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Efficacy of Punch Reduction Prior to Cryotherapy in Patients with Viral Warts: A Case-Control Study in a Single Tertiary Center

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cutaneous warts are a common complaint to visit dermatologic clinic and its course is variable, ranging from spontaneous resolution to a chronic condition refractory to treatment.

Objective: To evaluate the efficacy and safety of punch biopsy for cutaneous warts.

Methods: Thirty-nine patients who received punch biopsy for warts were reviewed through charts and photos. Among them, 15 were matched with cryotherapy-only controls in terms of size and location of the wart. We compared the number and cost of treatments between the two groups.

Results: Eleven of the total 39 patients were treated with cryotherapy in addition to punch biopsy and the average number of treatments was 4.1±3.3 (mean±standard deviation). In a case-control study, the ratio value of cost was 2.9±3.6 in the experimental group and was 5.9±4.1 in controls (p<0.05).

Conclusion: Punch biopsies can decrease the number and cost of treatment by reducing the size of warts and inducing local inflammation to accelerate resolution. Therefore, punch reduction should be considered as a viable measure to treat warts.

No MeSH data available.


Related in: MedlinePlus

(A) Clinical image of the sole prior to treatment (51 years/male, dotted circle: viral wart). (B, C) Cup-shaped mass with hyperkeratosis, acanthosis and koilocytes, total excision (H&E; B: ×40, C: ×200). (D) Complete clearance without scar six weeks after punch biopsy (dotted cicrle: treated area). (E) A wart on the proximal nail fold of fifth toe, prior to treatment (25 years/female, dotted circle: viral wart). (F, G) Partially removed hyperkeratotic mass with koilocytes and eosinophilic keratohyaline granules (H&E; F: ×40, G: ×100). (H) Complete clearance without scar or nail deformity seven weeks after punch biopsy (dotted cicrle: treated area).
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Figure 1: (A) Clinical image of the sole prior to treatment (51 years/male, dotted circle: viral wart). (B, C) Cup-shaped mass with hyperkeratosis, acanthosis and koilocytes, total excision (H&E; B: ×40, C: ×200). (D) Complete clearance without scar six weeks after punch biopsy (dotted cicrle: treated area). (E) A wart on the proximal nail fold of fifth toe, prior to treatment (25 years/female, dotted circle: viral wart). (F, G) Partially removed hyperkeratotic mass with koilocytes and eosinophilic keratohyaline granules (H&E; F: ×40, G: ×100). (H) Complete clearance without scar or nail deformity seven weeks after punch biopsy (dotted cicrle: treated area).

Mentions: Thirty-nine patients were collected who received punch biopsy. The mean age of patients is 35.3±20.8 years (range, 2~73 years) and the sex ratio is 1.6 (Table 1). The age distribution of patients that underwent punch biopsy in this study is as follows: 0~9 years, 15.4%; 10~19 years, 10.3%; 20~29 years, 23.1%; 30~39 years, 10.3%; 40~49 years, 10.3%; 50~59 years, 17.9%; and ≥60 years, 12.8%. Common wart locations include the feet (43.6%) and hands (28.2%). Other sites include the face, scalp, leg, arm and trunk in descending order. Twenty three cases were suspected of warts clinically, but sixteen were presumed to be corn, seborrheic keratosis, malignancy, epidermal cyst, or pyogenic granuloma. Histopathologically, 17 patients were totally excised and 19 patients were partially excised (Fig. 1, 2). In three cases, it is unclear as whether to excise completely. All patients came to the clinic 2 or 3 weeks after removal of stitches for decisions on additional treatment. There were no adverse effects such as wound dehiscence or infection. Twenty-eight patients (71.8%) had no residual warts (Fig. 2). Eleven patients (28.2%) were treated by cryotherapy after punch biopsy and the average number of cryotherapy treatments is 4.1±3.3 (mean±standard deviation). All patients were treated to complete remission and there were no recurrences during the follow-up period (30±16 months).


