isotretinoin and Warts

The use of combined systemic retinoids and intralesional immunotherapy in the management of warts is still debatable without straightforward evidence. Through network meta-analysis, the current study evaluated the efficacy and safety of systemic retinoids alone or combined with other remedies in the treatment of warts. We searched six literature databases for clinical trials that compared systemic retinoids to local treatments or placebo in wart management. Outcomes were calculated as odds ratios (OR) with 95% confidence-interval. We used the R software to perform conventional and network meta-analyses (with a frequentist approach). Network meta-analysis of eight trials showed that oral acitretin plus intralesional Candida Ag (OR = 367.71), INF-α plus oral isotretinoin (OR = 223.77), oral acitretin (OR = 117), Candida Ag (OR = 91.93), oral isotretinoin (OR = 62.26) and topical isotretinoin (OR = 17.69) had higher complete recovery rates than placebo. Regarding the P-score, oral acitretin plus intralesional Candida Ag had the highest efficacy in achieving complete response (P-score = 0.88), followed by INF-α plus oral isotretinoin (P-score = 0.79), then oral acitretin (P-score = 0.60). Variable baseline characteristics and lack of data on some outcomes. The current study shows the efficacy for systemic retinoids in the treatment of warts, especially reluctant or recurrent types. Moreover, combinations of systemic retinoids with intralesional immunotherapy yield higher rates of complete clearance with lower recurrence.

Topics: Acitretin; Humans; Immunotherapy; Isotretinoin; Network Meta-Analysis; Warts

Solid organ transplant recipients (SOTRs) are at an increased risk of epithelial malignancies, mainly squamous cell carcinoma, and its precursor lesions such as actinic keratoses, warts, and porokeratosis, which may respond to retinoid therapy.. To review the published evidence on the efficacy and safety of topical and systemic retinoids for the treatment and prophylaxis of malignant and premalignant conditions that mostly afflict SOTRs.. Systematic review of the literature to summarize the level of evidence and grade of recommendation for retinoid therapy with emphasis in the SOTR population.. Acitretin has the highest strength of recommendation (Grade A) for prophylaxis of nonmelanoma skin cancer (NMSC) and treatment and prophylaxis of actinic keratoses in SOTR. In nonimmunosuppressed patients, acitretin and isotretinoin have a Grade B recommendation for treatment of recalcitrant warts. Topical retinoids have not shown efficacy in preventing NMSC in immunocompetent patients.. Retinoids constitute a highly efficacious alternative for the management of the most common conditions that affect SOTRs. Acitretin has the most robust evidence for chemoprophylaxis in SOTRs. Knowledge about the specific indications and expected side effects of topical and systemic retinoids may help optimize their therapeutic potential.

Topics: Acitretin; Administration, Cutaneous; Administration, Oral; Carcinoma, Squamous Cell; Dermatologic Agents; Dermatology; Evidence-Based Medicine; Graft Rejection; Humans; Immunosuppressive Agents; Isotretinoin; Keratosis, Actinic; Organ Transplantation; Skin Neoplasms; Transplant Recipients; Treatment Outcome; Warts

While the use of isotretinoin has revolutionized the treatment of acne vulgaris, isotretinoin is increasingly recognized as a useful therapeutic option for many other cutaneous conditions. We review the evidence underlying the use of isotretinoin for a variety of dermatological indications including hidradenitis suppurativa, sebaceous gland pathology, rosacea, scarring alopecia, cosmetic dermatology, and non-melanoma skin cancer prophylaxis amongst other uses, and thus consider alternative uses within dermatology practice. The studies found benefit of isotretinoin, however most trials lacked statistical power and in many cases the use was limited to case series. Isotretinoin, if used within the correct cohort with appropriate pretreatment counseling regarding side-effects, is a well-tolerated medication with potential as either an adjunctive treatment or a second-line agent in those recalcitrant cases unresponsive to first-line therapy.

Topics: Acne Vulgaris; Dermatitis, Seborrheic; Dermatologic Agents; Hidradenitis Suppurativa; Humans; Isotretinoin; Rosacea; Warts

Management of multiple recalcitrant common warts represents a therapeutic challenge. Both oral isotretinoin and acitretin have shown a promising efficacy in the treatment of various types of warts. However, a comparative study of the two medicines in wart treatment has not yet been conducted.. The aim of this study was to assess the efficacy and adverse effects of oral isotretinoin versus acitretin in the treatment of multiple recalcitrant common warts.. This study was conducted on 75 adult male patients with recalcitrant multiple common warts. The patients were randomly assigned to three groups: group 1 (30 patients) received oral isotretinoin, group 2 (30 patients) received acitretin, and group 3 received oral placebo (15 patients). The treatment was given daily until complete clearance or for a maximum of 3 months.. Complete clearance of the treated lesions was observed in 18 patients (60%) of the isotretinoin group, in 22 patients (73.3%) of the acitretin group, and in 0 patients (0%) of the placebo group. A statistically significant difference was observed in the therapeutic response between the treatment groups, and the placebo group was observed. Adverse effects of the used drugs were mild and transient.. Oral isotretinoin and acitretin are promising effective modalities with minimal side effects for the treatment male patients with multiple recalcitrant common warts with a relative superiority of acitretin.

