الفهرس 
HUMAN PAPILLOMAVIRUSESOnly 14 pages are availabe for public view
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Abstract
Warts are tumors or growths caused by infection with Human Papilloma virus (HPV). More than 100 HPV subtypes are known. They are common presenting disease in children and adolescents which spread by direct contact or autoinoculation.
Warts are classified clinically by location into cutanous and mucosal lesions. There are various types of viral warts including common warts, plantar warts, plane or flat warts, filiform warts, periungual warts, epidermodysplasia verruciformis (EV), oral warts and genital warts.
The treatment of warts poses a therapeutic challenge for physicians. No single therapy had been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. These approaches include chemotherapy by (salicylic acid, TCA, formaldehyde, glutaraldehyde, formic acid, cantharidin, 5-fluorouracil, bleomycin, podophyllin, podophyllotoxin, silver nitrates and retinoids), cryotherapy mostly by liquid nitrogen, electrosurgery (curettage and cauteary), laser therapy by (CO2 laser, Er: YAG laser, and Nd: YAG laser) and photodynamic therapy.
All these previous destructive modalities are variably effective, frequently painful and usually cause scarring. Moreover these modalities require individual treatment of each wart and do not prevent recurrence.
There are new trends towards the use of immunotherapy in treatment of warts, as the immune system seems to play an important role in the control of warts infection. Although the exact mechanisms are unclear, but most evidences suggest that cell mediated rather than humoral immunity plays an important role in control of HPV infection as the incidence of warts increases in subjects with cell mediated immune defects e.g. (HIV infection patients, malignant diseases.)
Various methods have been used to stimulate the immunological response as oral zinc sulfate, oral levamisole, cimetidine, cidofovir, intralesional interferons, topical DNCB, DPCP, SADBE, imiquimod, intralesional immunotherapy with mumps, candida and trichophyton antigens, intradermal BCG vaccine, and intralesional Mw vaccine.
In this study, we investigated oral zinc sulfate as an immunotherapeutic modality. Our study included 80 patients, 40 in the patients group all had received oral zinc sulfate (10mg/kg/day) maximum of 600 mg/kg/day, and 40 patients in the control group who received a placebo in the form of starch capsules.
The results showed that 7 patients had complete clearance, 1 had moderate improvement, 2 had mild improvement and 30 had no response in the patients group. In the control group, all of the patients had shown no response.
We found that oral zinc sulfate is safe and inexpensive but needs time to act and the response is not high, so it is not fit to be used as a monotherapy, but rather to be combined with other wart treatment modalities.
Conclusions
Oral zinc sulfate is safe but not effective in treatment of multiple recalcitrant warts in most of our patients so it can be taken with other modalities of treatment and not as monotherapy.
The failure to respond in some patient may be explained by the fact that immunity is just a part of the pathogenesis of warts, we also think that compliance of the patient played an important role in response to treatment.
Oral zinc sulfate is considered safe inexpensive and not destructive mode for treatment of warts but not very effective.