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Warts are the cutaneous manifestations of human papilloma virus infection. Immunotherapy with human papillomavirus (HPV) vaccines has been tried with promising outcomes. Acyclovir is an antiviral with established efficacy against DNA viruses, could become a possible revolutionary therapeutic option for warts. This study aims to assess the efficacy and safety of intralesional acyclovir versus quadrivalent human papilloma virus vaccine in treatment of recalcitrant cutaneous warts. A total of 60 patients with recalcitrant warts were assigned into 3 groups: group I, 20 patients received Intralesional injection of acyclovir, group II, 20 patient received intralesional quadrivalent HPV vaccine, and group III, 20 patients received intralesional injection of normal saline. The patients were followed up monthly for 3 months after the last injection to detect any recurrence. Complete clearance was observed in 8 patients (40%) in group I, 16 patients (80%) in group II and no response in group III. The most common side effects were pain (100%) among all groups, hemorrhagic eschars in group I(100%), edema in group II(30%) while the least was flu like symptoms (5%) in group II. both intralesional quadrivalent HPV vaccine and intralesional acyclovir seem to be promising, well-tolerated therapeutic options for the treatment of warts, with statistically significant superiority of the quadrivalent vaccine over acyclovir.

Plantar warts, or verrucae plantares, are skin lesions on the soles of the feet caused by human papillomavirus (HPV). These warts are prevalent and affect up to 33% of children and 3.5% of adults. While they may regress spontaneously, plantar warts often persist and resist conventional treatments such as excision, cryotherapy, and laser procedures. This study investigated microwave-induced hyperthermia as a treatment for recalcitrant plantar warts. The study was conducted at a dermatology practice in Lübeck, Germany. Thirty-two adult patients with long-lasting, treatment-resistant plantar warts were randomly assigned to either a treatment or placebo group. The treatment group received microwave therapy (Swift ® , Emblation Medical Ltd., UK), while the placebo group underwent sham treatment with a ruby laser (Sinon ® , Alma Lasers Ltd., Israel). Treatments were administered every four weeks, for a total of 3 treatments, with a follow-up period of 3 months after the third session. The primary outcome was complete wart clearance. Of the 32 participants, 6 dropped out, leaving 28 for analysis. Complete clearance was achieved in 27.3% of the treatment group (3/11) compared to 0% of the placebo group (p = 0.032). Six patients in the treatment group achieved a partial response ranging from 41.1 to 88.4% of the total wart area, with a partial clearance rate of 54.5% versus 13.3% in the placebo group. The average pain score for the microwave treatment group was 5.44. Microwave therapy has proven to be superior to placebo treatment. The clearance rate in this study was lower than that reported in previous uncontrolled studies, potentially due to differences in treatment protocols. The pain level and cost of consumables present challenges. However, further studies are needed to optimize the protocol and assess its efficacy in larger populations and for different wart types.

Warts are small, benign growths caused by human papilloma virus (HPV) infection of the skin or mucous membrane. Photodynamic therapy in dermatology is simplified by the accessibility of the skin to light application and allows using any light source with the appropriate spectrum. This study aimed to compare the efficacy and safety of daylight-PDT versus pro yellow laser (577 nm)-PDT mediated by 10% methylene blue (MB) gel in the treatment of plane warts. This prospective comparative study was carried out on 34 patients presented with common warts (≥ 1 warts). Patients were divided into two equal groups by simple randomization process. Group 1: treated with daylight PDT using MB (MB-DL PDT), group 2: treated with Pro yellow laser as PDT using MB. The results of the present study revealed excellent response of warts in 9 patients (52.9%), very good response in 4 patients (23.5%) and poor response in 2 patients (11.8%) of group (1). In group (2), excellent response of the treated warts was observed in 5 patients (29.4%), poor response in 5 patients (29.4%) and no response in 7 patients (41.2%). Daylight-photodynamic therapy (DL-PDT) using MB is an effective treatment, nearly pain free and of convenience to patients. Careful consideration should be given to patient-specific factors such as immune status and previous treatment history. Future research with larger sample sizes, HPV genotyping, and longer follow-up periods is warranted to optimize patient-tailored PDT protocols.

