We read with interest the article by Mclaughlin et al1 evaluating the efficacy and safety of treatment of warts, which consists of puncturing warts at least 10 times with a 18- to 25-gauge needle through the top of the lesion into the base. The authors hypothesized that tissue injury by multiple needle punctures may induce local inflammation and a subsequent cell-mediated immune response against human papillomavirus. We do not disagree. However, in our experience, microneedles are as effective as 18- to 25-gauge needles and are almost painless. Microneedling is a simple, safe, effective, and minimally invasive therapeutic technique which is used for the treatment of skin wrinkles2-4 and atrophic scars.5 Microneedling produces a controlled skin injury. These microinjuries set up a wound healing cascade, in which platelets release chemotactic and growth factors causing invasion of other platelets, neutrophils, monocytes/macrophages, and new collagen production.5
We recruited 62 patients aged 18 to 70 years (median: 39 years) with a total of 98 hand warts to evaluate the efficacy and safety of microneedling in the treatment of hand warts. Of the 98 warts, 34 were on fingers, 36 on the palm, and 28 on the back of hand. The average wart size was 8 mm, with a range of 3 to 15 mm. The median onset time prior to treatment was 76 days, with a range of 22 to 224 days. The patients received no other treatment before enrolling in this study. The participants were excluded from the study if they were prone to impaired healing, were immunosuppressed or were taking immunosuppressant drugs, were unable to give informed consent, were currently in a trial evaluating other treatments for their warts, were intending to treat their warts by other means during the trial period, had neuropathy, or were otherwise deemed not fit for treatment. The dermatologist punctured each wart 10 times using a tool with 6 titanium microneedles of 1.5 mm (Figure 1), which is usually used for the treatment of isolated atrophic scars. All the patients received a single treatment session and were seen every week for 8 weeks.
Figure 1.
The tool with 6 titanium microneedles of 1.5 mm, which is usually used for the treatment of isolated atrophic scars.
The primary outcome of our study was complete regression of treated warts 8 weeks after initial treatment. The secondary outcomes were: (1) pain evaluation by participants using a 10-point verbal rating scale (10 being “worst pain imaginable” and 1 being “no pain”’); and (2) documentation of adverse events.
The full 8-week follow-up period was completed by 56 patients with a total of 90 warts. Complete resolution was seen for 74 warts (82%); 9 warts (10%) were smaller but had not been resolved yet; 7 warts (8%) were of the same size or were bigger. The average time to resolution was 21 days, with a range of 14 to 42 days. The average pain value was 2.7, with a range of 1 to 5. No adverse effects were reported.
Our results suggest that microneedles are as effective as 18- to 25-gauge needles for the treatment of warts. However, contrary to 18- to 25-gauge needles, microneedling is almost painless, thus not requiring anesthesia, specific training, and additional costs.
Footnotes
Ethical Approval: This study was approved by our institutional review board.
Statement of Human and Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.
Statement of Informed Consent: Informed consent was obtained from all patients for being included in the study.
Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.
References
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