الفهرس 
HUMAN PAPILLOMA VIRUSOnly 14 pages are availabe for public view
Abstract
Warts are a common dermatologic complaint resulting from infection with HPV, with increasing incidence in children and young adults which spread by direct skin-to-skin contact or by autoinoculation.
The clinical appearance of warts is variable and depends to some extent on the type of HPV involved and the site of infection. There are various types of viral warts including common warts, plantar warts, plane warts and genital warts. Usually diagnosis is made by clinical examination of the lesions and no laboratory investigations are required.
Multiple treatment modalities are available for treating different types of warts. Most treatments directly destroy the visibly infected tissue, such as chemotherapy by (salicylic acid, TCA acid, formaldehyde, glutaraldehyde, formic acid, silver nitrates, podophyllin, podofilotoxin, retinoids and 5-FU), cryotherapy mostly by liquid nitrogen, electrosurgery, laser therapy by (CO2 laser, Er:YAG laser, and Nd: YAG laser), and photodynamic therapy. However, non-visible infected lesions are not targeted by these approaches.
As the ideal aims of treatment of warts should be removing the wart without recurrence, avoiding aggressive procedures, and to assist the immune system in dealing more effectively with the HPV and inducing life-long immunity against it.
Therefore, 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 wart infection, thus manipulating the immune system to achieve HPV-targeted immune reaction offers a theoretical advantage of obtaining an effective and sustained control of viral replication, and preventing recurrence.
Various methods have been used to stimulate the immunological response as oral (levamisole, or zinc sulfate), topical (DNCB, DPCP, and imiquimod), and intralesional immunotherapy (with INFs, mumps, candida, tuberculin antigen, MMR vaccine, BCG vaccine and Mw vaccine).
In the present study, we attempt to investigate the efficacy and safety of autoinoculation as an immuno-therapeutic approach in multiple recalcitrant warts. Our study included 40 patients (24 males and 16 females) aged 20 to 50 years old with 5 or more recalcitrant warts.
Results of our study reported that after 12 weeks of autoinoculation procedure, (42.5%) of patients showed complete clearance with satisfaction score 10 (extremely satisfied), (27.5%) of patients showed moderate clearance with satisfaction score 8 (very satisfied), (15.0%) of patients showed mild clearance with satisfaction score 3 and 4 (slightly satisfied) and (12.5%) of patients didn’t show any improvement (Treatment failure) with satisfaction score 1 (dissatisfied).
There were no significant correlations between treatment response and gender and age of patients, or size, number and type of warts. However a highly significant negative correlation was found between treatment response and duration of disease (the cure rate was better in patients with a shorter duration of disease).
Follow up after autoinoculation procedure revealed that 3 patients showed only mild signs of inflammation appeared 24 hours after the procedure in form of erythema, and mild pain. No signs of infections as pustulation or fever appeared in any patient. Also no recurrence (at the site of cured warts) or appearance of new lesions (at any distant site) was reported after 16 weeks following the autoinoculation procedure.
In conclusion, homologous autoinoculation is an easy, safe, effective, inexpensive minimally invasive modality of immunotherapy especially in less hyperkeratotic recent onset warts, with negligible side effects and no recurrence rate.
However, this method would take a long time waiting for the immunological response against HPV which might be refused by some patients.