Verrucae plantaris (plantar warts) are common cutaneous lesions of the plantar aspect of the foot that are caused by the human papillomavirus (HPV). Ubiquitous in our environment, asymptomatic infection with HPV occurs frequently, with most infections controlled or cleared by cellular and humoral immune responses. However, certain populations have been observed to manifest plantar warts at higher rates compared with the general population, placing them at increased risk for wart-induced pain and complications. Plantar warts shed HPV, which can then infect other sites in the plantar region or spread to other people. Although controlling risk factors is useful in preventing infection, the pervasive nature of HPV makes these preventive measures frequently impractical. This literature review outlines the current knowledge regarding the relationship between plantar wart pathophysiology, HPV transmission, and epidemiologic characteristics. Given the high propensity for treatment resistance of plantar warts and no established, practical, and reliable method of prevention, HPV prophylaxis for populations that demonstrate high rates of plantar warts may be of benefit in controlling the spread of lesions.

WHIM syndrome is a rare combined primary immunodeficiency disease named by acronym for the diagnostic tetrad of warts, hypogammaglobulinemia, infections, and myelokathexis. Myelokathexis is a unique form of non-cyclic severe congenital neutropenia caused by accumulation of mature and degenerating neutrophils in the bone marrow; monocytopenia and lymphopenia, especially B lymphopenia, also commonly occur. WHIM syndrome is usually caused by autosomal dominant mutations in the G protein-coupled chemokine receptor CXCR4 that impair desensitization, resulting in enhanced and prolonged G protein- and β-arrestin-dependent responses. Accordingly, CXCR4 antagonists have shown promise as mechanism-based treatments in phase 1 clinical trials. This review is based on analysis of all 105 published cases of WHIM syndrome and covers current concepts, recent advances, unresolved enigmas and controversies, and promising future research directions.

IntroductionOptimal management of treatment-refractory viral warts caused by human papillomavirus is unknown. One of the treatment methods is intralesional bleomycin solution.ObjectiveTo determine risk factors for resistant viral warts (not responding to conventional treatments for ≥ 6 months), to determine the effectiveness and safety of intralesional bleomycin in a group of patients with viral warts resistant to conventional treatment methods, and to assess the utility of dermoscopy in monitoring treatment effects during intralesional bleomycin therapy.Material and methodsThe study group consisted of consecutive 12 adult patients with resistant viral warts treated with intralesional bleomycin (0,5 U/ml) at the Department of Dermatology, Venereology and Allergology, Medical University of Gdansk between July 2019 and December 2021. Inclusion criteria were age > 18 and previous unsuccessful treatment of viral warts with ≥ 2 methods used according to guidelines over a period of 6 months. The control group consisted of 8 adult patients who presented with viral warts of the total duration of less than 6 months with no previous treatment, and qualified for cryotherapy.ResultsBleomycin showed 100% efficacy. Except for periprocedural pain, no side effects were observed. Dermoscopy proved to be effective in clinical evaluation of patients, as it allowed to differentiate wart remnants from eschar observed after bleomycin injection. In one patient we observed CD4+ lymphocytopenia at the inclusion stage, and no other risk factors of resistant warts could be identified, however a relatively small number of patients studied could influence this observation.ConclusionsIntralesional bleomycin may be considered as possible therapeutic option in patients with therapy-resistant viral warts.

Background The clinical strategy of oral supplementation of Vitamin D (VD) as a preventive and therapeutic measure for warts needs further exploration. Methods The clinical data of patients with skin diseases who visited the Children's Hospital affiliated with Chongqing Medical University from February 2018 to June 2024 were collected. The serum VD levels in patients with warts (common warts, flat warts, and plantar warts) and patients with other common skin diseases (atopic dermatitis, psoriasis, alopecia areata, vitiligo, and chronic urticaria) were compared. Two‐sample bidirectional Mendelian randomization (MR) analysis was performed to investigate potential causal associations between VD and warts. Results The average serum VD level of children with warts was 23.27 ± 7.07 ng/mL, which showed no statistically significant difference compared to children with other common skin diseases. The inverse variance weighted (IVW) method analysis indicated a positive causal relationship between VD and warts (Odds Ratio [OR] = 1.86, [95% CI: 1.19−2.92], p = 0.007). Sensitivity analysis did not show any indication of horizontal pleiotropy or heterogeneity. The MR‐PRESSO method did not identify any outliers. Conclusion The levels of serum VD in children with warts do not significantly decrease compared to children with other common skin conditions. The evidence from the MR analysis indicates a positive causal relationship between VD and warts, suggesting caution in supplementing VD for children with warts who have normal or elevated serum VD levels. Further clinical studies are needed for validation in the future.

BACKGROUNDWarts, hypogammaglobulinemia, infections, and myelokathexis (WHIM) syndrome is a primary immunodeficiency disorder caused by heterozygous gain-of-function CXCR4 mutations. Myelokathexis is a kind of neutropenia caused by neutrophil retention in bone marrow and in WHIM syndrome is associated with lymphopenia and monocytopenia. The CXCR4 antagonist plerixafor mobilizes leukocytes to the blood; however, its safety and efficacy in WHIM syndrome are undefined.METHODSIn this investigator-initiated, single-center, quadruple-masked phase III crossover trial, we compared the total infection severity score (TISS) as the primary endpoint in an intent-to-treat manner in 19 patients with WHIM who each received 12 months treatment with plerixafor and 12 months treatment with granulocyte CSF (G-CSF, the standard of care for severe congenital neutropenia). The treatment order was randomized for each patient.RESULTSPlerixafor was nonsuperior to G-CSF for TISS (P = 0.54). In exploratory endpoints, plerixafor was noninferior to G-CSF for maintaining neutrophil counts of more than 500 cells/μL (P = 0.023) and was superior to G-CSF for maintaining lymphocyte counts above 1,000 cells/μL (P < 0.0001). Complete regression of a subset of large wart areas occurred on plerixafor in 5 of 7 patients with major wart burdens at baseline. Transient rash occurred on plerixafor, and bone pain was more common on G-CSF. There were no significant differences in drug preference or quality of life or the incidence of drug failure or serious adverse events.CONCLUSIONPlerixafor was not superior to G-CSF in patients with WHIM for TISS, the primary endpoint. Together with wart regression and hematologic improvement, the infection severity results support continued study of plerixafor as a potential treatment for WHIM syndrome.TRIAL REGISTRATIONClinicaltrials.gov NCT02231879.FUNDINGThis study was funded by the Division of Intramural Research, National Institute of Allergy and Infectious Diseases.

WHIM syndrome (warts, hypogammaglobulinemia, infections, and myelokathexis) results from hyperactivity of the chemokine receptor CXCR4. Plerixafor blocks the receptor. It was used in three patients who could not receive granulocyte colony-stimulating factor and was associated with sustained improvement.

Current therapeutic modalities for viral warts are mostly ablative and are limited by high recurrence rates besides being unsuitable for numerous lesions. Immunotherapy has the potential to overcome these limitations. The aim of this study was to compare the effectiveness and safety of Bacillus Calmette-Guerin vaccine versus tuberculin purified protein derivative in the immunotherapy of warts. Patients received three doses of 0.1 ml of Bacillus Calmette-Guerin vaccine or tuberculin purified protein derivative intradermally over the deltoid region at 4-weekly intervals. They were followed-up for another month. Number of warts, complete cure rates and quality of life were assessed. A total of 60 patients were included. Complete clearance was noted in 16 (48.5%) out of 33 patients in the Bacillus Calmette-Guerin group and in 5 (18.5%) out of 27 in the tuberculin purified protein derivative group (P = 0.121). The number of lesions reduced statistically significantly from baseline in both the groups (P < 0.001) from the first follow-up visit onward (P < 0.05). The reduction was statistically significantly more in the Bacillus Calmette-Guerin group than in the tuberculin purified protein derivative group from the second follow-up onward. Dermatologic life quality index improved statistically significantly with both treatments. Adverse events (pain during injection, abscess formation and scarring at injection site) were more frequent with Bacillus Calmette-Guerin. No recurrence was seen after lesions cleared. Patients were not followed up for more than 4 weeks after treatment. We could not estimate the cytokine levels or the peripheral blood mononuclear cell proliferation in response to Bacillus Calmette-Guerin/tuberculin purified protein derivative injections. Both intradermal Bacillus Calmette-Guerin and tuberculin purified protein derivative hold promise in the treatment of viral warts. Bacillus Calmette-Guerin may be more effective, though it had more adverse events in our study.