SciELO - Scientific Electronic Library Online

 
vol.93 issue5Multifocal cutaneous Rosai-Dorfman disease masquerading as lupus vulgaris in a childAcral persistent papular mucinosis with pruritic skin lesions author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Anais Brasileiros de Dermatologia

Print version ISSN 0365-0596On-line version ISSN 1806-4841

An. Bras. Dermatol. vol.93 no.5 Rio de Janeiro Sept./Oct. 2018

http://dx.doi.org/10.1590/abd1806-4841.20187820 

Letters

Multipuncture technique with ingenol mebutate in the treatment of a periungual wart*

Gerson Dellatorre1 
http://orcid.org/0000-0002-9657-0002

Anarosa Barbosa Sprenger1 
http://orcid.org/0000-0002-2282-0195

1Department of Dermatology, Hospital Santa Casa de Curitiba, Curitiba (PR), Brazil.


Dear Editor,

Periungual warts (PW) are very common and frequently encountered in the clinical setting. A variety of treatment modalities have been reported, including topical, intralesional, systemic, and surgical approaches.1 Despite the existence of several treatment approaches, PW are still characterized by their therapeutic resistance.

We report a case of a 37-year-old female patient presenting a recalcitrant PW on her left thumb (Figure 1). Previous treatments included cryotherapy (15 treatments) and imiquimod 5% cream (3 times a week for 8 weeks), without improvement.

Figure 1 Periungual wart. Verrucous lesion on the left thumb with subungual impairment and black dots 

We applied ingenol mebutate (IM) gel (Picato®, 0.05%, LeoPharma, Balerup, Denmark) using a multipuncture technique. After skin antisepsis with clorexidine 0.2% solution, IM 0.05% gel was applied over the lesional area (4 x 4mm) and 150 superficial punctures per treatment were made with a 31G needle. The treatments were repeated 3 times at 15-day intervals. Fifteen days after the third procedure, complete resolution was observed (Figure 2). Regarding to adverse effects, only mild desquamation occurred after each application.

Figure 2 Clinical clearance of the lesions 15 days after the third procedure 

IM gel has been effective against human papilloma virus (HPV) lesions, as shown previously in two case series of genital warts, with total lesional clearance in 18 of 19 patients.2,3 The therapeutic response observed in our case suggests that IM can also be a therapeutic modality in more keratotic HPV-related lesions, such as PW, since drug penetration can be improved by multipuncture technique.

*Work conducted at the Hospital Santa Casa de Curitiba, Curitiba (PR), Brazil.

Financial support: None.

REFERENCES

1 Herschthal J, McLeod MP, Zaiac M. Management of ungual warts. Dermatol Ther. 2012;25:545-50. [ Links ]

2 Schopf RE. Ingenol mebutate gel is effective against anogenital warts - a case series in 17 patients. J Eur Acad Dermatol Venereol. 2016;30:1041-3. [ Links ]

3 Braun SA, Gerber PA. Ingenol mebutate for the management of genital warts in sensitive anatomic locations. J Am Acad Dermatol. 2017;77:e9-e10. [ Links ]

Received: November 05, 2017; Accepted: January 20, 2018

Mailing Address: Gerson Dellatorre. E-mail: dellatorre@gmail.com

Conflict of interest: None.

AUTHORS'CONTRIBUTIONS

Gerson Dellatorre

0000-0002-9657-0002

Approval of the final version of the manuscript, Design and planning of the study, Preparation and writing of the manuscript, Intellectual participation in propaedeutic and/or therapeutic conduct of studied cases, Critical review of the literature

Anarosa Barbosa Sprenger

0000-0002-2282-0195

Approval of the final version of the manuscript, Collecting, analysis and interpretation of data, Effective participation in research orientation, Intellectual participation in propaedeutic and/or therapeutic conduct of studied cases, Critical review of the literature, Critical review of the manuscript

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial License which permits unrestricted noncommercial use, distribution, and reproduction in any medium provided the original work is properly cited.