There are several treatments for non-genital skin warts; however, no single therapy for the treatment of this disease has been established. Patience and observation is a new treatment option for warts because many of these lesions will heal spontaneously. However, patients often seek treatment for these lesions due to social stigma or discomfort. Normally, the treatment should be simple with low cost and side effects. Available evidence supports the effectiveness of salicylic acid but the effect of this medication is slow and requires frequent use even upto 12 weeks. Cryotherapy with liquid nitrogen is a desirable option for many patients but it is not a comprehensive treatment and it has not shown effectiveness on many patients. New and improved treatments as alternative to physical and chemical treatments are the herbal remedies such as green tea extract, figs, bananas, apples, garlic, Chelidonium majus (Mamyran), Euphorbiaceous, mandrake (a barberry), Eastern red cedar, onions, West tree, juniper, fruit of Spruce (Tanub), lemon, cloves, black beans, podophyllin, roses, thyme and eggplant. In this study, the researcher developed an herbal treatment of wart using smoke of burned dried fruit of the pine tree that during short periods, removed the warts in several cases.
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Skin warts are benign epidermal proliferations caused due to the infection with Human Papilloma Virus (HPV). Although more than 100 serotypes of HPV are known but identifying the kind of serotypes does not affect the treatment of benign warts. Depending on the type of wart, involved epithelium, in terms of appearance, size, shape and response to treatment are different. Skin warts can be divided into 6 types (Table 1) (Burns, 1992; Walboomers et al., 1999).
Warts transfer by person-to-person contact or indirectly through infection transferring objects (fomites). Non-genital skin warts are common in children and its peak incidence is in adolescence and after the adolescence, it will reduce significantly. People who walk barefoot often are at increased risk of developing plantar warts. People who are dealing with meat are at risk for hands warts and people who chew their nails are more commonly at risk of warts around the nails. Immunosuppression is another important major risk factor. An observational study on immunosuppressed patients showed that within at least 5 years after receiving a kidney transplant, 90% of them had developed warts (Sterling, 2004).
Patience and observation is a new treatment for warts, because these lesions tend to improve spontaneously and treatment does not reduce the amount of virus transfer. In 17 trials, the average cure rate within 10 weeks was equivalent to 30%.
|Table 1:||Types of non-genital cutaneous warts|
|HPV: Human papilloma virus|
|Table 2:||Treatment of non-genital cutaneous warts|
|*Considering a period of 2-3 months seems reasonable, +Treatment that has the most evidence of its effectiveness|
Observational studies showed that half of skin warts within 1 year and about two-thirds of them within 2 years were recovered spontaneously. However, many patients due to discomfort or social stigma want to treat them (Handley et al., 1991).
Normally, the treatment should be simple with low cost and low side effects. The effectiveness of any single therapy in the treatment of this disease has not been established. There are several treatment options in this field (Table 2). Efficacy and safety of these treatments, usually in the context of Randomized Controlled Trials (RCT) has not been evaluated. Many studies were published that were not in the context of RCT but given the substantial placebo effect, the interpretation of the combined results of these studies should be done cautiously (Bashi, 1985; Sterling et al., 2001; Gibbs et al., 2002; Bruggink et al., 2010).
HISTORY OF WARTS
Wart was known in ancient Greece and Rome. Regarding its terminology, wart is derived from the Anglo-Saxon primitive natives. Codyloma has a Greek origin and is the name of a finger or a handle. Myrmecia that is a term used for deep and painful feet warts is derived from the Greek word Anthill. Verruca, first used by Snartus, basically means height or a steep location. He used this word for warts, because on their skin, it looked like the leading characters of Little Hills. During the roman Hellenism, genital warts were called Ficus and Thymus. Ficus was thought to have been used as an obscene word. Die Feigwarze (fig warts) is a German term for genital warts. Aulus Cornelius Cossus which lived in the region of Tiberius Caesar, in discussing the warty lesions in his classical work about a physician called De Medicina, mentioned 3 types: One type that the Greeks called it Acrochordon, another type was called Tthymion and the third type was named Myrmecia (Mulhem and Pinelis, 2011; Akhyani et al., 2010).
HERBAL TREATMENT FOR WARTS
Currently, there is a need for new and improved treatment with minimum cost, maximum effect with minimal side effects to replace chemical and physical treatments for cutaneous warts. The association of traditional medicine research of Tehran University of Medical Sciences (Iran) has considered the use of some plants in the treatment of warts which some of them is mentioned bellow.