Topics: Acitretin; Adult; Humans; Isotretinoin; Male; Treatment Outcome; Warts

Although oral isotretinoin has been considered as a potential therapeutic option for the treatment of different types of warts, the optimum dosage regimen is not yet well-established. To evaluate the efficacy and adverse effects of high versus low doses of oral isotretinoin in the treatment of cutaneous and genital warts. The study included 100 patients who were randomly assigned to two groups, 50 patients in each. Group 1 received 0.6 mg/kg/day (high dose isotretinoin) and Group 2 received 0.3 mg/kg/day (low dose isotretinoin). In both groups, therapy was given daily until resolution was achieved or for a maximum of 3 months. Complete clearance of warts was observed in 76% of the high dose isotretinoin group and in 46% of the low dose isotretinoin group. There was a statistically significant difference in the therapeutic response between the two groups. Recurrence was higher in the low dose group (26%) than the high dose group (7.8%). Adverse effects were mild and tolerable. High dose of systemic isotretinoin is more effective than low dose and seems to be a promising well-tolerated and effective therapeutic option for the treatment of cutaneous and genital warts.

Topics: Administration, Oral; Condylomata Acuminata; Dermatologic Agents; Humans; Isotretinoin; Papillomaviridae; Warts

Oral isotretinoin and intralesional immunotherapy by Candida antigen have shown promising efficacy and safety for the treatment of plane warts in a few studies.. To evaluate the efficacy and safety of a combination of oral isotretinoin and Candida antigen versus either agent alone in the treatment of multiple plane warts.. The study included 108 patients who were randomly assigned to three groups, 36 in each. Group 1 received oral isotretinoin alone at a dose of 0.3 mg/kg/day. Group 2 received intralesional injection of Candida antigen alone at a dose of 0.1 ml of 1/1000 solution into the largest wart. Group 3 received a combination of Candida antigen and oral isotretinoin by the same method and dose mentioned above.. Complete clearance of warts was observed in 44.4% of the oral isotretinoin alone group, in 55.6% of the Candida antigen alone group, and in 38.8% of the combination therapy group. A statistically significant difference in favor of the Candida antigen alone group was demonstrated.. Candida antigen, oral isotretinoin and a combination of both represent potential effective and safe modalities for the treatment of plane warts, with the Candida antigen alone as the most effective.

Topics: Antigens, Fungal; Candida; Humans; Immunotherapy; Injections, Intralesional; Isotretinoin; Treatment Outcome; Warts

Plane warts are a common therapeutic problem. Our aim was to assess the efficacy and safety of oral versus topical isotretinoin in the treatment of plane warts.. Forty patients with multiple plane warts were randomized into two groups. Group A was treated with oral isotretinoin capsules in the dose of 0.5 mg/kg/d and Group B with topical isotretinoin 0.05% in gel formulation once daily at night. Treatment was given to the patients for 3 months or until the complete clearance of lesions, whichever was earlier. Patients with complete response were followed up monthly for 4 months to record the relapse rate.. Results were analyzed in 16 patients of Group A and 13 patients of Group B. At the end of 3 months of therapy, 11 (69%) patients in Group A had complete remission whereas five (31%) had partial remission. In Group B, at the end of study, five (38%) patients had complete remission and six (46%) had partial remission, whereas two patients had no remission. The difference was statistically significant between two groups; P < 0.0001. The most common side effect in Group A was cheilitis. In Group B, five patients had to be dropped because they developed severe erythema and scaling.. Oral isotretinoin showed better and earlier response than topical isotretinoin. Oral isotretinoin should definitely be given a trial particularly in cases of multiple facial warts before trying various destructive procedures.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Cheilitis; Dermatologic Agents; Erythema; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Middle Aged; Remission Induction; Warts; Young Adult

Abstract Background: Recalcitrant facial flat warts are caused by human papillomavirus and may persist for years despite treatment. Isotretinoin has demonstrated benefits in the treatment of recalcitrant, genital and common warts, but placebo-controlled trials have not been performed.. To determine whether isotretinoin is safe and effective for recalcitrant facial flat warts.. Isotretinoin 30 mg/day or placebo was administered to 16 and 15 patients, respectively, in double-blind, randomized fashion for 12 weeks. Cutaneous lesions were assessed and adverse events including serologic and ophthalmologic changes were recorded. It is considered that warts were recalcitrant if the patient was treated for at least 3 years with at least three of the following options: retinoids, 5-fluorouracil, imiquimod and cryotherapy using liquid nitrogen.. Each patient in the istotretinoin group showed complete clearance of all flat warts, while none of the patients in the placebo group showed any improvement (p=0.0001). The most frequent adverse event was cheilitis. There were no statistically significant changes in the laboratory findings.. The study design does not permit complete blinding of the dermatologist who can easily recognize the adverse effects of isotretinoin. The clinical findings, however, were so dramatic that this would not have impacted the findings. Another limitation of the study is a lack of follow-up to assess for recurrence after the drug was discontinued.. Isotretinoin is an effective treatment for recalcitrant flat facial warts with a well-known, manageable safety profile.

