Micali G, Dall'Oglio F, Nasca M R
Dermatology Clinic, University of Catania, Piazza S. Agata La Vetere 6, 95124 Catania, Italy.
J Dermatolog Treat. 2003 Dec;14(4):233-6. doi: 10.1080/09546630310016763.
Periungual and subungual warts are very difficult to eradicate with current therapies. Most are destructive in nature (liquid nitrogen, cantharidin, vascular lesion laser) and inflammation, pain and pigment dyschromia are common side effects. Furthermore, failure to respond or appearance of new lesions often leads to even more destructive treatments (CO(2) laser, excisional surgery) and can lead to more pain and scarring.
In an open trial, the efficacy, safety, and tolerability of topical imiquimod 5% cream was assessed in 15 patients with resistant and recurrent periungual and subungual warts over a 16 week period.
Twelve patients (80%) completed therapy, showing complete resolution after a mean time of three weeks (range 1-6 weeks), with the remaining three patients (20%) being classified as non-responders. Local side effects (erythema, pruritus, burning and pain) were generally mild and well-tolerated. No relapses occurred during a 6-month follow-up.
Topical imiquimod is an interesting novel treatment for multiple periungual and subungual warts. Tolerability is excellent when compared to other commonly used modalities and there are few side effects. This trial suggests a high clinical response rate. This treatment is applicable to patients who have failed conventional therapies before embarking on potentially scarring approaches such as excisional surgery.
目前的治疗方法很难根除甲周疣和甲下疣。大多数现有治疗具有破坏性（液氮、斑蝥素、血管病变激光），炎症、疼痛和色素沉着异常是常见的副作用。此外，治疗无反应或出现新病灶往往导致更具破坏性的治疗（二氧化碳激光、切除手术），并可能导致更多疼痛和瘢痕形成。
在一项开放试验中，对15例耐药性和复发性甲周疣和甲下疣患者在16周内评估了5%咪喹莫特乳膏的疗效、安全性和耐受性。
12例患者（80%）完成治疗，平均3周（1 - 6周）后完全消退，其余3例患者（20%）被归类为无反应者。局部副作用（红斑、瘙痒、烧灼感和疼痛）一般较轻且耐受性良好。在6个月的随访中未发生复发。
外用咪喹莫特是一种治疗多发性甲周疣和甲下疣的有趣的新方法。与其他常用方法相比，耐受性极佳，副作用很少。该试验表明临床反应率很高。这种治疗方法适用于那些在采取如切除手术等可能导致瘢痕形成的方法之前，传统治疗失败的患者。