Green tea extract: Sinecatechin is a standardized extract of green tea leaves which is a species of the Theaceae family. It mainly contains tea polyphenols, especially the catechin that forms more than 85% of it. Green tea catechins have numerous biological activities, including potent antiviral activities and antioxidant. Catechins are connected to a number of proteins, including enzymes involved in the generation of inflammatory mediators, proteases promoting tumor invasion, kinase required for tumor cell signaling, modification of cell cycle and induction of apoptosis (Tatti et al., 2008).
Garlic: Garlic is beneficial in the treatment of many diseases including skin diseases. In a study, the organic and aqueous extracts of garlic were extracted and used in the treatment of warts and corns. Thirty seven patients were selected that 28 of them had warts and 9 had corns. The extract was placed on the wart or corn 2 times a day for 7-14 days. The results showed that the patients with corn were 100% cured while improvement was observed in 90% of patients with warts (Silverberg, 2002).
Fig resin, a white matter that burns and seeps from the junction of the unripe fig on the tree branch is useful in the treatment of warts. The white sap that comes out from breaking the fig tree branch or from the unripe fruit is very toxic and in contact with the skin, it kills the cells. Fig leaves have Glycosiderutin. A study to evaluate the efficacy of fig resin and its comparison with chemical drugs on hand warts was conducted in visiting several clinics. The sample size was 60 and was divided into 2 treatment groups. One group was treated with herbal medication (fig resin) and the other group was given chemical medication (16.7% solution of 6 g salicylic acid, 6 g of lactic acid and 15 g Claudine). The results showed that the effectiveness of fig resin was higher (Highfield and Kemper, 1999).
Banana: There are several important chemicals in bananas including serotonin, norepinephrine, dopamine and catecholamine. The treatment method for skin warts with banana peel is that at first, the wart should be gently sanded and then a fresh peel of banana is placed on it for over the night. Using this natural substance has been somewhat effective against skin warts (Highfield and Kemper, 1999).
Apple: Sour apple juice is useful for the treatment of skin warts. Its effectiveness is due to the magnesium in the juice. Using this natural substance has been somewhat effective against skin warts (Highfield and Kemper, 1999).
Chelidonium majus (mamyran): Warts can be eliminated with the fresh sap of mamyran. Mamyran is used in the treatment of different warts such as papilloma, condyloma and nodules. This plant can grow anywhere especially around fences and streams as weeds. So, there is no problem accessing it. In a study, its sap was placed on the wart 20 times a day for 2-3 min. Full cure was observed in 135 patients after 15-20 days (Highfield and Kemper, 1999).
Euphorbiaceous: This genus has about 70 species of herbaceous and shrubs in Iran. All of which are leachate. Euphorbiaceous sap like Mamyran, is used to treat warts. This herb contains anti-viral and anti-tumor matters. It has a white sap containing lactone, forbone and resin. Ten species of Euphorbiaceous are used by traditional healers to treat ulcers, cancers, tumors, warts and other diseases. Among the 10 species, the highest activity was observed in the methanol aqueous extract of the stems and leaves in Euphorbiaceous cotinifolia and Euphorbiaceous tirucalli (Salem et al., 2013).
Onion: A number of researchers had hollowed the central cavity of an onion, poured salt in it and left it, so that water was accumulated. They used that water on the skin wart and this natural substance has been somewhat effective against skin warts (Salem et al., 2013).
West tree: A number of researchers rubbed the ashes of the West tree wood with vinegar on the skin wart. This natural substance has been somewhat effective against skin warts (Salem et al., 2013).
Juniper: Some researchers rubbed its powder to remove warts. This natural substance has been somewhat effective against skin warts (Salem et al., 2013).
Lemon: A number of researchers pierced a lemon and poured vinegar in it until the lemon absorbed all the vinegar. Then, once a day, they rubbed the lemon soaked with vinegar on the skin wart. This natural substance has been somewhat effective against skin warts (Salem et al., 2013).
Cloves: Cloves contain phenol and other compounds that have local anesthetic and disinfectant effects. Clove essential oil has a strong odor and a burning taste, its essence is white and in contact with air, it will turn dark and thick. Clove essential oil contains eugenol, benzyl alcohol, 2-methyl benzoates, fefol and ethylene. Some researchers rubbed Eugenol, the main ingredient of clove, powder to remove skin wart. This natural substance has been somewhat effective against skin warts (Salem et al., 2013).
