Ann Dermatol.  2017 Apr;29(2):200-205. 10.5021/ad.2017.29.2.200.

Efficacy of Punch Reduction Prior to Cryotherapy in Patients with Viral Warts: A Case-Control Study in a Single Tertiary Center

• Choi JY
• Park JH
• Oh SH
• Lee JH
• Lee JH
• Lee DY
• Yang JM

• KMID: 2394844
• DOI: http://doi.org/10.5021/ad.2017.29.2.200

Abstract

BACKGROUND
Cutaneous warts are a common complaint to visit dermatologic clinic and its course is variable, ranging from spontaneous resolution to a chronic condition refractory to treatment.
OBJECTIVE
To evaluate the efficacy and safety of punch biopsy for cutaneous warts.
METHODS
Thirty-nine patients who received punch biopsy for warts were reviewed through charts and photos. Among them, 15 were matched with cryotherapy-only controls in terms of size and location of the wart. We compared the number and cost of treatments between the two groups.
RESULTS
Eleven of the total 39 patients were treated with cryotherapy in addition to punch biopsy and the average number of treatments was 4.1±3.3 (mean±standard deviation). In a case-control study, the ratio value of cost was 2.9±3.6 in the experimental group and was 5.9±4.1 in controls (p<0.05).
CONCLUSION
Punch biopsies can decrease the number and cost of treatment by reducing the size of warts and inducing local inflammation to accelerate resolution. Therefore, punch reduction should be considered as a viable measure to treat warts.

Keyword

Biopsy; Cryotherapies; Papillomaviridae; Therapy; Warts

MeSH Terms

Biopsy
Case-Control Studies*
Cryotherapy*
Humans
Inflammation
Papillomaviridae
Warts*

Figure

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  Fig. 1 (A) Clinical image of the sole prior to treatment (51 years/male, dotted circle: viral wart). (B, C) Cup-shaped mass with hyperkeratosis, acanthosis and koilocytes, total excision (H&E; B: ×40, C: ×200). (D) Complete clearance without scar six weeks after punch biopsy (dotted cicrle: treated area). (E) A wart on the proximal nail fold of fifth toe, prior to treatment (25 years/female, dotted circle: viral wart). (F, G) Partially removed hyperkeratotic mass with koilocytes and eosinophilic keratohyaline granules (H&E; F: ×40, G: ×100). (H) Complete clearance without scar or nail deformity seven weeks after punch biopsy (dotted cicrle: treated area).

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  Fig. 2 The percentage of patients who were treated with additional cryotherapy after punch biopsy. Three of 17 patients (17.6%) needed further cryotherapy despite total excision and 6 of 19 patients (31.6%) with specimens that were partially excised needed additional cryotherapy.

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  Fig. 3 Clinical image of the matched case (A, B, C, D) and control (A', B', C', D') groups (dotted circles: viral wart).

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