DISCUSSION
Standard therapy methods for periungual warts
include cryotherapy, laser, surgery, interferon, or local drug therapy,
which causes severe pain, scar ulcers, and irreversible destruction of
the nail matrix, leading to nail deformation4, 5. SXRT
is effective at treating periungual warts, and is associated with mild
side effects, such as pruritus, hyperpigmentation, erythema, pain and
swelling3. Therefore, we made the decision to use SXRT
to treat our patient.
Radiotherapy treatment for warts might range from 1200r to 3000r (1r
corresponds to, roughly, 0.876 cGy) total dose, which may be
administered at once, or divided into four fractions3,
6. Our previous study showed that SXRT combined with Tretinoin is
effective for periungual warts3. Given that side
effects, such as radiation ulcer, are more likely to occur when higher
dosage is used, we administered a 5 Gy fraction per week, up to a total
dose of 20 Gy. The warts began to shed after three fractions and were
completely removed 26 days after treatment completion (Figures 2 and 3).
The patient showed mild pruritus. No recurrence was observed after one
year follow-up.
Warts are caused by human papilloma viruses (HPVs). Cellular replication
induced by viral DNA amplification leads to the formation of hyper
keratinized papules that form the wart.7 Therefore,
tissue defects caused by warts are highly unlikely to occur. In the
reported case, a lesion of roughly 4mm was observed, which is a rare
occurrence. Such lesion might result from the lack of treatment for a
prolonged period of time. Furthermore, the exposure to alkaline
intestinal fluid might have enhanced the damages to the soft tissue
during this period.
To the best of our knowledge, this is the first clinical report
concerning a fingertip defect caused by warts, which was successfully
treated, imposing only mild side effects. SXRT combined with Tretinoin
is recommended for refractory warts, when acute pain is associated with
conventional treatments. Nevertheless, we acknowledge that our report
might be biased, as the clinical presentation might have been somehow
related to the contact of the affected areas with alkaline intestinal
fluid.