warts at Boston Children's Hospital. All patients had a diagnosis of cutaneous warts with at least one follow‐up visit and were receiving active treatment for cancer either during or after concurrent treatment of their warts. We examined the modality and effectiveness of wart treatments while both on and offactive treatment of their cancer. Results: The median age was 12 years (range 4–18). Fifty‐four percent of patients were documented to have plantar warts. Sixty percent of patients with a documented number of warts had more than five warts at presentation. For cases in which outcomes were specified, treatment resulted in complete resolution of warts in only 24.0% of patients undergoing active cancer treatment compared to 63.3% of patients not on active treatment. Warts persisted or worsened in 56.0% of patients undergoing active cancer treatment compared to only 13.4% of patients not on active treatment. Conclusion: These data may help guide clinicians in evaluating and treating warts in pediatric oncology patients. [ABSTRACT FROM AUTHOR]

Cutaneous warts are benign epithelial lesions caused by human papillomavirus and are common entities, affecting nearly 10 percent of the United States population. While most warts spontaneously resolve, the immunocompromised are susceptible to recalcitrant warts which often require medical treatment. Most current therapies use either physical or chemical destruction for wart removal, but these treatments are associated with adverse effects. Intralesional vitamin D3 has the potential to demonstrate a stronger treatment response due to its ability to stimulate the immune system at the injection site via cell-mediated immunity. We sought to test the efficacy of intralesional vitamin D3 for wart treatment in a sample size of 70 patients over a three-month period. Efficacy was determined as "excellent" if there was greater than a 90-percent reduction in both size and number of lesions, "good" if there was a 60 to 89-percent reduction, and "fair" if there was less than a 60-percent reduction. Treatment efficacy was excellent in 20 (28.6%) patients, good in 29 (41.4%) patients, fair in 18 (25.7%) patients, and poor in three (4.3%) patients. Patients in the younger age group had a higher treatment efficacy compared to other treatment groups. Thus, intralesional vitamin D3 has promising qualities as a treatment for cutaneous warts and should be considered at the clinician's disposal. Vitamin D is an innovative approach for treating warts without the various side effects posed by other commonly used agents. The unique features of this treatment modality including its simplicity, safety, and efficiency make it a promising option for a very common cutaneous condition. [ABSTRACT FROM AUTHOR]

A 65-year-old man with acute myeloid leukemia 6 was treated by bone marrow allograft, developed a systemic classic chronic graft versus host disease with hepatic, rheumatologic, ophthalmic, and muco-cutaneous involvement. He received systemic corticosteroid, ruxolitinib and extracorporeal photopheresis which resulted in complete remission. During follow-up the patient presented with viral cutaneous warts on his neck and submandibular area. After various subsequent topical treatments, he developed localized cutaneous GVHD without any general GVHD reactivation symptoms. To the best of our knowledge, there has been no description in the literature of a graft versus host disease developing after local immunomodulatory or cytotoxic treatments. Topical therapies are commonly used by dermatologists for superficial skin cancers and some viral skin lesions, in high risk populations such as organ transplant patients with regular follow-up.Practitioners should be made aware of a possible localized cutaneous GVHD reactivation induced by Koebner phenomenon after local therapy.

An acral fibrochondromyxoid tumor is a newly described type of benign soft tissue neoplasm that presents as a single nodular lesion on a finger or toe. There has only been one previous report on this tumor, a case series that described the initial pathologic and clinical findings; however, details on clinical history, physical examination, and outcome are unknown. In this report, we describe a case of a 39-year-old male who presented with a painful enlarging mass involving the distal right 3rd finger and hyponychium. Punch biopsy was performed and the lesion was identified as an acral fibrochondromyxoid tumor on microscopic examination. X-ray showed no bony involvement. The tumor was successfully excised with complete resolution of pain symptoms. We discuss the clinical features and immunohistochemistry findings of our case in the context of the current limited knowledge about this very rare tumor.

