Department of Dermatology, Venereology and Andrology, Al-Azhar University Faculty of Medicine, Cairo, Egypt.
Dermatol Ther. 2022 Nov;35(11):e15815. doi: 10.1111/dth.15815. Epub 2022 Sep 21.
Plantar warts continue to represent a therapeutic challenge due to treatment resistance and high recurrence rates. Intralesional methotrexate, a cytotoxic chemotherapeutic agent with in-vitro anti-viral properties has been used for many dermatological indications. Two previous studies evaluated intralesional injection of diluted methotrexate (in 0.5, 1, and 2 mg/ml dilutions) in the treatment of warts and found it poorly effective. The concentrations used in these studies were much lower than those used for other indications. The current, open-label, prospective, pilot study aimed to evaluate the safety and efficacy of the intralesional injection of full concentration (25 mg/ml) methotrexate in the treatment of plantar warts. Twenty patients with plantar warts, 10 (50%) males, and 10 (50%) females, with mean ± SD age of 28.45 ± 8.66 years (range, 18-46 years) received biweekly sessions of intralesional methotrexate (25 mg/ml) until complete clearance or for a maximum of 6 sessions. Complete clearance of warts was achieved in 2 (10%), 6 (30%), and 7 (35%) patients after 4, 5, and 6 sessions, respectively. Another 8 (40%) patients showed partial improvement after 6 sessions. The response rate did not correlate significantly with the number of warts. Nine (45%) patients did not report any side effects. Pain and bruises were reported by 8 (40%) and 6 (30%) patients, respectively. These findings suggest that biweekly sessions of full (25 mg/ml) concentration of methotrexate are a safe and effective treatment for plantar warts. It may be considered an alternative line of treatment for resistant cases.
足底疣由于治疗耐药和高复发率，仍然是一个治疗挑战。甲氨蝶呤（methotrexate）是一种细胞毒性化疗药物，具有体外抗病毒特性，已被用于许多皮肤科适应症。有两项先前的研究评估了低浓度（0.5、1 和 2mg/ml 稀释度）的病灶内注射甲氨蝶呤（methotrexate）治疗疣的效果，发现效果不佳。这些研究中使用的浓度远低于其他适应症的浓度。目前这项开放性、前瞻性、初步研究旨在评估病灶内注射全浓度（25mg/ml）甲氨蝶呤治疗足底疣的安全性和疗效。20 名足底疣患者（10 名男性，50%；10 名女性，50%）纳入研究，平均年龄为 28.45±8.66 岁（18-46 岁）。每两周接受一次病灶内甲氨蝶呤（25mg/ml）注射，直至疣体完全清除或最多 6 次。4、5 和 6 次注射后，分别有 2 名（10%）、6 名（30%）和 7 名（35%）患者完全清除疣体，另外 8 名（40%）患者在 6 次注射后有部分改善。疣体数量与治疗反应率无显著相关性。9 名（45%）患者未报告任何副作用。8 名（40%）和 6 名（30%）患者分别报告出现疼痛和瘀斑。这些发现表明，每两周一次的全浓度（25mg/ml）甲氨蝶呤注射是一种安全有效的足底疣治疗方法。对于耐药病例，它可能被视为一种替代治疗方法。
