الفهرس 
Human Papilloma virus
Intralesional TuberculinOnly 14 pages are availabe for public view
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Abstract
Plantar warts are caused by HPV subtypes 1,2,4 and 63.The virus attacks the skin through direct contact, entering through tiny cuts and abrasions into the stratum corneum, which is the outermost layer of skin. After infection, lesions may not become visible for several weeks or months. Because of pressure on the sole of the foot, the lesion is pushed inward and a layer of hard skin may be formed over it. Diagnosis is based on clinical examination.
Warts are often a difficult treatment problem for clinicians because of the lack of specific antipapillomavirus agents available for therapy. Approximately 60% of warts regress spontaneously within 2 years. In many cases, warts will multiply or continue to enlarge, making treatment more difficult. In addition, many warts are unsightly and may be painful.
No single treatment has been proven effective at achieving complete remission in every patient. All treatments are hampered by wart persistence and recurrence. As a result, different types of treatment can be combined for greater effectiveness. The treatment methods include destructive, virucidal, antimitotic and immuno-modulator methods. Destructive methods such as cryotherapy, cantharidin, laser ablation, and surgical excision are variably effective, but are frequently painful and may cause scarring. Moreover, these modalities require individual treatment of each wart, which is especially traumatic for children.
Cryotherapy is one of the most common procedures used to treat warts. Cryosurgery literally means ’cold handiwork’. It makes use of local freezing for the controlled destruction or removal of living, but abnormal tissue.
A wide spectrum of skin conditions can be treated with cryosurgery. If done correctly with suitable freezing time, cryosurgery is an efficient, effective, simple and minimally painful procedure. Post treatment care should be taken to prevent secondary infections, scarring and pigmentation. Post inflammatory hypopigmentation will improve over a period of 3-6 months.
Many trials have compared cryotherapy with different types of lasers (e.g. CO2 or Er:YAG laser) in the treatment of warts. However, no published studies comparing cryotherapy with 595nm PDL for plantar wart treatment were found. Thus, our aim was to compare the effect of PDL laser versus cryotherapy on plantar warts as regards morbidity and the clinical response.
Our study included thirty patients with multiple plantar warts. The warts in each patient were equally divided into two groups; group A lesions received 595 nm PDL and group B lesions received cryotherapy (double-freeze thaw cycle) every 2 weeks for a maximum of five sessions for PDL and six sessions for cryotherapy.
Treated warts were initially evaluated after completion of the 5 sessions for PDL group and 6 sessions for cryotherapy treated group, for clearance. Cleared warts were evaluated monthly for 3 months to assess the recurrence rate.
We found that the PDL gave a statistically non significant higher percentage of complete clearance with a fewer number of sessions. PDL was associated with a statistically significant lower rate of recurrence as well as less discomfort, making it an attractive option whenever available. We conclude that the introduction of relatively new approaches in the treatment of plantar warts may be beneficial in the discovery of easier treatment options of this type of warts with less recurrence rates.