Psoriasis is a common, chronic, recurrent, immune-mediated disease that leads to dysregulation of epidermal proliferation. Plaque psoriasis is the most common psoriasis variant characterized with pruritic, well-defined erythematous plaques accompanied with thick silvery scales. Widespread lesions may require long-term immunosuppressive treatments that can lead to certain opportunistic infections such as verruca vulgaris. The role human papillomavirus (HPV) in psoriatic skin lesions is still unclear. It is thought that HPV is associated with the precipitation of psoriatic lesions. We report a case of a 65-year-old male patient with severe plaque psoriasis with an uncommon clinical presentation of widespread verruca vulgaris overlapping the psoriasis lesions thought to be caused by long-term treatment of methotrexate, prompting physicians to be more aware of the potential complications of using immunosuppressants for the management of various immunological diseases. [ABSTRACT FROM AUTHOR]

Introduction: Warts are benign lesions caused by human papilloma virus. Various types of cutaneous warts include verruca vulgaris, genital warts, and palmoplantar warts. Various therapeutic modalities are available for warts with varying response. These include destructive therapies, cytotoxic agents (Bleomycin), and immunotherapy (measles, mumps, and rubella [MMR], candida antigen, etc.). We have analyzed the efficacy of intralesional MMR immunotherapy in patients with different kinds of cutaneous warts. Aim: The purpose of this study was to retrospectively analyze the effectiveness and safety of MMR immunotherapy in the treatment of different kinds of cutaneous warts. Materials and Methods: We included all the patients with cutaneous warts receiving MMR vaccine between March 2014 and March 2022. Demographic data were recorded. MMR vaccine was given for four doses at 3 weeks interval or till there was complete clearance, whichever was earlier. Clearance and reduction of wart sizes and potential side effects were recorded. Results: A total of 184 patients were enrolled, and 45% patients were women. Predominant age group of patients was 21--40 years. Most common types of warts observed was palmoplantar warts. Complete resolution was seen in 66% patients and partial response in 22% patients. Palmo-plantar and warts on extremities responded completely to immunotherapy, whereas 43% of genital warts had no improvement. Pain at injection site was observed in all patients, and 32% patients had flu-like symptoms. Conclusions: Immunotherapy with MMR vaccine shows a promising response in the treatment of palmo-plantar warts and warts on extremities, without any serious adverse effect, whereas the genital warts and verruca plana respond variably to immunotherapy. [ABSTRACT FROM AUTHOR]

Cidofovir is an antiviral nucleotide analogue with relatively new treatment capacities for dermatological conditions, specifically verruca vulgaris caused by human papilloma virus infection. In a 10-year old boy with severe verruca vulgaris recalcitrant to multiple therapies, topical 1% cidofovir applied daily for eight weeks proved to be an effective treatment with no adverse side effects. This case report, in conjunction with multiple published reports, suggests that topical 1% cidofovir is a safe and effective treatment for viral warts in pediatric patients.

Simple Summary: The present systematic review aimed to gain deeper insight into the epidemiology, clinical presentation, and histopathology of HPV-related benign and malignant lesions of the oral mucosa in pediatric patients to improve the multidisciplinary preventive and therapeutic management of oral and general healthcare. The emerging role of HPV in oral carcinogenesis in pediatric subjects, along with benign oral mucosal lesions and asymptomatic infections, brings HPV vaccination to the forefront specifically for this age group. The present systematic review aimed to assess the prevalence of oral HPV-related lesions, categorized as benign (verruca vulgaris "VV", squamous cell papilloma "SP", condyloma acuminata "CA", and focal epithelial hyperplasia "FEH") and malignant (oral squamous cell carcinoma "OSCC"), in descending order of occurrence in pediatric subjects (≤18 years of age). The secondary objectives were to evaluate the frequency and types of oral lesions described in relation to HPV genotypes and the HPV vaccine type (if any). The study protocol, compliant with the PRISMA statement, was registered at PROSPERO (CRD42022352268). Data from 60 studies, of which quality was assessed using the ROBINS-I tool, were independently extracted and synthesized. Along with seven poorly described benign HPV-related oral lesions that could not be categorized, a total of 146 HPV-related oral lesions, namely 47.26% (n = 69) VV, SP, and CA, 51.37% (n = 75) FEH, and 1.37% (n = 2) OSSC, were diagnosed in 153 pediatric subjects (M:F ratio = 1:1.4) with a mean age of lesion onset of 8.46 years. The viral genotypes detected were HPV-13 (30.61%), -6 (20.41%), -11 (16.33%), HPV-2 (12.24%), -32 (10.20%), -57 (6.12%), and -16 (4.08%). No HPV vaccination was reported in any case. Further studies should be conducted to evaluate the prevalence of HPV-related benign and malignant lesions and the potential role of HPV and associated vaccination in oral carcinogenesis in pediatric subjects. [ABSTRACT FROM AUTHOR]

