Method Virusidal
A. Formaldehyde
Formasidal is virusidal agent and is in packaging gel 0.7% or 3% solusio. By cooling will accelerate the eradication of the virus verruca. Two hundred children with plantar verruca treated with 3% formaldehyde for 6 - 8 weeks to produce 80% verruca eradication. A control study comparing the use of formaldehyde with the soaking liquid and the second with saccharose showed no difference in eradication rates between the three groups.
B. Glutaraldehyde
Glutaraldehyde in solusio packaging or 10% formaldehyde gel and the like, this hardened skin and cause peeling easier. In studies without control by the use solusio 20% once a day at verruca eliminate 72% of 25 patients in three months. The disadvantage is that your skin is brown and there are reports of skin necrosis after the use of glutaraldehyde 20%.
Antimitotik Therapy
A. Podofillin / Podofillotoksin
Podofillotoksin, an active ingredient in a mixture of raw podofillin which acts as a binding coil antimitotik during mitosis. Inhibited cell division. This agent is used in therapy veruka anogenital, but weak in the penetration into the thick stratum corneum and podofillin more effective for treatment of skin verruca. Cessation of use after peeling verruca, may be effective, but there is a risk of inflammation, the formation of sterile pustules, and secondary infections.
B. Bleomisin
Bleomisin (blenoksan) is a kemoterapeutik agent that inhibits DNA synthesis in cells and viruses. Bleomisin is verruca alternative therapies that do not respond to other therapies or difficult verruca removed by surgery. Bleomisin in 1 - 5 unit vial diluted with 30 mL of physiological salt and 0.3 mL ( 0.15 units) injected into the verruca. Additional injections can be given every three or four weeks until resolution is reached. The pain is the biggest factor for therapy. Potential side effects is the formation of scar tissue, changes in pigmentation, nail damage, and Raynaud's phenomenon. Bleomisin recorded against pregnancy in category D, potentially absorbed after injection. One study reported that bleomisin used for the naughty verruca therapy. After the use of topical anesthetic, is injected into the bleomisin needle verruca. Resolution level reached 92%.
Although a number of RCT (randomized control trial) who reported that the level of effectiveness is low bleomisin, one article has been concluded that there was no consistent evidence on the effectiveness of therapy bleomisin intralesi in verruca nongenital and the data is not meant entirely for analysis. Another article based on RCT and a series of four different cases that present evidence of the effectiveness bleomisin, advocated its use as a third-line therapy for verruca vulgaris and plantar verruca.
C. Retinoids
Systemic retinoids have been used in the management of verruca for its ability to alter and accelerate the eradication keratinisasi way verruca induces irritant dermatitis. Small study reported etretinat effectiveness in children with a wide veruka. Etreninat not used widely in the United States, asitretin (soriatan) is now used. Etretinat dose of 1 mg / KgBB / day given no more than three months. In the 20 children who were included in this study, 16 of which showed complete resolution of verruca and without recurrence. Verruca relapse in four other patients after regression part.
One article found evidence supporting the use of topical retinoids based on one cohort study that examined the effectiveness of retinoids using a number of case reports and a number of experiments using systemic retinoids. Other articles from several case studies suggest the use of oral and topical retinoids as second-line therapy as a treatment verruca Plana.
Immune stimulation
A. Topical sensitization
Slow induction of hypersensitivity reactions have been used as verruca therapy. Dinitroklorobenzen and squarit dibutilester acid has been used, but many studies have seen difensipron effects. Two open studies have shown the difensipron great results. In one study, difensipron used every week for 8 weeks in 134 patients and provides approximately 60% response (complete resolution occurred in 44% of patients within 4 months). In another retrospective study, 48 patients were treated every 3 weeks, 88% of patients in verruca net 14 weeks. Return to this therapy that some patients can not sensitisation, while others have dermatitis reaction.
B. Cimetidin
Cimetidin have imunomodulator effects that are not clear and are used for therapies that have been advanced verruca. Open trial reported some effectiveness, but studies with controls showed no benefit compared with placebo.
C. Immunotherapy Intralesi
Intralesi Immunotherapy uses the immune system's ability to recognize viral antigens and certain fungi. Antigens for Candida skin test commonly used. It is believed that the slow type hypersensitivity reaction induced by this antigen improve the immune system's ability to identify and eradicate HPV. One study showed complete resolution of verruca participants and 47% ,75 - 99% resolution in 13% of participants. In the 34% who enrolled in this study had documented complete resolution of all verruca remote from the injection site. In 22% of participants, the level of 75 - 99% verruca resolution remote from the injection site has also been noted. Regression verruca remote from the injection site was not found on other therapies. Although some recent RCT has been published, an article states that intralesi Immunotherapy as second-line therapy for plantar verruca and third-line therapy for verruca vulgaris and verruca Plana.
Other Therapies
Many other therapies have been used to therapy verruca, although few are receiving these types of therapy. Traditional medicines are still used but without evaluation. Homeopathy uses a variety of drugs that contain calcium, netrium, and sulfur which showed the advantage over placebo. Hypnosis has been evaluated with a double-blind placebo-controlled trial of 40 individuals who were treated for more than 6 weeks. The group that got hypnosis lost more than verruca groups received topical salicylic acid or placebo. Local warming therapy has been tested on 13 patients. At 29 verruca who were treated, 86% net, while 41% of the placebo group, verruca regresses. Intralesi interferon has shown some effect on the experiment verruca open. Imiquimod 5% cream for 9-11 weeks has been used by a minority of patients with great results. Irradiation, one of the most commonly used, now no longer used for treatment of benign.
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