Topical immunotherapy with diphenylcyclopropenone is effective and preferred in the treatment of periungual warts

Abstract

Background: There exists a treatment challenge with periungual warts. Topical immunotherapy with diphenylcyclopropenone (DPCP) has recently been reported to be an effective treatment for recalcitrant warts, including periungual types.

Objective: We aimed to evaluate the effectiveness and preference of topical immunotherapy with DPCP in treating periungual warts.

Methods: Twenty-seven patients with periungual warts who were treated with DPCP immunotherapy (2007 through 2010; Dongguk University Ilsan Hospital, Goyang, Korea) were retrospectively recruited. Other treatment modalities were also used in some patients. Lesions were grouped into the types according to the following locations: proximal nail fold, lateral nail fold and hyponychium. Total and group clearance rates as well as treatment periods according to location and disease duration were evaluated. A patient questionnaire was performed to assess the satisfaction for the treatments in those who received multiple therapies.

Results: Total success rates were 85% (by subjects) and 91% (by individual lesions). Success rate and treatment period for proximal nail fold type seemed more desirable than other locations. Success rate decreased and treatment period increased as disease duration increased. The questionnaire revealed a significantly higher satisfaction rate for DPCP immunotherapy than for cryotherapy and pulsed-dye laser.

Conclusion: Topical immunotherapy with DPCP is an effective and preferred method in the treatment of periungual warts.

Keywords: Diphenylcyclopropenone; Immunotherapy; Periungual wart; Therapy.

Fig. 1

Periungual warts completely cleared with DPCPi. (A, B) Proximal nail fold type treated with DPCPi alone. (C, D) Lateral nail fold type treated with DPCPi following pulsed-dye laser. (E, F) Hyponychium type treated with DPCPi following cryotherapy. (G) Initial untreated periungual wart. (H) 'After PDL' in the middle, showing the remaining lesion with an ill-defined margin. (I) Lesion was completely cleared after DPCPi. PDL: pulsed-dye laser, DPCPi: diphenylcyclopropenone immunotherapy.

Fig. 2

Flow diagram of the study. Within parenthesis is the number of subjects. DPCP: diphenylcyclopropenone, Cryo: cryotherapy, PDL: pulsed-dye laser. ^*Two patients were not sensitized and the other two did not show proper reactions on wart lesions treated with DPCP immunotherapy.

Fig. 3

(A) Success rate by individual lesions (total and subgroups according to locations). Within parenthesis is the number of lesions. (B) Success rate according to disease duration. (C) Treatment period for each location. (D) Treatment period according to disease duration. ^*p<0.05 when compared to 6 to 12 months; ^†p<0.05 when compared to over 12 months.

Fig. 4

(A) VAS score of pain and satisfaction for each treatment modality. (B) DPCP is preferred to other methods. Eleven out of twelve subjects who experienced multiple therapies chose DPCP for a new wart. VAS: visual analogue scale, DPCP: diphenylcyclopropenone, Cryo: cryotherapy, PDL: pulsed-dye laser, DPCPi: diphenylcyclopropenone immunotherapy. ^*p<0.05 when compared to cryo; ^†p<0.05 when compared to PDL.