Plane warts on the back of the hand successfully treated with oral isotretinoin

A 31-year-old female was admitted to the Dermatology Clinic because of fine, skin-colour, shiny surface papules on the back of both hands (Figure 1 A). These skin lesions were present for several months, and periodically were associated with pruritus. The pathology exacerbated following an acute sinusitis treated with antibiotic – cefuroxime. Plane warts were diagnosed based on the medical history and the clinical presentation. The patient was initially treated with cryosurgery and laser therapy. Subsequently, topical pharmacotherapy was applied: imiquimod cream, podophyllotoxin liquid, fluorouracil ointment, tretinoin liquid and monochloride acetic acid liquid in a few weeks’ time period. Dissemination of fresh dermatological changes was observed peripherally and in vicinity of lesions treated with monochloride acetic acid and laser therapy (Figure 2 A). Afterwards, the patient received isoprinosine at a daily dose of 4 g, with no evident improvement. Considering the exacerbation of dermal changes and lack of any improvement, a decision was made to introduce the oral form of isotretinoin at a daily dose of 0.5 mg/kg b.w. After three weeks of this treatment a complete remission was achieved. Only scars left by previously applied treatments were observed (Figures 1 B, 2 B). Adverse effects of the treatment included dryness and exfoliation of the red zone of lips and dryness of conjunctiva of eyes. The treatment was continued for 3 months. At present the patient is followed-up.
Plane warts are dermatological lesions caused by the human papilloma virus (HPV), predominantly by types 3 and 10. The condition most often develops in young people and occupies the visible surfaces of the skin, such as the forehead and chin on the face and backs of hands. The diagnosis is based mainly on the clinical presentation.
The most commonly applied therapeutic methods include topical retinoids, usually tretinoin, isotretinoin, tazarotene, as ointments or liquids. However, topical retinoids are associated with numerous adverse effects leading to the development of erythaema, exfoliation, and skin irritation. In case of chronic treatment those may be noxious, as they occur in visible areas of the skin. Moreover, immunomodulating formulas are used, including imiquimod cream, as well as anti-mitotic drugs, such as fluorouracil liquid or ointment, and podophyllotoxin liquid. These preparations may also evoke a local hypersensitivity reaction. Majority of topical...


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