Verruca Vulgaris (Warts)

Arch Dermatol. 2007 Mar;143(3):309-13. Abstract quote

OBJECTIVE: To evaluate the efficacy of duct tape occlusion therapy for the treatment of common warts in adults.

DESIGN: Double-blind controlled clinical intervention trial.

SETTING: Veterans Affairs medical center.

PARTICIPANTS: A total of 90 immunocompetent adult volunteers with at least 1 wart measuring 2 to 15 mm were enrolled between October 1, 2004, and July 31, 2005. Eighty patients completed the study.

INTERVENTION: Patients were randomized by a computer-generated code to receive pads consisting of either moleskin with transparent duct tape (treatment group) or moleskin alone (control group). Patients were instructed to wear the pads for 7 consecutive days and leave the pad off on the seventh evening. This process was repeated for 2 months or until the wart resolved, whichever occurred first. Follow-up visits occurred at 1 and 2 months.

MAIN OUTCOME MEASURE: Complete resolution of the target wart. Secondary outcomes included change in size of the target wart and recurrence rates at 6 months for warts with complete resolution.

RESULTS: There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group). Of patients with complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month.

CONCLUSION: We found no statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population.

Epidemiology
Disease Associations
Pathogenesis
Laboratory/Radiologic/Other Diagnostic Testing
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Special Stains/ Immunohistochemistry/ Electron Microscopy
Differential Diagnosis
Prognosis
Treatment
Commonly Used Terms
Internet Links

EPIDEMIOLOGY	CHARACTERIZATION
SYNONYMS	Warts Common warts

HISTOPATHOLOGICAL VARIANTS	CHARACTERIZATION
ATYPICAL LYMPHOID INFILTRATE
Verruca Vulgaris With CD30-Positive Lymphoid Infiltrate: A Case Report Anna M. Cesinaro, M.D.; Antonio Maiorana, M.D.	Am J Dermatopathol 2002; 24(3):260-263 Abstract quote Expression of CD30 has been reported in reactive lymphoid cells that accompany some cutaneous viral infections. It is interpreted as a marker of lymphocyte activation in response to the infecting virus. We report on a case of viral wart presenting with an inflammatory infiltrate with numerous CD30+ atypical lymphoid cells. These cells comprised approximately 10% of the reactive cell population and showed a T-helper phenotype. Infection by human papillomavirus should be included among the causes of cutaneous CD30+ reactive lymphoid infiltrates.

