Warts are common dermatological lesions. They are solid lesions with skinny or gray - brown color and rough surface with a few millimeters of diameter that are single or multiple. They can join together and form plaque and regular, bold and rough surface shapes. They are usually painless; however, they are painful when they are cumulative or around the joints and nail or their surface are full of cleft (1). Previous studies showed that the prevalence rate of warts is different based on different age groups, population and periods of time. In two studies, the prevalence rate was 0.84% in the US and 12.9% in Russia (2, 3). In school children and young adults, the prevalence rate was 12% in the UK (4) and 24% in Australia (5).
Warts are caused by epithelial cells’ infection with human papilloma virus (HPV) (6). Human papillomavirus is a small double-stranded DNA virus (55 - 50 millimicron), which can infect squamous epithelial cells and cause cell proliferation. The most common effect of HPV infection is to develop the warts. This tumor is created by pleomorphic viruses and can be created in different areas such as hand and feet skin, genitelia skin and mucous, larynx and the mouth mucosa. The virus infects the basal layer of the epithelium. Stem cells can also be infected. However, viral replication happened in places where keratinocytes have fully differentiated such as layer cells (spinosum and granulosum) (7). These viruses replicate inside of the cells since they do not have cover, they are resistant to drought, freezing and solvents (8).
Based on the anatomical distribution, warts are found on the face, hands, nail, foot and genitalia. Warts are contact and inoculated lesions and transmitted by an indirect contact with contaminated materials or walking barefoot. By aging resistance against HPV will develop. Warts are common in children and young adults and rare in the elderly. Some warts that are resistant to treatment and posttreatment relapsed and became more widespread. Histologically, warts have the same changes such as acanthosis and hyperkeratosis. Common warts mainly be generated in children and usually on hands (1).
Previous studies have shown that therapeutic methods such as using salicylic acid, cryotherapy, hydroxychloroquine and zinc are effective on warts, but for cimetidine, levamisole or homeopathy consistent evidence was not found (9-12). Gibbs and Harvey in a review study for the topical treatment of warts concluded that only 12 of the 50 studies were of high quality (13). Also, several systematic therapeutic methods were used for warts; however, there are not sufficient evidence-based data on their effectiveness.
The local people of Baneh city in some areas have used contraceptives such as HD tablets for topical treatment of warts. The HD tablet is containing 50 mcg ethinylestradiol and 250 mcg levonorgestrel (or L-norgestrel or D-norgestrel). Estradiol is the most effective estrogen. Estrogens by binding to estrogen receptors in the cytoplasm increase the rates of DNA and RNA and other proteins’ construction in target tissues. Levonorgestrel is a synthetic progestin (progestin). It has very strong progesteronic effects, weak androgenic effects and very weak mineralocorticoid effects. Levonorgestrel is the most widely used progestin in Iran and the world (14).
Figure 1.
Skeletal Formulae of Levonorgestrel (A) and Estradiol (B)
Estrogen takes into account as mitosis and cell proliferation stimulating factor and in many cells prevents cell death. High dose of estrogen has caused regression of the hormone-dependent breast cancer in the postmenopausal age. In laboratory studies, it has been shown that the apoptotic effect of estrogen is an important factor in reducing the number of some of the cells (15). Regarding the above and experiences of local people in topical use of HD tablets to cure warts, this clinical trial study was designed and conducted to investigate the use of this drug for wart treatment scientifically.
LEAVE A COMMENT HERE: