Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study

Nofal, Ahmad; Elkot, Reham; Nofal, Eman; Mazen, Mai

doi:10.1111/jocd.12848

Cited by 8 publications

(19 citation statements)

References 38 publications

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“…Many authors have reported better control of HPV infections using combined therapeutic modalities compared with monotherapy in the treatment of warts, particularly the recalcitrant ones . Recently, we have shown that the combined therapy of acitretin and Candida antigen injection is superior to either agent alone in the treatment of recalcitrant warts and that Cervarix is effective in the treatment of recalcitrant common warts (data not yet published).…”

Section: Discussionmentioning

confidence: 95%

Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts

Marei

Nofal

Alakad

et al. 2019

J of Cosmetic Dermatology

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Background The burden of human papillomavirus (HPV) infection and HPV‐associated diseases is consistently growing worldwide. Several combination therapies are being tested nowadays for the treatment of recalcitrant warts, with promising results. Aims To evaluate the potential therapeutic role of combined bivalent HPV vaccine (Cervarix) and Candida antigen versus candida antigen alone in the treatment of multiple recalcitrant warts. Patients/Methods Forty patients with recalcitrant warts were enrolled into this study. They were divided into two groups (A and B), each including 20 patients. Patients in the group (A) received intralesional Candida antigen injection alone for five sessions at 2‐week intervals. Patients in the group B received combined treatment of bivalent recombinant HPV vaccine and intralesional Candida antigen. Candida antigen was administered as in the group A, while Cervarix vaccine was given intramuscularly at 0, 1, and 6 months as scheduled. Follow‐up was made monthly for 6 months to detect any possible recurrence. Results Eight patients (40%) in the group (A) showed complete clearance of warts after intralesional Candida antigen injection alone, while 14 patients (70%) in the group (B) showed complete regression of warts after the combined therapy. No significant side effects were reported in both groups, and no recurrence was detected. Conclusion Bivalent human papillomavirus vaccine combined with Candida antigen is a promising, effective, and safe modality for the treatment of multiple recalcitrant warts.

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Section: Discussionmentioning

confidence: 95%

Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts

Marei

Nofal

Alakad

et al. 2019

J of Cosmetic Dermatology

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“…Acitretin is a second‐generation, aromatic systemic retinoid that possesses potent immunomodulatory, antiproliferative and antidifferentiative properties and has been widely used for the treatment of psoriasis and various disorders of keratinization 14,15 . Several single case reports 16‐26 and case series reports 27,28 have demonstrated that acitretin either as monotherapy or in combination with other treatments has good clinical efficacy in the treatment of extensive and recalcitrant warts. In this study, the efficacy and safety of acitretin monotherapy was assessed in patients with extensive/recalcitrant warts.…”

Section: Introductionmentioning

confidence: 99%

Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study

Zhang

Liu

et al. 2020

Dermatologic Therapy

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Most available options for the treatment of warts are limited by the potential for scarring, pain, lack of response, or recurrences, and the patients are often unable to tolerate and accept those experiences. The aim of this study was to evaluate the clinical efficacy and safety of oral systemic acitretin monotherapy in patients with extensive/recalcitrant cutaneous warts. The patients were given a dose of acitretin of 0.8 mg kg−1 day−1, and the clinical efficacy and safety of acitretin was assessed every 2 weeks for 2 months. A total of 14 patients (12 males and 2 females) were included, with an age of 14‐60 years (mean 33 ± 14.7 years) and a course of 4‐48 months (mean 21.6 ± 13.4 months). After 2 months of acitretin treatment, 42.9% (6/14) of patients (including warts of the feet, legs, and hands) exhibited complete response, 28.6% (4/14) excellent response, and 28.6% (4/14) good response. All patients demonstrated significant improvement, and the drug was well tolerated, with no patients discontinuing therapy due to side effects. Common mild side effects included dry skin and cheilitis. There were no recurrences during a follow‐up period of 6 months. Acitretin monotherapy is an effective, safe, and well‐tolerated treatment for patients with extensive/recalcitrant cutaneous warts who are unsuitable for or unwilling to accept traditional treatment methods.

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“…The goal of the Er:YAG laser Retinoids: Both topical and oral retinoids can be employed to treat warts via inhibition of HPV replication. Acitretin is a systemic retinoid that can be used [16]. While its use for warts was only studied in adults, acitret in is prescribed in the adolescent population to treat acne.…”

Section: Photodynamic Therapy (Pdt)mentioning

confidence: 99%

“…While its use for warts was only studied in adults, acitret in is prescribed in the adolescent population to treat acne. Recommendations in children have not been specifically studied [16].…”

Section: Photodynamic Therapy (Pdt)mentioning

confidence: 99%

Treatment of Warts in Pediatrics: A Review

Marisa¹,

Kyriakides²,

Cindy³

2020

J Fam Med Dis Prev

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Cutaneous warts, or verruca vulgaris, are a viral skin condition caused by the Human Papilloma Virus (HPV) that are very common in children. Many physicians struggle with treatment of warts, due to the resistant nature of the lesions. There are a variety of treatment modalities that are offered. The goal of this paper is to review the different treatments that are beneficial and safe to use for warts in the pediatric population. We will break down the adverse effects, benefits, and efficacy of each of the options. Literature review Check for updates groups: physical or chemical destruction, immune modulating agents, and antiproliferation agents. The goal of this review is to examine and assess each of the different treatment options. Treatments Destructive methods Salicylic acid: Salicylic acid is a topical chemical agent that destroys the epithelial layer infected by the wart. It is considered a type of destructive treatment. A systematic review reported a cure of 75% with salicylic acid compared to 48% cure rate placebo after reviewing data from six different studies [5]. It is still considered the only treatment that is approved by the Food and Drug Administration (FDA) [6]. Therefore, salicylic acid is considered a first line treatment. A Cochrane systematic review assessed six studies comparing placebo versus salicylic acid treatment, showing a significant improvement in reduction of warts with the administration of salicylic acid recording a 95% Confidence Interval 1.20 to 2.03 [7]. There were no significantly harmful side effects reported except minor skin irritation [7]. Another study found that it was beneficial to file the wart down alongside the treatment with salicylic acid [8]. Salicylic acid may be a favorable option for children due to the lack of significant side effects. However, reported duration of treatment with salicylic acid is approximately 3 to 6 months until clearance of warts, making this option a relatively lengthy treatment course [6]. Cryotherapy: Cryotherapy is another type of destructive wart treatment. This technique includes "freezing" a wart with liquid nitrogen for 20-30 seconds with treatments repeated every 3 to 4 weeks until resolution [6]. A systematic analysis examined 3 trials that showed

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Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study

Cited by 8 publications

References 38 publications

Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts

Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts

Successful clearance of extensive/recalcitrant cutaneous warts by acitretin monotherapy: A case series study

Treatment of Warts in Pediatrics: A Review

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