An acral fibrochondromyxoid tumor is a newly described type of benign soft tissue neoplasm that presents as a single nodular lesion on a finger or toe. There has only been one previous report on this tumor, a case series that described the initial pathologic and clinical findings; however, details on clinical history, physical examination, and outcome are unknown. In this report, we describe a case of a 39-year-old male who presented with a painful enlarging mass involving the distal right 3rd finger and hyponychium. Punch biopsy was performed and the lesion was identified as an acral fibrochondromyxoid tumor on microscopic examination. X-ray showed no bony involvement. The tumor was successfully excised with complete resolution of pain symptoms. We discuss the clinical features and immunohistochemistry findings of our case in the context of the current limited knowledge about this very rare tumor. [ABSTRACT FROM AUTHOR]

A 54-years-old man presented with a plaque on his right knee for 10 years, with ulceration and scabs for 2 years. Dermatological examination revealed a demarcated, intact, keratinized plaque with tenderness, covered by thick scabs, on the right medial knee. Histopathology showed hyperkeratosis, parakeratosis, acanthosis, downward projection of rete ridges, and koilocytes in the epidermis. Other features included dermal papillomatous hyperplasia, granule cells between the papillary projections, disorganized atypical cells and dyskeratosis, with normal basal layer, in the epidermis. The upper dermis was infiltrated by mixed inflammatory cells. The diagnosis was squamous cell carcinoma arising from giant verruca vulgaris.

Background: Verruca vulgaris is one of the most common benign skin tumor caused by human papillomavirus (HPV) type 1, 2, 3, 4, 27 and 57. HPV caused infection is often recurrent leading to frustration due to loss of time and medical expenses. Monotherapy gives a varied response, and in the case of recurrence, combination therapy can be an option. Purpose: To evaluate the cause and management of recurrent verruca vulgaris. Case: This is a case report of a 33 years-old man complaining of a recurrent wart with a rough surface on his right index finger in the past three months. Initially the patient was treated with electrosurgery, but the warts came back. The patient was a smoker. The warts disappeared after electrosurgery and two sessions of 80% trichloroacetate (TCA), and at the 4th week of observation no new lesion was reported. Discussion: Recurrence of verruca vulgaris often occurs using monotherapy, thus requires other modalities. The combination of electrocautery and 80% TCA provides good clearance with low recurrence. Conclusion: Combination treatment for recurrent warts is effective for clearing the lesion and prevent recurrence.

ackground: Topical zinc sulfate application has lower efficacy in comparison with intralesional usage, due to less penetration of ionic drug within the epidermis. Niosomes introduce new method of drug delivery with improved penetration and sustained release of medicaments within epidermis. On the other hand, combined cryotherapy with topical immunomodulators can increase the efficacy of cryotherapy with less recurrence rate. In this study, we compared the efficacy of 2% niosomal zinc sulfate suspension with cryotherapy versus combined conventional 2% zinc sulfate and cryotherapy in the treatment of Verruca vulgaris.Methods: This is a triple-blind randomized clinical trial on 60 patients. Patients were randomized in 2 groups including combined 2% niosomal zinc sulfate suspension with cryotherapy versus combined 2% conventional zinc sulfate suspension combined with cryotherapy. The efficacy of treatment was evaluated during the treatment sessions until 12 weeks. Patients were followed for 3 months after the end of the treatment to evaluate recurrence rate. We used chi-square test to evaluate the efficacy of treatment and side effects. Mean number of treatment sessions was evaluated by t-test.Results: Mean number of the treatment sessions for complete remission was 3.66±0.92 and 4.63±0.66, in niosomal group and conventional group, respectively (P=0.001). The rate of complete remission was higher at the 6th and 8th weeks of the treatment in niosomal group compared to conventional group (P=0.001).Conclusion: This study demonstrated significant rapid remission of wart lesions treated with cryotherapy plus 2% niosomal zinc oxide suspension in comparison with cryotherapy plus 2% conventional zinc oxide suspension.

