الفهرس 
Human Papiloma Virus (HPV)Only 14 pages are availabe for public view
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Abstract
Plane warts are small outgrowths that have flat tops that are similar to the size of a pinhead. These can be skin coloured, yellow, pink or light brown. Since they are more prominently found in children or teenagers, they are also called juvenile warts. They commonly develop on the face, forehead and sometimes on the neck, arms, and hands.
Plane warts are caused by human papillomavirus that has more than 100 strains. The main cause of Plane warts is HPV strains 3, 10, 28, 41 and 49. Viruses generally grow in warm and moist areas so human skin and mucosal surfaces are ideal for their growth. Once the HPV finds the right place for its survival, it begins to grow and divide rapidly. HPV is a contagious virus that spreads easily either by direct or indirect contact.
HPV remains dormant for a long duration inside the host. Once the infection occurs it might take up to a year for the warts to become visible. Plane warts are tiny outgrowths that are flesh in color, have flat tops and smooth texture. They generally invade the skin from cuts and abrasions which means that you will find them appearing near the scratches. Though they may grow prominently on the face and around the neck area, they can grow on hands as well. Generally the areas that are shaved very frequently. Thus the men’s face and women’s legs are more prone to HPV infection.
Plane warts develop in clusters, usually painless and can be very unattractive.
There is no permanent cure to a flat wart and they have the possibility of re-occurrence after a few months of treatment, since they occur in multiples and in areas prone to re-infection, flat warts can be rather difficult to treat. Treatment is not always necessary as the warts will go away after a few months; a result of the body’s immune system fighting back.When treatment is needed the most common options are non-prescription drugs which cause the skin to be saturated with water. Eventually the skin peels away taking the virus particles with it. Moist patches are another option, and these are placed over the affected area for 48 hours at a time. Success depends on the size of the wart and the depth of its growth. Flat wart remedies may take up to three months to work. If the problem persists and the warts are painful a doctor must be consulted. They will have access to stronger chemicals such as salicylic acid, glycolic acid, retinoin and potassium hydroxide to remove the top layer warts. A doctor may even use cryotherapy, where the tissue is frozen with liquid nitrogen. Other options include electro-surgery or pulsed laser beams which burn and kill the warts. Then, they simply DROP off.
Cryotherapy, is one of the most common procedures. Its mechanism of action is necrosis, which results from freezing and thawing of cells. It is widely used for the treatment of various
benign and malignant lesions. Cryotherapy is an efficient, effective, simple and minimally painful procedure. Side effects included burning pain, dyspigmentation. Post inflammatory hypopigmentation improve over a period of 3-6 months.
The chemical compound potassium hydroxide, is a metallic base. It is very alkaline and is a ”strong base, corrosive chemical used in medical practice in the diagnosis of fungal infection, diagnosis of bacterial vaginosis, treatment of male genital wart, and treatment of molluscum contagiosum in children.
As no published studies have compared cryotherapy with potassium hydroxide solution in the treatment of plane warts, the aim of this study was to compare the effect of potassium hydroxide solution 5% and 10% versus cryotherapy on plane warts as regards morbidity and the clinical response
This study included 60 patients with plane warts. The patients were randomly recruited from the outpatient clinics of the Dermatology and Venereology Department, El Matariya Teaching Hospital and Ain Shams University Hospitals. An informed consent was taken from the patients before participation in the study. All the patients in the study were subjected to history taking about the duration, the number of plane warts, and the previous treatments. Standarized digital photography of the lesion before and after treatment was done.
The patients were randomly assigned into one of three groups. The first group included 20 patients subjected to topical 5% KOH solution once at night for up to 6 weeks. The second group included 20 patients subjected to topical 10% KOH solution once at night for up to 6 weeks. The third group included 20 patients subjected to cotton bud method of cryotherapy every two weeks for up to 6 weeks. The liquid nitrogen was applied by keeping the cotton bud perpendicular to the warts till a frozen halo of 2mm around the base of the wart appears. This was achieved within10 seconds.
Treated warts were initially evaluated after completion of 6 weeks therapy for the cryotherapy treated group and KOH 5% and 10% treated group, to assess the clearance rate. Cleared warts were evaluated 2 weeks after the last visit to assess the recurrence rate.
Complete clearance, partial improvement and no response were
found in 55%, 20%, and 25% of patients respectively in the KOH
5% treated group; in 55%, 25%, and 20% of patients respectively
in the KOH 10% treated group; and in 80%, 15%, and 5% of
patients respectively in the cryotherapy treated group.
The rate of recurrence was equal in all groups. No serious side effects were reported in patients included in this study with cryotherapy and potassium hydroxide treatments. Only reported were local reactions in the form of itching, burning pain, hypopigmentaion, hyperpigmentation. Itching, burning sensation
were significantly higher in KOH treated groups, while hypopigmentation was significantly higher in cryotherapy treated group.
We found a statistically significant relation between the response to treatment in the 3 groups and the number of plane warts, patients with smaller number of warts showed a better response to treatment than those with larger number. In contrast, the duration of plane warts did not seem to have an effect on the response to treatment in the three study groups.