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- Presentation
The Evolving Toolbox for Treating Difficult Warts
Description
In a presentation on treating difficult warts, Peter Friedman discusses the challenges and evolving toolbox available to dermatologists. He explains that warts, caused by a virus, can be resistant to standard treatments, particularly when they persist for over two years, are of significant size, or located in sensitive areas like the face or near the nails. Factors such as patient age, compliance, and the potential for adverse reactions also influence treatment choices. Friedman emphasizes the importance of standard treatments, including salicylic acid and cryotherapy, noting their modest efficacy. Additionally, he explores advanced modalities like immunotherapy and chemotherapy, including intralesional injections of substances like Candida or HPV, and mentions the promise of newer agents like isotretinoin and topical interferon. He also highlights the role of patient-centered care by considering the burden of treatments on the patient, thus advocating for a more personalized approach rather than a one-size-fits-all solution. The presentation concludes on an optimistic note, urging practitioners to stay informed about emerging therapies and to think creatively about combinations to enhance treatment effectiveness.
View moreConclusions
- Warts become difficult to treat when they persist for more than two years, are larger or numerous, or are located in medically or cosmetically sensitive areas.
- Standard wart treatments, including salicylic acid and cryotherapy, have variable efficacy and can be painful, highlighting the need for alternative approaches.
- Intralesional immunotherapy shows promise by inducing immune responses to treat warts, with agents like Candida, MMR, and PPD being explored for efficacy.
- Combination therapies that include multiple treatment modalities may yield better results than single approaches.
- Emerging treatments such as intralesional chemotherapy, topical therapies like imiquimod, and antiviral treatments including cidofovir and acyclovir present potential options for resistant cases.
- Topical treatments are favored for smaller, superficial warts when patient compliance is achievable, while intralesional options may be more appropriate for larger or resistant lesions.
- Innovative approaches such as platelet-rich plasma (PRP) and microneedling have shown some efficacy in wart treatment, suggesting additional avenues for research and application.
- Future research and clinical trials are essential in optimizing treatment methods for warts, as well as understanding patient-specific factors that influence treatment response.
- Cochrane review (2012): RR 1.56, 95% CI 1.20-2.03
- Cochrane review (2012): RR 1.45, 95% CI 0.65-3.23
- Artese et al. 1994
- Nofal et al. JAAD 2019
- Salman et al. JAAD 2019
- Ibrahim et al. Derm Th 2022
- Attwa et al. J Derm Tr 2020
- Ju et al. Indian J Dermatol Venereol Leprol 2022
- Ahn et al. Am J Clin Dermatol 2014
- Ghonemy et al. Dermatologic Therapy 2020
- Konicke et al. Derm Surg 2016
- Al-Naggar et al. J Cosmet Dermatol 2018
- Mohta. Clin Exp Dermatol 2022
- Wu et al. JAMA Derm 2022
- Broganelli et al. Derm Therapy 2012
- Anshelevich et al. JAAD 2020
- Elsayed et al. J Cut Med Surg 2022
- Poppens et al. J Derm Treatment 2023
- Reddy et al. Cureus 2023