Verruca vulgaris is a prevalent childhood condition, but treatments are often poorly tolerated. Early treatment is preferable because delays increase the probability of pain, disfigurement, and failed eradication. However, typical treatments require multiple sessions without promising cure. We describe the use of a single intralesional treatment with the measles, mumps, and rubella (MMR) vaccine to successfully eliminate both local and distant recalcitrant warts as well as the proposed mechanism of this method. There are no other known reports of complete wart regression at distant untreated sites after a single intralesional MMR treatment.

Nail unit verruca is the most common nail tumor encountered in clinical practice and may be highly distressing to patients due to reduced functionality, cosmesis, and stigmatization. Subungual and periungual verrucae present a challenge for treatment compared to cutaneous warts of other sites and recurrence rates are high. The risk of spread to other skin and mucosal areas inherent to all warts may be increased given location on the fingertips. There are a multitude of therapeutic options, and treatment is individualized based on patient characteristics, anatomic location, number of verrucae, and size of verrucae. Destructive techniques, if used too aggressively, can permanently damage the nail matrix. In this clinical review, nail unit verruca epidemiology, pathogenesis, clinical features, treatments, and therapeutic approaches to various patient populations, including pediatric and immunosuppressed patients, are described., (Copyright © 2024. Published by Elsevier Inc.)

Therapies of common warts are cumbersome and not very effective. Recurrences are common. A new 20 MHz high-intensity focused ultrasound (HIFU) method is introduced as a new potential treatment modality. With HIFU, selected targets in the epidermis and dermis can be treated with full control of the depth and position of the ultrasound lesion and the energy applied to the target. The treatment can be monitored directly in real-time via an integrated dermoscope in the ultrasound probe. Two warts were treated with 8–10 shoulder-by-shoulder treatment doses, focal depth 1.3 mm, and 1.2 J/dose. Pretreatment ultrasound B-mode scanning had shown the thickness and depth of the warts. The treated areas developed a dry wound covered by a crust over the next 1–2 days. After 2 weeks the skin was healed, with no wart and no scar. Observation showed no reoccurrence. HIFU has future potential for treatment of common warts and flat warts, and a broad range of skin lesions being logic further candidates for targeted ablative treatment. One single treatment may suffice. It is, therefore, a new modality in dermatology with a large range of indications.

Plantar warts caused by human papilloma virus (HPV)may be challenging to treat when conventionalmodalities fail. We report a case of severely recalcitrantplantar warts, successfully treated with oral acitretinand topical 40% urea cream.

Paring is useful for both diagnosis and treatment of plantar warts. Paring techniques generally involve scalpel blades, abrasive tools, or curettes. However, these tools do not permit the use of an “awl-like” carving technique of the wart afforded by using a punch biopsy tool. We have found this technique to be associated with greater precision and safety, as well as potentially increased efficacy compared to traditional methods.

Lichen nitidus typically presents as shiny pin-head sized papules on the trunk and extremities, often affecting children and young adults. In this prototypical form, it rarely presents a diagnostic challenge being characterized by distinctive clinical and histopathologic findings. We describe a rare variant of lichen nitidus, which we term “hyperkeratotic and hypertrophic lichen nitidus."

Objective: To evaluate the clinical efficacy and safety of 595‐nm pulsed dye laser in the treatment of verruca vulgaris in children and to compare the efficacy of this method against two other methods, microwave tissue coagulation and liquid nitrogen cryotherapy. Methods: A total of 90 children being treated in the dermatology outpatient department of our hospital from 2019 to 2021 were selected and divided into three groups: the treatment group A (n = 30, treated with a 595‐nm pulsed dye laser), treatment group B (n = 30, treated with microwave tissue coagulation), and treatment group C (n = 30, treated with liquid nitrogen cryotherapy). All the patients in the treatment group A, treatment group B, and treatment group C were treated once every two weeks, with a maximum of six treatments. Results: The response rate of the treatment group A was 93.3%, which was higher than the 83.3% rate of treatment group B and the 66.7% rate of treatment group C. The average treatment times of the treatment group A (2.45 ± 1.10) were lower than group B (3.51 ± 0.98) and group C (4.63 ± 0.96). The adverse reaction rate in the treatment group A (16.7%) was significantly lower than that in treatment group B (56.7%) and treatment group C (63.3%). The differences were statistically significant (all p < 0.05). Conclusions: The 595‐nm pulsed dye laser is safe and seems to be the most effective treatment for verruca vulgaris in children. Further high‐level clinical trial is warranted to verify our results. [ABSTRACT FROM AUTHOR]