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSIS
KERATIN SUBTYPES
Retinoids Strongly and Selectively Correlate With Keratin 13 and Not Keratin 19 Expression in Cutaneous Warts of Renal Transplant Recipients Willeke A. M. Blokx, MD; Jurgen V. Smit, MD; Elke M .G. J. de Jong, MD, PhD; Monique M. G. M. Link; Peter C. M. van de Kerkhof, MD, PhD; Dirk J. Ruiter, MD, PhD	Arch Dermatol. 2002;138:61-65 Abstract quote Objective To compare the expression of keratin (K) 13 and K19 in cutaneous warts of renal transplant recipients (RTRs) and immunocompetent individuals (ICIs). Design Retrospective, nonrandomized immunohistochemical study. Patients and Methods Specimens from cutaneous warts of RTRs and ICIs were retrieved from the archives of the Department of Pathology, University Medical Center St Radboud, Nijmegen, the Netherlands. Twenty-one warts from RTRs and 21 from ICIs were examined. Nine RTRs (10 specimens) received either systemic acitretin or topical all-trans retinoic acid, and their effect on both keratins was assessed. Main Outcome Measures Frequency and expression patterns of K13 and K19 in warts of RTRs vs ICIs and the effect of retinoids. Results A significantly higher percentage of warts of RTRs expressed K13 compared with warts of ICIs (86% vs 14%, 18 vs 3 cases, respectively; P<.001). In warts of RTRs, retinoid treatment correlated significantly with a particularly strong, segmental K13 expression pattern, which we termed zebroid. Without use of retinoids, K13 was mostly restricted to suprabasal single cells. Keratin 19 was absent in all warts of both patient groups. Conclusions Retinoids strongly correlate with K13 in a characteristic zebroid pattern in warts of RTRs, making K13 a sensitive marker for retinoid bioactivity in skin (lesions) of RTRs. In non�retinoid-treated RTRs, K13 is also frequently found in warts but without the dramatic zebroid pattern noted in retinoid-treated warts.
TREATMENT	Dermatol Clin. 1997;15:331-340 Cryotherapy remains the first-line treatment Alternative Agents: Keratolytics or cantharidin Laser ablation Surgical excision Immunologic manipulation
VIRAL OR FUNGAL ANTIGENS
Intralesional Injection of Mumps or Candida Skin Test Antigens A Novel Immunotherapy for Warts Sandra Marchese Johnson, etal.	Arch Dermatol. 2001;137:451-455 Abstract quote Background Warts are common and induce physical and emotional discomfort. Numerous therapies exist, yet none is optimal. Despite theoretical advantages, immunotherapeutic modalities are often neglected as first-line wart therapies. Objective To compare treatment with intralesional skin test antigen injection of 1 wart vs cryotherapy of all warts. Design Pilot study. Setting University dermatology outpatient clinic. Patients A total of 115 consecutive patients with at least 1 nongenital wart. Interventions Patients with warts were tested for immunity to mumps and Candida using commercial antigens. Nonresponders received cryotherapy and immune individuals received cryotherapy or intralesional injection of 1 antiserum. Results Thirty-four (30%) of the 115 patients did not respond to the test injections and 81 (70%) had detectable immunity. Of the immune group, 26 (32%) received cryotherapy, 45 (56%) received intralesional mumps antiserum, and 10 (12%) received intralesional Candida antiserum. Of the anergic patients, 28 (82%) were treated with cryotherapy; 6 (18%) refused cryotherapy. Of the 39 patients who were treated with immunotherapy and completed the protocol, 29 (74%) had complete clearing of the treated wart. Fourteen (78%) of 18 patients with complete resolution of their immunotherapy-treated wart also had resolution of untreated, distant warts. Conclusions Intralesional injection of mumps or Candida antigens into warts of immune individuals represents effective treatment. Observation of clearing of anatomically distinct and distant warts suggests acquisition of human papillomavirus�directed immunity in some patients. We conclude that this novel approach to immunotherapy may serve as first-line treatment in immune individuals with multiple or large warts and as second-line treatment in immune patients for whom cryotherapy fails.
CIMETIDINE AND LEVAMISOLE
Cimetidine and levamisole versus cimetidine alone for recalcitrant warts in children. Parsad D, Pandhi R, Juneja A, Negi KS. Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.	Pediatr Dermatol 2001 Jul-Aug;18(4):349-52 Abstract quote Various immunomodulating agents have been used in the treatment of recalcitrant warts, but none is uniformly effective. Aggressive surgical therapy of warts in children is painful and may require general anesthesia. Drugs such as cimetidine and levamisole have been tried with varying success rates. Given the different target of activities of immunomodulation by cimetidine and levamisole, we questioned whether the combination might be more effective and conducted a double-blind comparative trial of a combination of cimetidine and levamisole versus cimetidine alone. Forty-four patients with multiple recalcitrant warts were assigned to one of two treatment groups (groups A and B) in double-blind fashion. Of the 44 patients, 19 in group A and 20 in group B could be evaluated. At the end of therapy, cure rates (complete clearance) obtained were 31.5% of those in group A and 65% of those in group B (combination treatment). A statistically significant improvement was seen in patients treated with the combination of levamisole and cimetidine (p=0.0150). The rate of regression was faster in group B (average regression period of 7.8 weeks compared with 11 weeks in group A). The present study demonstrated that the combination of cimetidine with levamisole is more effective than cimetidine alone and is a highly effective therapy for the treatment of recalcitrant warts.
DUCT TAPE
Duct tape for the treatment of common warts in adults: a double-blind randomized controlled trial. Wenner R, Askari SK, Cham PM, Kedrowski DA, Liu A, Warshaw EM. Department of Dermatology, University of Minnesota, Minneapolis, USA.	Arch Dermatol. 2007 Mar;143(3):309-13. Abstract quote OBJECTIVE: To evaluate the efficacy of duct tape occlusion therapy for the treatment of common warts in adults. DESIGN: Double-blind controlled clinical intervention trial. SETTING: Veterans Affairs medical center. PARTICIPANTS: A total of 90 immunocompetent adult volunteers with at least 1 wart measuring 2 to 15 mm were enrolled between October 1, 2004, and July 31, 2005. Eighty patients completed the study. INTERVENTION: Patients were randomized by a computer-generated code to receive pads consisting of either moleskin with transparent duct tape (treatment group) or moleskin alone (control group). Patients were instructed to wear the pads for 7 consecutive days and leave the pad off on the seventh evening. This process was repeated for 2 months or until the wart resolved, whichever occurred first. Follow-up visits occurred at 1 and 2 months. MAIN OUTCOME MEASURE: Complete resolution of the target wart. Secondary outcomes included change in size of the target wart and recurrence rates at 6 months for warts with complete resolution. RESULTS: There were no statistically significant differences in the proportions of patients with resolution of the target wart (8 [21%] of 39 patients in the treatment group vs 9 [22%] of 41 in the control group). Of patients with complete resolution, 6 (75%) in the treatment group and 3 (33%) in the control group had recurrence of the target wart by the sixth month. CONCLUSION: We found no statistically significant difference between duct tape and moleskin for the treatment of warts in an adult population.