RELATIVE EFFICACY AND SAFETY OF HOMOLOGOUS AUTOIMPLANTATION AND INTRALESIONAL MMR IN MULTIPLE AND RECALCITRANT VERRUCAE VULGARIS

INTRODUCTION: Verrucae are the viral infection of skin and mucosae caused by Human Papilloma Virus (HPV). Destructive modalities, mainstay of treatment have their own shortcomings like pain, infection, scarring and recurrence. To overcome these, immunotherapy is the emerging modality. MATERIALS AND METHODS: 40 patients with multiple ( >5) and recalcitrant warts were enrolled and divided randomly into two groups (Group A and Group B): In Group A, autoimplantation was done in 20 patients whereas in Group B, 20 patients were injected 0.3ml MMR vaccine into the largest wart at 2 weeks interval until complete clearance or for maximum of 3 injections whichever was earlier. Patients were followed up at 4 week intervals for 12 weeks. RESULTS: In Group A, 13 (65%) patients showed Grade 4, 1 (5%) patients had Grade 3 , 5 (25%) patients had Grade2 and only 1 (5%) patient had Grade 1 improvement. In Group B on the other hand, 15 (75%) patients showed Grade 4, 3 (15%) patients had G3, 2 (10%) patients had Grade 2 and 0 (8%) patients had Grade 1 improvement. CONCLUSION: Both the immunotherapeutic treatments are safe, economic and less traumatic to the patients as compared to the destructive procedures for the treatment of warts.

Relative efficacy and safety of intralesional measles mumps rubella vaccine (MMR) and intralesional vitamin D in multiple and recalcitrant verrucae vulgaris

Verrucae or Warts are the viral infection of skin and mucosae caused by Human Papilloma Virus (HPV). Destructive modalities are the mainstay of treatment. They can have their own shortcomings like pain, infection, scarring and recurrence. To overcome these, immunotherapy is the emerging modality. To study the relative efficacy and safety of intralesional Measles Mumps Rubella (MMR) vaccine and intralesional Vitamin D in the treatment of multiple and recalcitrant verruca vulgaris. 50 patients with multiple (>5) and recalcitrant warts were enrolled and divided randomly into two groups (Group A and Group B): In Group A, 25 patients were injected 0.3ml MMR vaccine whereas in Group B, 25 patients were injected 0.5ml Vitamin D injection after achieving anaesthesia with 0.2ml injection Lignocaine into the largest wart at 2 weeks interval until complete clearance or for maximum of 3 injections whichever was earlier. Patients were followed up fortnightly for 12 weeks. In Group A, 19 (76%) patients showed Grade IV, 2 (8%) patients had Grade III, 3 (12%) patients had GII and only 1 (4%) patient had Grade I improvement. In Group B on the other hand, 15 (60%) patients showed Grade IV, 4 (16%) patients had GIII, 4 (16%) patients had Grade II and 2 (8%) patients had Grade I improvement. None of the patients developed new lesions in both groups. Both the immunotherapeutic treatments are safe, economic and less traumatic to the patients as compared to the destructive procedures for the treatment of warts.

Dorsal expansion-related manual disability in verrucae vulgaris patients treated with cryotherapy: A longitudinal study via big data

Background: Common warts frequently occur over the hands and may overlie critical structures, including the extensor expansion of the digits, for which cryotherapy can lead to manual disability. Aims and Objectives: We aim to implement big data to infer knowledge on the interest of web users regarding the dorsal expansion-related manual disability in verrucae vulgaris patients managed with cryotherapy. Materials and Methods: We mapped the interest of users of the surface web in connection with five topics: cryosurgery, extensor digitorum muscle, human papillomavirus, manual disability, and verruca vulgaris. We retrieved longitudinal data [2004-2019] concerning the spatio-temporal variations of interest in these topics, using Google Trends. We are also reporting a case of interest while analyzing it using the Bradford Hill criteria. Results: Sixty-four nations contributed to the spatial (geographic) map, including ten countries from the Middle East and the north of Africa (15.63%). There was high temporal variability concerning cryosurgery 29.61 (+/- 0.94), extensor digitorum muscle 64.43 (+/- 0.86), human papillomavirus 0.01 (+/- 0.01), manual disability 2.89 (+/- 0.13), and verruca vulgaris 9.39 (+/- 0.20). Conjoint inference, via Post-Hoc testing and neural networks [machine learning], assigned the highest synaptic weight [effect size] to “cryosurgery” and “extensor digitorum muscle”, thus indicating that these topics are of prime interest for web users, including anatomists and dermatologists. Conclusions: We are conveying two messages: 1) Dermatologists are encouraged to collaborate with data scientists to realize the importance of big data for evidence-based dermatology. 2) Physicians should exercise extra caution in managing patients with verrucae vulgaris using cryotherapy.

Spontaneous Regression of Palmar Warts after Suffering from Diffuse Contact Dermatitis against Alkyl Bromide

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.

Apoyo diagnóstico con ecografía en papilomas plantares: caso clínico

Las verrugas cutáneas son tumores intraepidérmicos benignos de la piel con una variedad de manifestaciones incluyendo verrugas comunes (verrucae vulgaris), verrugas palmar y plantar (verrugas palmares y plantares), verrugas en mosaico, verrugas planas (verrugas planas) generalmente diagnosticado por su apariencia clínica aunque el diagnóstico definitivo depende del examen histopatológico. La ecografía puede definir su extensión, ubicaciones exactas y patrones de flujo sanguíneo siendo extremadamente útil en casos difíciles, especialmente cuando los síntomas como el dolor persisten en el tiempo. También puede dar relevancia información prequirúrgica y, finalmente, puede proporcionar ideas importantes sobre las condiciones asociadas del pie.