Contact immunotherapy with several sensitizing chemicals such as diphenylcyclopropenone (DPCP) or squaric acid dibutyl ester (SADBE) have been used for the treatment of recalcitrant or multiple warts. Here, we report a case of multiple verrucae vulgaris (VV) on the palm which spontaneously resolved after the development of systemic contact dermatitis against alkyl bromide. We considered that our case accidentally mimics contact immunotherapy against multiple VV. VV sometimes regress spontaneously, which may be triggered by accidental contact dermatitis, as shown in our case.

Introduction: Several modalities are used in the treatment of verrucae vulgaris; however, their side effects are common. Vitamin D3 has been recently used as a treatment in verruca vulgaris. Aim of the Work: We aimed to assess the expression of involucrin in verrucae before and after intralesional injection of vitamin D3 and its correlation with clinical response. Subjects and Methods: This study included 60 patients with verrucae vulgaris. These patients were subjected to intralesional injection of vitamin D3 at 3-week intervals for a maximum of five sessions. The pathological assessment was done by skin biopsies obtained from thirty patients before the first session and after the last session of injection and compared to skin biopsies from 30 healthy individuals. Results: The injected verrucae showed complete response in 39 patients (65%), partial response in 15 patients (25%), and no response in 6 patients (10%). Nonsmoker patients had a better response than smokers. Vitamin D3 injections also resulted in increasing involucrin expression and changing its pattern of expression. Conclusions: Intralesional vitamin D3 is an effective treatment for verrucae vulgaris. Involucrin expression is modified in verrucae.

Background: Topical zinc sulfate application has lower efficacy in comparison with intralesional usage, due to less penetration of ionic drug within the epidermis. Niosomes introduce new method of drug delivery with improved penetration and sustained release of medicaments within epidermis. On the other hand, combined cryotherapy with topical immunomodulators can increase the efficacy of cryotherapy with less recurrence rate. In this study, we compared the efficacy of 2% niosomal zinc sulfate suspension with cryotherapy versus combined conventional 2% zinc sulfate and cryotherapy in the treatment of Verruca vulgaris. Methods: This is a triple-blind randomized clinical trial on 60 patients. Patients were randomized in 2 groups including combined 2% niosomal zinc sulfate suspension with cryotherapy versus combined 2% conventional zinc sulfate suspension combined with cryotherapy. The efficacy of treatment was evaluated during the treatment sessions until 12 weeks. Patients were followed for 3 months after the end of the treatment to evaluate recurrence rate. We used chi-square test to evaluate the efficacy of treatment and side effects. Mean number of treatment sessions was evaluated by t-test. Results: Mean number of the treatment sessions for complete remission was 3.66±0.92 and 4.63±0.66, in niosomal group and conventional group, respectively (P=0.001). The rate of complete remission was higher at the 6th and 8th weeks of the treatment in niosomal group compared to conventional group (P=0.001). Conclusion: This study demonstrated significant rapid remission of wart lesions treated with cryotherapy plus 2% niosomal zinc oxide suspension in comparison with cryotherapy plus 2% conventional zinc oxide suspension. [ABSTRACT FROM AUTHOR]

Despite the promising results of intralesional vitamin D in verruca treatment; its precise mechanism of action is not fully understood. To investigate immunohistochemical expression of cathelicidin (LL 37) before and after injection of vitamin D in verruca vulgaris and to clarify its possible role in pathogenesis of verruca. This study included 20 patients with multiple verrucae vulgaris. Vitamin D was intralesionally injected every 2 weeks for a maximum of 4 sessions or clearance of verrucae. Skin biopsies were taken from the patients before and at the end of the study and compared to skin samples from ten apparently healthy, age and sex matched individuals for histopathological and immunohistochemical assessment of LL37 expression. Eight (40%) verrucae showed complete response, seven (35%) showed partial response and five (25%) showed no response. Decreased epidermal thickness and reduced density of inflammatory cells in dermis were observed after injection. Significant increase in LL37 intensity of expression was observed after intralesional injection of vitamin D3 (p =.003) and in verrucae showing complete clinical response (p =.022). Intralesional injection of vitamin D is effective and safe treatment for verruca vulgaris and causes increase in LL37 expression. [ABSTRACT FROM AUTHOR]

