الفهرس 
WARTS
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Abstract
W
arts are benign epithelial proliferations caused by the human papillomavirus (HPV). They are very common dermatological problem and can affect many different sites including the face, hands, feet and genitalia. Incidence and prevalence vary widely between different age groups: they increase during childhood, peak in adolescence and decline thereafter.
Lesions are usually asymptomatic, with the exception of plantar warts (PW), because of the pressure exerted on the hyperkeratotic tissue by the body weight. A break in the skin barrier due to trauma or maceration allows entry of the virus, and factors such as the host’s humoral and cellular immunity status determine if the HPV will be pathogenic. Warts can develop clinically anywhere from a few weeks to greater than a year after inoculation with HPV.
Aims of the treatments are to cure the patient’s physical and psychological discomfort, and to prevent the spread. The treatment is challenging and no single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to wart therapy exist. First, there are methods of direct destruction such as cryotherapy, radiotherapy, hyperthermia, local chemical and electro-cautery, surgical excision, laser ablation (CO2 laser, puled dye laser and etc). Second, warts can be treated by inhibition of mitosis using DNA inhibitors or antimitotics like bleomycin. Finally, the local immunity can be augmented to stimulate the clearing of warts, for instance by contact immunotherapy.
A novel approach for the treatment of warts is photodynamic therapy which combines the administration of a photosensitizer and the subsequent irradiation of wavelengths that, after being absorbed by the chromophore, lead to the destruction of the target tissue.
Photodynamic therapy is also thought to stimulate local immunity in areas with lesions, because the treatment leads to the release of inflammatory mediators, like interleukin-2, interleukin-1 β and tumour necrosis factor- α.
We aimed in this work to assess safety and effectiveness of liposome loaded methylene blue based photodynamic therapy in treatment of plantar and periungual warts.
We performed our study on 25 patients (11 male patients and 14 female patients) with multiple, recurrent and recalcitrant plantar and periungual warts aged 20-50 years old.
Each patient received salicylic acid for a week prior to the first session. Then liposome loaded methylene blue was applied to each wart area and left for 5-15 minutes followed by 2 pulses of IPL at wavelength 570-700nm. Each patient received from 3-5 sessions one week apart. Response was evaluated by reduction in size of wart lesion and by dermoscopic picture as regards disappearance of sclerosed vessels and appearance of normal skin markings.
There was significant improvement as 16(64%) patients showed very good response, 3 (12%) patients showed good response and 6(24%) patients showed poor response. As regards plantar wart patients, 13(68.4%) patients had very good response, 2(10.5%) patients had good response and 4(21.1%) patients had poor response.
As regards periungal wart patients, 3(50%), patients had very good response 1(16.7%) patient had good response and 2 (33.3%) patients had poor response denoting that DPT with liposome loaded methylene blue is effective in treatment of plantar and periungual warts.
There was no significant difference between plantar and periungal wart patients response as regard sex, age and disease duration.
No serious side effects were reported in patients included in this study except for slight stinging pain at time of session and staining by methylene blue. Furthermore, none of our patients developed new lesions at the site of cured warts during the next 9 months following the procedure.
Many researches have reported the use of 5-ALA as a photosensitizer but in our study we indicate that there are advantages of using liposome loaded methylene blue compared to 5-ALA as it is cheaper, available, needs shorter contact time and with no serious side effects.
Taken together, first our work further supports the effectiveness of PDT in treatment of warts. Second, PDT with liposome loaded methylene blue is safe and effective in treatment of recurrent and recalcitrant plantar and periungual warts with negligible side effects and with no recurrence.