CASE PRESENTATION
In September 2021, a 69-year-old man was admitted into our department with hand warts (Figure 1). Diagnosis was performed by clinical observation. The fingertip of the right thumb showed soft tissue defect with warts extending to the finger stump. The patient reported that this finger was normal prior to wart occurrence. The thumb of the left hand also presented periungual warts, which caused nail damage. The patient reported the existence of pimples in this finger for more than 10 years, and which started to worsen during the past 4 years. The patient further reported that he had not performed any previous treatment and family history, due to his function as a caregiver to a colon colostomy patient, which made him manage the excrement from the fistula. The patient reported no physical discomfort except itching. However, such lesions had a psychological impact, as the patient reported to feel shame in showing his hands and was afraid that he could infect others. The patient reported no additional diseases.
Our previous study showed that Superficial X-Ray Therapy (SXRT. SRT-100, Sensus Healthcare, Boca Raton, Florida) combined with Tretinoin is effective for periungual warts3. Therefore, we made the decision to use SXRT combined with Tretinoin to treat our patient. We administered a 5 Gy fraction per week, up to a total dose of 20 Gy. Tretinoin cream (Med-Xine Pharmaceutical Co. LTD, Sichuan, China) was evenly smeared and the lesion was subsequently wrapped with saran for 8 hours a day during 20 days from the first fraction of radiotherapy. The compliance of patient was good. The warts began to shed after three fractions and were completely removed 26 days after treatment completion (Figures 2,3). The patient showed mild pruritus. No recurrence was observed after one year follow-up.