Background: Cutaneous horns are not malignant per se. It is a rare, dark keratinized protrusion on the surface of the skin. The incidence and prevalence in general population is unknown. However, most cases occur in elderly aged 60 years and older. Case Report: We reported an interesting case of an 80-year-old man who developed a giant cutaneous horn on a forearm which was gradually increasing in size over seven years. He was referred to our primary care clinic by a doctor who is involved in humanitarian mission in an old folk's home who noticed a hornlike projection growth over his forearm. He was then referred to orthopedic department and underwent an excisional biopsy with adequate margin. Histology findings reported as prominent epithelial hyperplasia marked by hyperkeratosis and papillomatosis which indicates the lesion is caused by verruca vulgaris or a common wart. Such warts are usually benign which is caused by subtypes of human papilloma virus that are not associated with malignant transformatio n. Conclusions: This is a rare case of giant cutaneous horn located on forearm of an elderly man. It's highlighted that giant cutaneous horn is not always associated with malignancy especially when they are slow growing over a period of time. It also highlights the role of biopsies for skin lesions of uncertain aetiologies. In this case, it helped us to rule out squamous cell carcinoma, which can be a more locally invasive and destructive. Hence, early referral for excisional biosy and histopathological studies is mandatory for all cases. [ABSTRACT FROM AUTHOR]

Abstract Injectable bleomycin is infrequently used for recalcitrant warts despite its efficacy, acceptable safety profile, and high patient satisfaction compared with other treatment modalities. We present an immunocompromised patient with a large recalcitrant wart successfully treated with intralesional bleomycin to provide greater clinical exposure, training, and practice with intralesional bleomycin.

Tea Tree Oil (TTO) is one of the most widely used aroma oil and is documented to be beneficial in the management of viral infections such as Herpes Simplex Virus (HSV) and Human Papilloma Virus (HPV). Hereby, authors report a case of 22-year-old female diagnosed with HPV infection with cutaneous wart (Verruca Vulgaris) on distal phalange of the right index and middle fingers. She had complained of pain and discomfort while writing. Tea tree oil was mixed with carrier oil (coconut oil) in a ratio of 1:5, and she was advised to apply it over the wart directly for 21 days. At the completion of 21 days, the warts resolved completely and there was no recurrence during the one month follow-up after intervention. In addition, the patient also reported a reduction in pain with the treatment. Tea tree oil could thus be effectively used for treating cutaneous warts. However, further studies with adequate sample size would help further validate the findings.

Background: Warts are a common dermatologic complaint with an increased incidence within the pediatric population. Warts are caused by multiple strains of the human papillomavirus (HPV). There is little research on how a patient's HPV immunization status affects the response to treatment of warts in pediatric patients. Aims: The purpose of this study is to investigate the relationship between HPV vaccination status and wart resolution. Materials and Methods: This is a retrospective chart review that investigates the relationship between response to routine treatment of warts and a subject's HPV vaccination status. Results: There was no significant relationship found between HPV vaccination status and resolution of warts (p = 0.797). However, there was a significant positive correlation between having the HPV vaccine and number of visits for the treatment of warts (r = 0.180, P = 0.024). Conclusion: This study did not show a significant correlation between HPV vaccination status and wart resolution, although it demonstrated a significant positive relationship between those immunized with the HPV vaccine and an increased number of treatment visits. Possible explanations for this unexpected correlation include the variation in HPV vaccine formulation, vaccination status, and frequency of office visits, since vaccinated patients are more likely to be compliant with office visits. [ABSTRACT FROM AUTHOR]

