|Year : 2018 | Volume
| Issue : 4 | Page : 214-216
Successful treatment of common warts with alum
Ehsan Saburi1, Asma Behdari2
1 Department of Medical Genetics and Molecular Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Zanjan Branch, Zanjan, Iran
|Date of Submission||18-Jun-2018|
|Date of Decision||09-Sep-2020|
|Date of Acceptance||15-Jul-2021|
|Date of Web Publication||04-Jan-2022|
Mrs. Asma Behdari
M.Sc, Department of Microbiology, Faculty of Basic Sciences, Islamic Azad University, Zanjan Branch, Zanjan
Source of Support: None, Conflict of Interest: None
Verruca vulgaris (Vv) as named common wart is an epidermal proliferation caused by the Human Papilloma Virus. Due to specialists and equipment requirements as well as high cost, the most effective treatment for wart such as cryosurgery and electrocautery are not most popular, availability and minimally invasiveness of topical agents turned them into the most appropriate and preferred method especially in children and citizens with low incomes. The purpose of this study was evaluating the efficacy of Alum in the treatment of Vv in two cases. Warts have been disappeared and recurrences were not seen for more than one-year follow-up. For years, Alum used as a powerful adjuvant in many types of vaccines based on its role in immune system activation as adjuvant to activation of cytotoxic T-cells.
Keywords: Alum, complementary therapies, therapeutics, warts
|How to cite this article:|
Saburi E, Behdari A. Successful treatment of common warts with alum. Ancient Sci Life 2018;37:214-6
| Introduction|| |
Common wart (Verruca vulgaris = Vv) is caused by HPV (human papillomavirus) a DNA virus that usually infects epithelial tissues and mucosal membranes. Vv also known as common warts is a benign epidermal proliferation usually increases the risk of squamous cell carcinoma especially in immunocompromised patients. Vv as among the most common infections of the skin worldwide, may induce cosmetic, psychological and social problems. In the treatment of viral warts, the available treatments as cryosurgery, electrocautery, topical agents (such as cantharidin, podophyllin, tretinoin, salicylic acid, imiquimod), and laser surgery modalities have efficacy. All methods contain their advantages and disadvantages; However, the treatment methods selected is based on many factors including kind of the wart(s) or participant/specialist preference. Due to its comparative advantages, cryotherapy is a commonly used method, although is restricted in children. Post-inflammatory pigments, scarring and being dependent on specific equipment are disadvantages of cryotherapy. Some reports are available on the effectiveness of herbal or chemical therapy in treatment of viral warts.,, Alum or potassium Alum with the chemical name hydrated potassium aluminum sulfate [KAl(SO4)2·12H2O], was considered as a useful traditional therapy in dermatologic complications, such as hyperhidrosis and cutaneous Leishmaniasis., Due to the impact of the alternative approaches including traditional therapy, the purpose of this study was to evaluate the efficacy and safety of Alum in the treatment of wart. We presented the outcomes in two cases of common wart treated with the saturated solution of Alum.
| Case Report|| |
The first case was a 29-year-old man, with a self-employed job and with the surface wart on the upper part of the finger is the left hand pointer near three years. The second case was a 10-year-old girl, a student with a surface wart in the thumb of the right hand more than two years. Both cases were enrolled in study in May 2016 after clinical examinations by clinicians have proved common warts (Vv). They were living in the metropolitan areas of Mianeh (northwestern Iran). None of them had an uneventful medical history and did not consume any special medication. In both cases, no drug treatment for warts had been initiated since the onset of the disease. After a complete explanation of the treatment process, the consent of both patients was obtained from using the combination. Alum crystals were powder and water-saturated solution prepared. The water-saturated solution of Alum was dressing up with cotton on the wound overnight for almost two weeks (15 and 14 days in case 1 and 2, respectively). In that time frame, the lesions were experienced several times till the resolution of wart completed. During this period and until the removal of warts, the lesions were examined daily by the specialist. The warts in the early days are slightly swollen and soft, and then their size is reduced to a small extent and disappears. After ensuring the removal of warts, recurrence of lesions was monitored for one year and monthly. There were no recurrences after treatment in more than one year patients follow-up [Figure 1]. Also, participants in the study, while using the combination, did not experience any side effects and discomfort.
|Figure 1: The clinical improvement following the use of alum (a; a 10-year female, b; a 29-year male)|
Click here to view
| Discussion|| |
There are several therapies for common wart, such as cryotherapy, electrodessication, immunotherapy or treatment based on chemical or biological compounds as salicylic acid, fluorouracil, imiquimod, and etc., Regardless of the advantages and disadvantages, all these methods may not be available in all regions nor be effective in some people. Today, tend to use of traditional medicines have risen in many countries. Alum in Iranian traditional medicine has been used as a helpful compound in treatment of many dermal complications. Since the early twentieth century, Alum used as powerful adjuvant for many type of vaccines. Many articles have addressed the Alum effectiveness as well as its mechanisms in immune system activation. Both humoral and cell-mediated immune responses (especially cytotoxic T-cell activation) mentioned following administration of Alum (and its derivatives) as an adjuvant, make it a suitable candidate for many kinds of virus vaccines such as HPV.,
Nowadays Alum in combination with MPL (monophosphoryl lipid) named AS04 (Adjuvant System04) [Cervarix®], has been used in vaccines against HPV successfully. From the perspective of molecular mechanism, Alum binds to ITAM (Immunoreceptor tyrosine-based activation motif)-containing receptors cluster on cell membrane of macrophages or dendritic cells and activates the Syk-PI3Kd pathway. Many kinds of signaling cascade activated which caused Th2 response eventually., Also, based on sequential events, apoptosis activation occurs, inflammatory cytokines released and inflammatory monocytes migrated. Importantly, numerous evidences suggests mechanisms mentioned above are effective in controlling viral infections as HPV. In some cases, cell-mediated immunity (CMI) to the virus causes self-limitation lesions spontaneously. It has been proved that CMI considered as a most effective approaches against viruses and as it is mentioned, many types of adjuvants play important roles in the activation of cell Immunity., Although, some studies have shown that immunotherapy with other adjuvant is helpful in the treatment of cutaneous warts,, this is the first report of efficacy of Alum in warts. According to the permanent presence of HPV-antigens locally, it seems entrance of Alum as an adjuvant can be used to boost the immune system to play an effective role, quickly. However, there are many evidence in effectiveness of Alum on Leishmaniasis, aquagenic acrokeratoderma, Respiratory syncytial virus (RSV) and reduction of house-dust mite allergen,, adjuvant role of Alum for HPV vaccines is more valuable.,
In conclusion, it can be said that ablative therapy including cryotherapy, laser and etc., despite the high success rate is accompanied by the high cost of treatment, postoperative pain and scarring. Therefore, simpler and cheaper solutions as herbal, traditional or supplement therapy can be effective.