Black seed: Black Seed is a yearly gramineous plant with 30 cm height sometimes covered with delicate fluff. This herb has anti-bacterial, anti-parasitic and anti-virus effects. Its chemical composition is oil, aponin and essence. Researchers have shown that this herb is effective in improving skin warts and corns (Salem et al., 2013).
Roses: Researches showed that pulverized roses eradicate skin warts and caused deep wounds to heal.
Thyme: The researchers found that pulverized thyme eradicate skin warts (Salem et al., 2013).
Eggplant: Eggplant is an annual herbaceous with a relatively thick stem covered with fluff, its stem height can reach to 70 cm. Eggplant in addition to vitamins and minerals include important plant materials that have antioxidant activity. Also, have phytonutrients including phenolic compounds such as caffeic acid, chlorogenic and fluonid such as niacin. Researchers have shown that if an eggplant is burnt and its ashes are made into a paste with vinegar and rubbed on skin wart, the wart will be plucked off (Salem et al., 2013).
Authors innovative therapeutic approach: According to traditional doctrines in the residential area, the researcher used a method on his own skin warts and several other volunteers and obtained very quick and positive outcome. In this method, at first, he selected a dried ripe pine fruit, burnt it and then positioned the skin warts through the smoke.
Previous research studies showed that for the removal of skin warts, the pine fruit was crushed with flex seeds and used as a poultice on the wart and had positive result (Salem et al., 2013). Therefore, the researcher also gained positive results by using the smoke of pine fruit without flex seeds in a short period. For two times every day, this fruit was burnt and the patients warts were placed through the smoke for 10-15 min. Figure 1 shows the pine fruit in Isfahan, Iran.
Case 1: The patient was a 10 year old boy with light skin, 145 cm height and 46 kg weight and had 4 small skin warts on his right hand and 1 on his forehead.
|Fig. 1:||Pine fruit in Isfahan, Iran|
The lesions were common warts (Callen et al., 2000) and he had them for 1 year. One of the lesions on the hand had discharge and was being treated with a combination of salicylic acid and lactic acid and also salicylic acid tape was used but the wart was not removed. Until 1 day, from morning to night for several times, pine fruit was burned and the wart was placed through the smoke and improvement was observed. Figure 2 shows the patients warts before and after the treatments.
Case 2: The patient was a 15 year old girl with light skin, 155 cm height and 45 kg weight and had 3 medium size skin warts on her right hand and 1 on her left hand.
|Fig. 2(a-b):||Patients warts (a) Before and (b) After the treatment|
|Fig. 3(a-b):||Patients skin warts (a) Before and (b) After the treatment|
The lesions were Filiform warts (Callen et al., 2000) and she had them for 1 year. All the lesions on her hand had discharge due to several treatments (use of salicylic acid and the gentamicin antibiotic injection as chemical treatment and the use of onion, garlic and fig sap individually as herbal treatment). Neither of the previous treatments used had been effective. Until for 2 weeks (14 days), 2 times a day, once in the morning and once at night, she burnt the pine fruit and used its smoke on the skin warts and improvements were made. Figure 3 shows the patients skin warts before and after the treatment.
|Fig. 4(a-b):||Patients skin warts (a) Before and (b) After treatment|
Case 3: The patient was a 45 year old man with light skin, 185 cm height and 100 kg weight and had small and medium skin warts on his feet, meaning he had plantar warts (Semprimoznik et al., 2012). The lesions were small bright papules like Hindi bulgur (Sago grain) at first but eventually they turned to their typical shape that were circular lesions with well-defined limits with keratotic hard surface and were tight by a loop (collar). This patient had also experienced a variety of herbal treatments during 1 year but unfortunately had not received any positive results. Until for 2 month, every night, he burnt the pine fruit, smoked the skin warts and observed positive results. Figure 4 shows this patients skin warts before and after treatment.
According to the results of the treatment of warts, such as chemical and physical therapy and comparing it to the herbal treatment, it can be concluded that for 2 reasons herbal therapy can be beneficial in the treatment of warts. First, herbal treatments have the least side effects while a variety of physical and chemical treatment methods each have its own special effects but the results of treatment with herbal medicines indicated that it had the least side effects. Second, the results from the warts herbal treatment showed that the speed and quality of treatment with plants was higher than other treatments (Bunney et al., 1976). In the authors developed method, the shortest possible time was used to remove the lesions using the smoke of burning pine fruit with the least complications.
Appreciation goes to the 3 patients who volunteered for their warts treatment and for allowing their pictures to be taken.
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