Introduction: Verrucae vulgaris, or common warts, is a common skin condition for which there is no US Food and Drug Administration-approved treatment. Compounded cantharidin has been used to treat warts for years but lacks a controlled formulation, consistent application schedule and methods, and robust safety and efficacy studies. VP-102 is a proprietary drug-device combination product containing a topical formulation of 0.7% (w/v) cantharidin in a single-use delivery device. This objective of the phase 2 study was to evaluate the efficacy, safety, tolerability, and optimal regimen of VP-102 in the treatment of common warts. Methods: In this open-label trial, participants aged ≥ 2 years with one to six common warts were administered VP-102 topically to treatable common warts once every 14 days (Cohort 1) or once every 21 days in conjunction with paring (Cohort 2), for up to four treatments. Participants were evaluated through to day 84 (Cohort 1) or day 147 (Cohort 2). The primary endpoint was the percentage of participants with complete clearance of all treatable common warts (baseline and new) at day 84. Secondary endpoints included percentage of participants achieving complete clearance of all treatable common warts at other visits. Safety assessments included treatment-emergent adverse events (TEAEs), including local skin reactions (LSRs). Results: A total of 21 and 35 participants were enrolled in Cohort 1 and Cohort 2, respectively. Complete clearance at day 84 was seen in 19.0% of participants in Cohort 1 and 51.4% of those in Cohort 2. The most common TEAEs were expected LSRs and included application site vesicles, pain, pruritus, erythema, and scab. Most LSRs were mild or moderate in severity. Conclusion: VP-102 showed efficacy in complete clearance of common warts from baseline to day 84, as well as at follow-up visits. Due to the higher percentage of patients exhibiting complete clearance in Cohort 2, the treatment regimen of Cohort 2 will be pursued in future studies. TEAEs were expected due to the pharmacodynamic action of cantharidin, a vesicant. Clinical Trials ID: NCT03487549 [ABSTRACT FROM AUTHOR]

Introduction: Several modalities are used in the treatment of verrucae vulgaris; however, their side effects are common. Vitamin D3 has been recently used as a treatment in verruca vulgaris. Aim of the Work: We aimed to assess the expression of involucrin in verrucae before and after intralesional injection of vitamin D3 and its correlation with clinical response. Subjects and Methods: This study included 60 patients with verrucae vulgaris. These patients were subjected to intralesional injection of vitamin D3 at 3-week intervals for a maximum of five sessions. The pathological assessment was done by skin biopsies obtained from thirty patients before the first session and after the last session of injection and compared to skin biopsies from 30 healthy individuals. Results: The injected verrucae showed complete response in 39 patients (65%), partial response in 15 patients (25%), and no response in 6 patients (10%). Nonsmoker patients had a better response than smokers. Vitamin D3 injections also resulted in increasing involucrin expression and changing its pattern of expression. Conclusions: Intralesional vitamin D3 is an effective treatment for verrucae vulgaris. Involucrin expression is modified in verrucae. [ABSTRACT FROM AUTHOR]

Porokeratosis is a clonal expansion of keratinocytes. Among the neoplasms, squmous cell carcinoma (SCC) is the most commonly reported malignancy in porokeratosis. Porokeratosis of mibelli, keratoacanthoma and verruca vulgaris have association with human papilloma virus (HPV). We report here a case of keratoacanthoma, verruca vulgaris in a lesion of porokeratosis of mibelli. [ABSTRACT FROM AUTHOR]

Background: Cantharidin is a topical vesicant that causes intraepidermal acantholysis with clinical application that includes the removal of warts, molluscum contagiosum (MC), calluses, and acquired perforating dermatoses.Objective: To provide a comprehensive literature review of the efficacy and safety of cantharidin in the management of various cutaneous conditions. Methods: A PubMed search was conducted using the term “cantharidin” combined with “warts”, “plantar warts”, “verruca vulgaris”, “periungal”, “subungual”, “topical treatment”, “topical therapy for warts", molluscum contagiosum”, “perforating collagenosis,” and “acantholysis.”Results: A total of 749 articles were identified and 37 articles met inclusion criteria for this review.  The majority of studies show that cantharidin is an effective and safe treatment for removal of warts and MC.  Several studies also show potential novel applications of cantharidin in acquired perforating dermatosis, acute herpes zoster, and leishmaniasis. Adverse effects are generally mild but common and should be monitored, particularly in the pediatric population.Limitations: There is a paucity of high-powered clinical studies involving the use of cantharidin.Conclusion: Topical cantharidin is a safe and effective treatment for warts, molluscum contagiosum, and callus removal, with promising uses in perforating dermatoses and leishmaniasis.