Efficacy of Punch Reduction Prior to Cryotherapy in Patients with Viral Warts: A Case-Control Study in a Single Tertiary Center
(A) Clinical image of the sole prior to treatment (51 years/male, dotted circle: viral wart). (B, C) Cup-shaped mass with hyperkeratosis, acanthosis and koilocytes, total excision (H&E; B: ×40, C: ×200). (D) Complete clearance without scar six weeks after punch biopsy (dotted cicrle: treated area). (E) A wart on the proximal nail fold of fifth toe, prior to treatment (25 years/female, dotted circle: viral wart). (F, G) Partially removed hyperkeratotic mass with koilocytes and eosinophilic keratohyaline granules (H&E; F: ×40, G: ×100). (H) Complete clearance without scar or nail deformity seven weeks after punch biopsy (dotted cicrle: treated area).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383746&req=5

Figure 1: (A) Clinical image of the sole prior to treatment (51 years/male, dotted circle: viral wart). (B, C) Cup-shaped mass with hyperkeratosis, acanthosis and koilocytes, total excision (H&E; B: ×40, C: ×200). (D) Complete clearance without scar six weeks after punch biopsy (dotted cicrle: treated area). (E) A wart on the proximal nail fold of fifth toe, prior to treatment (25 years/female, dotted circle: viral wart). (F, G) Partially removed hyperkeratotic mass with koilocytes and eosinophilic keratohyaline granules (H&E; F: ×40, G: ×100). (H) Complete clearance without scar or nail deformity seven weeks after punch biopsy (dotted cicrle: treated area).
Mentions: Thirty-nine patients were collected who received punch biopsy. The mean age of patients is 35.3±20.8 years (range, 2~73 years) and the sex ratio is 1.6 (Table 1). The age distribution of patients that underwent punch biopsy in this study is as follows: 0~9 years, 15.4%; 10~19 years, 10.3%; 20~29 years, 23.1%; 30~39 years, 10.3%; 40~49 years, 10.3%; 50~59 years, 17.9%; and ≥60 years, 12.8%. Common wart locations include the feet (43.6%) and hands (28.2%). Other sites include the face, scalp, leg, arm and trunk in descending order. Twenty three cases were suspected of warts clinically, but sixteen were presumed to be corn, seborrheic keratosis, malignancy, epidermal cyst, or pyogenic granuloma. Histopathologically, 17 patients were totally excised and 19 patients were partially excised (Fig. 1, 2). In three cases, it is unclear as whether to excise completely. All patients came to the clinic 2 or 3 weeks after removal of stitches for decisions on additional treatment. There were no adverse effects such as wound dehiscence or infection. Twenty-eight patients (71.8%) had no residual warts (Fig. 2). Eleven patients (28.2%) were treated by cryotherapy after punch biopsy and the average number of cryotherapy treatments is 4.1±3.3 (mean±standard deviation). All patients were treated to complete remission and there were no recurrences during the follow-up period (30±16 months).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Cutaneous warts are a common complaint to visit dermatologic clinic and its course is variable, ranging from spontaneous resolution to a chronic condition refractory to treatment.

Objective: To evaluate the efficacy and safety of punch biopsy for cutaneous warts.

Methods: Thirty-nine patients who received punch biopsy for warts were reviewed through charts and photos. Among them, 15 were matched with cryotherapy-only controls in terms of size and location of the wart. We compared the number and cost of treatments between the two groups.

Results: Eleven of the total 39 patients were treated with cryotherapy in addition to punch biopsy and the average number of treatments was 4.1±3.3 (mean±standard deviation). In a case-control study, the ratio value of cost was 2.9±3.6 in the experimental group and was 5.9±4.1 in controls (p<0.05).

Conclusion: Punch biopsies can decrease the number and cost of treatment by reducing the size of warts and inducing local inflammation to accelerate resolution. Therefore, punch reduction should be considered as a viable measure to treat warts.

No MeSH data available.


Related in: MedlinePlus