skin; verruca 7 destructive therapy

Destructive Therapy

A. Salicylic acid
Salicylic acid is a slow acting keralolitik epidermis infected. Results with mild irritation may stimulate an immune response. Salicylic acid itself has shown the results of a resolution on 67% of patients with verruca in hand and 84% in patients with plantar verruca within 12 weeks.
There are many patented products salicylic acid, but no recent information to compare these products:
1. 11-17% salicylic acid in kolodio and gels such as kolodio lactic acid, copper
2. 26% salicylic acid in the basic poliakrilik designed to mix their own
3. salicylic acid with 25% podofilin in oinment, used for plantar verruca
4. 50% salicylic acid is used to ointment plantar verruca.
Before applying ointment verruca, keratin layer must first exfoliated or removed with sandpaper or a polished and smooth the surface by soaking in warm water. Kolodio products to form a layer of exfoliated before re-application. Product occlusion has been shown to increase the level of plantar verruca cleansing.
The comparison between the content of salicylic acid ointment and a single treatment with glutaraldehyde, folouroasil, podifilin, benzalklonium, cryotherapy with liquid nitrogen, does not prove more effective than salicylic acid.

B. Cryotherapy (Surgical Frozen)
Liquid nitrogen (LN2, 2196 8C) is the agent most frequently used. Mixture of dimethyl ether / propane (257 8C) is used as pleased with this product, but the effectiveness in making a sufficient temperature to necrotic cells was low. Cryotherapy have any effect on either resolution verruca necrosis by simple destruction keratinocytes infected with HPV and local condition inflammatory response to induce cell-mediated immune effective.
Different techniques between physicians with a variety of freezing time, the way the distance between the application and therapy. Many doctors use a cotton stick spray, but still widely used and better used in children or verruca close to the eye. Generally done freezing until halo around verruca lost and the time between 5-30 seconds depending on the location and size verruca. When an application re-LN2 with cotton sticks, to note that HPV and other viruses like HIV can survive in liquid nitrogen.
Verruca with surgical destruction of frozen every three weeks can give resolution results in 69% of patients with verruca in hand within 12 weeks. This study used liquid nitrogen with a cotton bud to disappear from the surrounding halo verruca (about 5-30 seconds). Cleanup levels increased when cryotherapy combined with salicylic acid ointment, although not significant.
Two cycles of freeze-liquid has been shown to improve resolution in plantar verruca but not in palmar verruca. The ideal interval between surgery frozen with the next one is not clear. Bunney study showed that the interval of more than three weeks, reducing the rate at 12 weeks of treatment, other studies show that the resolution depends on the amount of therapy, so that weekly therapy produces a more rapid resolution.
Patients should be reminded that the frozen surgical pain and heat. Need to be careful when passing tendon surgery and frozen in patients with little circulation. Can occur hypo and hyperpigmentation, especially in blacks. Therapy can be followed by onikodistrofi on verruca periungual.

C. Termokauter or Kuretase and cautery
Verruca surgery has been practiced mainly with a blunt kuretase or surgery followed by cautery. This method is particularly used in verruca filiformis on the face and extremities. In an open study, the success rate of patients reported an average of 65-85%. This procedure usually leaves scar tissue and recurrence occurs more than 30%. The growth of scar tissue on the soles of the feet is a relative contraindication in this surgical method.
A study conducted in India, which compare the effectiveness of 5-flouroasil (pyrimidin fluorine which cuts the viral DNA synthesis) with electrosurgery performed on 50 patients who were divided into two groups, showed 52% of patients showed good response to 5-flourourasil, whereas 72 patients showed good response to electrosurgery. 5-flouroasil give a better effect on verruca Plana, verruca plantar, and condyloma akuminata, whereas electrosurgery provides a better response to the verruca vulgaris especially in the case verruca filiformis. Electrosurgery side effect of pain, secondary infection, the growth of scars, and hipopigmentasi, while 5-flouroasil have side effects of eritem, photosensitive, and hiperpigmentasi.8

D. Chemical cautery: Batang Silver Nitrate
Chemical cautery with daily re-use silver nitrate sticks can cause destruction to effect adequate resolution verruca, but sometimes hyperpigmented scars formed. In a placebo control study in 70 patients, three silver nitrate application all verruca resolution at more than 9 days at 43% and 26% probandus improvement verruca one month after treatment compared to 11% and 14% in the placebo group.

E. Carbon dioxide laser
Destruction produced by CO2 laser has been used to therapy virus verruca. Periungual and subungual lesions are difficult resolusition with other treatment methods, appropriate when using this method. The level of recovery was reported in two cases of 64-71% after 12 months, but pain can occur after an operation scar tissue growth.

F. Pulsed Dye Laser
Therapy with vascular lesion laser, also known as pulsed dye laser therapy that can selectively target a hemoglobin contained in verruca. When hemoglobin heat, thermal energy dissipated into the surrounding tissue, causing the blood vessels cautery. The result is a frequent necrosis verruca peeling. The use of pulsed dye laser absorption of energy depending on the capillary matting in verruca and local tissue necrosis. Pain and less scarring than the laser occurs CO2.1 Many studies have studied the effectiveness of pulsed dye laser therapy after about two or three times a therapy reported cure rates of about 48-93% verruca at various locations. One study showed a resolution rate of about 72%. Highest resolution level of 85.7% in periungual and verruca lowest level in 50% verruca plantar.
In a separate study comparing the pulsed dye laser therapy with cryotherapy and cantaridin. In patients treated with cryotherapy and cantaridin, 70% showed the cleaning, while 66% of patients showed eradication after pulsed dye laser therapy. The researchers conclude that pulsed dye laser therapy effective as conventional therapy. Pulsed dye laser therapy is recommended as second-line therapy in verruca and third-line therapy for verruca vulgaris and verruca Plana. However, another article found EBM weak to support the use of pulsed dye laser as sole therapy for this study method can only be used for therapy verruca located on the hands and feet.

G. Fotodinamik Therapy
This therapy depends on the chemical capture by abnormal cells, usually an amino acid-levulinat (AAL) was involved in track and photograph porphyrin oxidation by irradiation using laser or non laser that affect the network. Comparison of responses in 45 patients who received three laser therapy with wavelengths of 589-700 nm after the AAL 20% cream or placebo cream showed that active treatment resulted in an increase or reduction of the size of the resolution after 4 months verruca with AAL and irradiation.