Topics: Administration, Oral; Adolescent; Adult; Aminoquinolines; Cryotherapy; Dermatologic Agents; Double-Blind Method; Female; Fluorouracil; Follow-Up Studies; Humans; Imiquimod; Isotretinoin; Male; Treatment Outcome; Warts; Young Adult

Intralesional immunotherapy with purified protein derivative (PPD) is an effective and tolerable therapeutic modality for the treatment of common warts. However, the complete clearance rates are still unsatisfactory. We thought to evaluate the efficacy and safety of adding low dose isotretinoin to intralesional PPD versus PPD monotherapy for viral warts. The study included two groups: Group (A) was treated by intralesional PPD at 2-week intervals until complete clearance or for a maximum of six sessions in addition to an oral placebo. Group (B): was treated with both intralesional PPD and low dose isotretinoin for a 3-month course. There was no statistically significant difference between both groups regarding the therapeutic response. In common warts, the low dose of isotretinoin did not add a true therapeutic value in the studied groups. Perhaps higher doses of isotretinoin could provide a better response, which warrants further investigation.

Topics: Humans; Immunotherapy; Injections, Intralesional; Isotretinoin; Treatment Outcome; Warts

An immunocompetent patient with extensive and recalcitrant common warts that was orally treated with isotretinoin (1 mg/kg/day) is reported. His lesions revealed a complete remission after 6 weeks of treatment, which was well tolerated. The patient has presently completed a 23-month follow-up and shows no evidence of relapse of his skin lesions. In view of these remarkable therapeutic results, further randomized controlled clinical studies in large numbers of patients are now warranted, which will definitely determine whether monotherapy with oral isotretinoin at a dose of 1 mg/kg/day may be regarded as a highly effective and well-tolerated therapeutic modality for extensive and recalcitrant common warts in both immunocompetent and immunocompromised patients.

Topics: Administration, Oral; Adult; Dermatologic Agents; Humans; Immunocompromised Host; Isotretinoin; Male; Remission Induction; Skin Diseases; Time Factors; Warts

Topics: Combined Modality Therapy; Dermatologic Agents; Humans; Isotretinoin; Warts

Treatment of recalcitrant warts in solid organ transplant recipients (SOTR) can pose a therapeutic challenge for dermatologists. Successful treatment of recalcitrant warts can serve as secondary prevention for skin cancer in those with chronic immunosuppression. Given the heterogeneity of associated comorbid conditions in SOTR, clinical trials are difficult to conduct in this high-risk population, therefore, our clinical practice is mostly driven by observed responses from studies in immunocompetent patients or from case reports of immunocompromised patients. The combination of systemic retinoids and candida immunotherapy likely provide the most effective treatment for recalcitrant warts in SOTR. However, many SOTR have chronic renal insufficiency and are not candidates for acitretin therapy. We provide two cases of recalcitrant warts in SOTR successfully treated with isotretinoin in the setting of impaired renal function.

Topics: Adult; Candida; Combined Modality Therapy; Dermatologic Agents; Humans; Immunotherapy; Isotretinoin; Male; Middle Aged; Organ Transplantation; Transplant Recipients; Warts

Warts constitute the most frequently observed dermatological manifestations of human papillomavirus (HPV). Although an extensive range of treatments exist for local warts, there is no specific therapy based on high-quality evidence of notable treatment success or high cure rate, or minimal adverse effects. Recalcitrant warts are, therefore, a common therapeutic problem. This case series refer to 14 immunocompetent patients with recalcitrant warts, who experienced full resolution of their warty lesions when treated with addition of low dose isotretinoin, in a dose of 0.1-0.2 mg/kg/day, for a 3-month course, with no significant adverse effects. Long-term remission was noted for up to 3 years with no signs of active lesions. Low dose isotretinoin should be in the priority of the treatment options of recalcitrant warts, alone or in combination.

Topics: Adolescent; Adult; Child; Dermatologic Agents; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Humans; Isotretinoin; Male; Middle Aged; Treatment Outcome; Warts; Young Adult

Warts are benign epithelial proliferations of the skin and mucosa caused by infection with human papilloma viruses (HPV). Plane warts are mainly caused by HPV-3 and HPV-10. There is no single treatment that is absolutely effective, and different types of treatment may be combined. One must take into account the possibility of spontaneous regression, and so the therapeutic approach should not be too aggressive. Two case reports are presented of two immunocompetent patients with multiple plane warts successfully treated with low-dose systemic isotretinoin.

Topics: Adult; Dermatologic Agents; Facial Dermatoses; Female; Humans; Isotretinoin; Male; Warts; Young Adult

Topics: Administration, Oral; Adult; Dermatologic Agents; Diagnosis, Differential; Hand; Humans; Isotretinoin; Lymphoma, B-Cell; Male; Recurrence; Warts

Topics: Adult; Foot; Foot Dermatoses; Humans; Immunologic Deficiency Syndromes; Isotretinoin; Male; Tretinoin; Warts