For the treatment and publication, written informed consent has been obtained from all patients.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
The authors would like to thank Dr. Amin Saburi (ImamReza Hospital, Birjand, Iran) for providing diagnosis and patients to appropriate cooperation. No financial support was received.
| References|| |
Shangkuan WC, Lin MY. Verruca vulgaris of tympanic membrane treated with topical immunotherapy. Am J Otolaryngol 2014;35:242-5.
Ural A, Arslan S, Ersoz Ş, Değer B. Verruca vulgaris of the tongue: A case report with a literature review. Bosn J Basic Med Sci 2014;14:136-8.
Joseph R, Pulimood SA, Abraham P, John GT. Successful treatment of verruca vulgaris with Thuja occidentalis in a renal allograft recipient. Indian J Nephrol 2013;23:362-4.
] [Full text]
Cengiz FP, Emiroglu N. An open, comparative clinical study on the efficacy and safety of 10% trichloroacetic acid, 25% trichloroacetic acid and cryotherapy for verruca plana. Cutan Ocul Toxicol 2015;34:144-8.
Shahidi S, Moeinzadeh F, Mohammadi M, Gholamrezaei A. Sirolimus-based immunosuppression for treatment of cutaneous warts in kidney transplant recipients. Iran J Kidney Dis 2011;5:351-3.
Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: Systematic review. BMJ 2002;325:461.
Bahrami AM, Khosravi A, Maspi N. Effects of drug combined of black and white alum on cutaneous leishmaniasis lesion. J Ilam Univ Med Sci 2010;17:53-60.
Luo DQ, Zhao YK, Zhang WJ, Wu LC. Aquagenic acrokeratoderma. Int J Dermatol 2010;49:526-31.
Sevki C, Levent A, Ender G, Firdevs M. Reduction of house-dust mite allergen concentrations in carpets by aluminium potassium sulfate dodecahydrate (alum). Allergy Asthma Proc 2006;27:350-3.
Garnock-Jones KP, Giuliano AR. Quadrivalent human papillomavirus (HPV) types 6, 11, 16, 18 vaccine: For the prevention of genital warts in males. Drugs 2011;71:591-602.
Leung TF, Liu AP, Lim FS, Thollot F, Oh HM, Lee BW, et al.
Comparative immunogenicity and safety of human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine and HPV-6/11/16/18 vaccine administered according to 2- and 3-dose schedules in girls aged 9-14 years: Results to month 12 from a randomized trial. Hum Vaccin Immunother 2015;11:1689-702.
Monie A, Hung CF, Roden R, Wu TC. Cervarix™: A vaccine for the prevention of HPV 16, 18-associated cervical cancer. Biologics 2008;2:107-13.
Tummers B, Burg SH. High-risk human papillomavirus targets crossroads in immune signaling. Viruses 2015;7:2485-506.
Conesa-Zamora P. Immune responses against virus and tumor in cervical carcinogenesis: Treatment strategies for avoiding the HPV-induced immune escape. Gynecol Oncol 2013;131:480-8.
Wang Y, Rahman D, Lehner T. A comparative study of stress-mediated immunological functions with the adjuvanticity of alum. J Biol Chem 2012;287:17152-60.
Kool M, Fierens K, Lambrecht BN. Alum adjuvant: Some of the tricks of the oldest adjuvant. J Med Microbiol 2012;61:927-34.
Brendle SA, Bywaters SM, Christensen ND. Pathogenesis of infection by human papillomavirus. Curr Probl Dermatol 2014;45:47-57.
Gao X, Chen H. Hyperthermia on skin immune system and its application in the treatment of human papillomavirus-infected skin diseases. Front Med 2014;8:1-5.
Wang B, Wang X, Wen Y, Fu J, Wang H, Ma Z, et al.
Suppression of established hepatocarcinoma in adjuvant only immunotherapy: Alum triggers anti-tumor CD8+T cell response. Sci Rep 2015;5:17695.
Saoji V, Lade NR, Gadegone R, Bhat A. Immunotherapy using purified protein derivative in the treatment of warts: An open uncontrolled trial. Indian J Dermatol Venereol Leprol 2016;82:42-6.
] [Full text]
Kim M, Jung HY, Park HJ. Topical PDT in the treatment of benign skin diseases: Principles and new applications. Int J Mol Sci 2015;16:23259-78.
Kim KH, Lee YT, Hwang HS, Kwon YM, Jung YJ, Lee Y, et al.
Alum adjuvant enhances protection against respiratory syncytial virus but exacerbates pulmonary inflammation by modulating multiple innate and adaptive immune cells. PLoS One 2015;10:e0139916.