Treatment of Warts
http://www.100md.com
《新英格兰医药杂志》
To the Editor: Topical application of an -lactalbumin and oleic acid complex was shown by Gustafsson and coworkers (June 24 issue)1 to reduce the size of cutaneous papillomas significantly after a three-week course of treatment. At two years of follow-up, all warts had resolved in 83 percent of patients. In the accompanying Perspective article, Bouwes Bavinck and Feltkamp2 imply that the complex may represent a breakthrough treatment for warts, and citing a review by Gibbs et al.,3 they state that at present, "simple preparations containing salicylic acid are the only topical treatments for which there is good evidence of efficacy and safety." Vitamin A is widely recognized as an effective and safe topical treatment for verruca plana, verruca vulgaris, and verruca plantaris (flat, common, and plantar wart).4 We have carefully followed more than 50 consecutive patients with refractory cutaneous warts in whom daily topical application of vitamin A was 100 percent effective (within five months). Warts display abnormal keratin expression. Retinoids, such as vitamin A, regulate keratinization. Vitamin A may interfere with the replication of the human papillomavirus, which is tightly synchronized with the keratinization and differentiation of epithelial cells, thereby allowing normal tissue to replace the warts.
Courtney E. Garry
Jeanette A. Garry, B.S.
Robert F. Garry, Ph.D.
Tulane University Health Sciences Center
New Orleans, LA 70112
rfgarry@tulane.edu
References
Gustafsson L, Leijonhufvud I, Aronsson A, Mossberg AK, Svanborg C. Treatment of skin papillomas with topical -lactalbumin-oleic acid. N Engl J Med 2004;350:2663-2672.
Bouwes Bavinck JN, Feltkamp MCW. Milk of human kindness? -- HAMLET, human papillomavirus, and warts. N Engl J Med 2004;350:2639-2642.
Gibbs S, Harvey I, Sterling J, Stark R. Local treatment for cutaneous warts: systematic review. BMJ 2002;325:461-461.
Tkac D, ed. The doctor's book of home remedies. Emmaus, Pa.: Rodale Press, 1995:625.
Drs. Bouwes Bavinck and Feltkamp reply: In our Perspective article, we emphasized that additional studies are required to establish the place of the -lactalbumin and oleic acid complex in the treatment of cutaneous viral warts as compared with conventional topical treatments containing salicylic acid or the application of liquid nitrogen. Bleomycin, fluorouracil, interferons, dinitrochlorobenzene, photodynamic therapy, and pulsed dye laser have also been suggested for the treatment of cutaneous warts.1 Garry et al. suggest that topical treatment with vitamin A is effective and safe. So far, local retinoids have not been systematically studied for the treatment of cutaneous viral warts.1 Except for acne, local retinoids are used for the treatment of photoaging,2 and local and oral retinoids have been used in the chemoprevention of actinic keratoses and squamous-cell carcinoma, especially in recipients of organ transplants.3 Recently, it was shown that the oral retinoid isotretinoin is more effective than placebo in the treatment of recalcitrant genital warts of the cervix.4 There is a definite need for high-quality, randomized, controlled trials that address the treatment of cutaneous viral warts.
Jan N. Bouwes Bavinck, M.D., Ph.D.
Mariet C.W. Feltkamp, M.D., Ph.D.
Leiden University Medical Center
2333 ZA Leiden, the Netherlands
References
Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461-461.
Fisher GJ, Wang ZQ, Datta SC, Varani J, Kang S, Voorhees JJ. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 1997;337:1419-1428.
De Graaf YG, Euvrard S, Bouwes Bavinck JN. Systemic and topical retinoids in the management of skin cancer in organ transplant recipients. Dermatol Surg 2004;30:656-661.
Georgala S, Katoulis AC, Georgala C, Bozi E, Mortakis A. Oral isotretinoin in the treatment of recalcitrant condylomata acuminata of the cervix: a randomised placebo controlled trial. Sex Transm Infect 2004;80:216-218.
Courtney E. Garry
Jeanette A. Garry, B.S.
Robert F. Garry, Ph.D.
Tulane University Health Sciences Center
New Orleans, LA 70112
rfgarry@tulane.edu
References
Gustafsson L, Leijonhufvud I, Aronsson A, Mossberg AK, Svanborg C. Treatment of skin papillomas with topical -lactalbumin-oleic acid. N Engl J Med 2004;350:2663-2672.
Bouwes Bavinck JN, Feltkamp MCW. Milk of human kindness? -- HAMLET, human papillomavirus, and warts. N Engl J Med 2004;350:2639-2642.
Gibbs S, Harvey I, Sterling J, Stark R. Local treatment for cutaneous warts: systematic review. BMJ 2002;325:461-461.
Tkac D, ed. The doctor's book of home remedies. Emmaus, Pa.: Rodale Press, 1995:625.
Drs. Bouwes Bavinck and Feltkamp reply: In our Perspective article, we emphasized that additional studies are required to establish the place of the -lactalbumin and oleic acid complex in the treatment of cutaneous viral warts as compared with conventional topical treatments containing salicylic acid or the application of liquid nitrogen. Bleomycin, fluorouracil, interferons, dinitrochlorobenzene, photodynamic therapy, and pulsed dye laser have also been suggested for the treatment of cutaneous warts.1 Garry et al. suggest that topical treatment with vitamin A is effective and safe. So far, local retinoids have not been systematically studied for the treatment of cutaneous viral warts.1 Except for acne, local retinoids are used for the treatment of photoaging,2 and local and oral retinoids have been used in the chemoprevention of actinic keratoses and squamous-cell carcinoma, especially in recipients of organ transplants.3 Recently, it was shown that the oral retinoid isotretinoin is more effective than placebo in the treatment of recalcitrant genital warts of the cervix.4 There is a definite need for high-quality, randomized, controlled trials that address the treatment of cutaneous viral warts.
Jan N. Bouwes Bavinck, M.D., Ph.D.
Mariet C.W. Feltkamp, M.D., Ph.D.
Leiden University Medical Center
2333 ZA Leiden, the Netherlands
References
Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ 2002;325:461-461.
Fisher GJ, Wang ZQ, Datta SC, Varani J, Kang S, Voorhees JJ. Pathophysiology of premature skin aging induced by ultraviolet light. N Engl J Med 1997;337:1419-1428.
De Graaf YG, Euvrard S, Bouwes Bavinck JN. Systemic and topical retinoids in the management of skin cancer in organ transplant recipients. Dermatol Surg 2004;30:656-661.
Georgala S, Katoulis AC, Georgala C, Bozi E, Mortakis A. Oral isotretinoin in the treatment of recalcitrant condylomata acuminata of the cervix: a randomised placebo controlled trial. Sex Transm Infect 2004;80:216-218.