Cases and Research Lelleters
Multiple Warts Appearing Exclusively on Psoriasis Plaques
Verrugas múltiples localizadas exclusivamente sobre las placas de psoriasis
L. Carnero
, R. González-Pérez, I. Arrue, R. Soloeta
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Servicio de Dermatología, Hospital Santiago Apóstol, Vitoria, Álava, Spain
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Ballester-Sánchez, V. Oliver-Martínez, V. Alegre de Miquel" "autores" => array:4 [ 0 => array:2 [ "nombre" => "B." "apellidos" => "de Unamuno-Bustos" ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Ballester-Sánchez" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Oliver-Martínez" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Alegre de Miquel" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0001731011003127" "doi" => "10.1016/j.ad.2011.03.026" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731011003127?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219012000273?idApp=UINPBA000044" "url" => "/15782190/0000010200000010/v1_201304241244/S1578219012000273/v1_201304241244/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Cases and Research Lelleters</span>" "titulo" => "Multiple Warts Appearing Exclusively on Psoriasis Plaques" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Editor:</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "835" "paginaFinal" => "836" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Carnero, R. González-Pérez, I. Arrue, R. Soloeta" "autores" => array:4 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Carnero" "email" => array:1 [ 0 => "LUCIA.CARNEROGONZALEZ@osakidetza.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "González-Pérez" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Arrue" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Soloeta" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital Santiago Apóstol, Vitoria, Álava, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Verrugas múltiples localizadas exclusivamente sobre las placas de psoriasis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2373 "Ancho" => 1582 "Tamanyo" => 249021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Back covered with small psoriasis plaques on which warts had developed.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Common warts (verruca vulgaris) are found very frequently in children and adults (prevalence, 10%) and can sometimes prove difficult to treat, particularly when multiple or recalcitrant.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a patient who developed multiple warts on psoriasis plaques.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 58-year-old man with a history of hypertension and an immunoglobulin A monoclonal gammopathy for which he was not receiving any treatment at the time. He had a history of plaque psoriasis with joint involvement since the age of 15. Treatment with topical corticosteroids and oral methotrexate had achieved only slight improvement in this condition. He attended our clinic because of an outbreak of small erythematous-desquamative lesions distributed symmetrically across his arms and trunk on which multiple spiny whitish papules had developed. The appearance of the papules was consistent with a diagnosis of viral warts (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The patient had never previously had warts. The results of the additional tests performed were normal, and serology for human immunodeficiency virus and hepatitis B and C viruses was negative. Skin biopsy revealed an acanthotic epidermis with papillomatosis, hyperkeratosis with focal parakeratosis, and no clear signs of viral cytopathic effect. A chronic inflammatory infiltrate was found in the underlying dermis. Genotyping for the human papillomavirus (HPV) performed using hybridization techniques (Clinical Arrays, Genomica) was positive for genotypes 6 and 31. The histologic diagnosis was verruca vulgaris on plaque psoriasis. Methotrexate was withdrawn and the patient started treatment with acitretin 35<span class="elsevierStyleHsp" style=""></span>mg/d. Virtually all the warts disappeared within 1 month, but the psoriasis plaques persisted. These were then treated with narrowband UV-B phototherapy with excellent results (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">On reviewing the literature we found 1 report of a case of psoriasis on viral warts in a patient treated with interferon-α.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It has been suggested that the HPV may contain proteins that stimulate keratinocyte proliferation. These proteins, and others included in the viral capsid, can be recognized by preactivated CD4+ lymphocytes and lead to the generation of specific antibodies (antigenic activation). The autoimmune reaction triggered in this way could lead to complement activation, neutrophil chemotaxis, and formation of the Munro microabscesses so characteristic of plaque psoriasis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Thus, while HPV does not cause the psoriasis, it may be involved in the pathogenesis of the disease, particularly in the case of genotypes 5 and 36,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> and contribute to keratinocyte proliferation and the perpetuation of the autoimmune reaction. Our patient tested positive for HPV 6 and 31, genotypes that carry only a low oncogenic risk and are often found in common warts.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In our patient, the inverse situation occurred as the viral warts only appeared on the psoriasis plaques. Some authors have suggested that the epidermal hyperproliferation characteristic of psoriasis may reactivate latent HPV infection, leading to the development of warts.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, HPV DNA has been identified in psoriasis plaques, carcinomas, and epidermodysplasia verruciformis, but not in other skin diseases, such as eczemas and atopic dermatitis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In our patient, there were also other factors that could have contributed to the appearance of these warts, such as the immunosuppressant therapy he received to treat his psoriasis and the monoclonal gammopathy. A case was recently reported in which viral warts appeared suddenly in a patient with psoriasis being treated with the anti-tumor necrosis factor agent etanercept.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The few articles published on the topic shed little light on this complex interrelationship between cytokines, psoriasis, and HPV infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–8</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally, in our review of the literature we found no reports of psoriasis with viral warts treated with acitretin, the drug that achieved complete resolution of the warts in our patient.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Carnero L, et al.Verrugas multiples localizadas exclusivamente sobre las places de psoriasis. Actas Dermosifiliogr. 2011;102:835-836.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2373 "Ancho" => 1582 "Tamanyo" => 249021 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Back covered with small psoriasis plaques on which warts had developed.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1055 "Ancho" => 1585 "Tamanyo" => 93482 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clearance of both the warts and psoriasis after treatment with acitretin 35<span class="elsevierStyleHsp" style=""></span>mg/d and narrowband UV-B phototherapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoriasis occurring predominantly on warts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "T. 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| 2021 Noviembre | 145 | 49 | 194 |
| 2021 Octubre | 149 | 46 | 195 |
| 2021 Septiembre | 175 | 47 | 222 |
| 2021 Agosto | 180 | 59 | 239 |
| 2021 Julio | 186 | 62 | 248 |
| 2021 Junio | 181 | 65 | 246 |
| 2021 Mayo | 181 | 64 | 245 |
| 2021 Abril | 369 | 102 | 471 |
| 2021 Marzo | 181 | 39 | 220 |
| 2021 Febrero | 160 | 37 | 197 |
| 2021 Enero | 125 | 37 | 162 |
| 2020 Diciembre | 81 | 34 | 115 |
| 2020 Noviembre | 80 | 21 | 101 |
| 2020 Octubre | 74 | 23 | 97 |
| 2020 Septiembre | 100 | 21 | 121 |
| 2020 Agosto | 83 | 36 | 119 |
| 2020 Julio | 81 | 37 | 118 |
| 2020 Junio | 62 | 55 | 117 |
| 2020 Mayo | 41 | 57 | 98 |
| 2020 Abril | 44 | 37 | 81 |
| 2020 Marzo | 33 | 49 | 82 |
| 2020 Febrero | 5 | 31 | 36 |
| 2020 Enero | 7 | 30 | 37 |
| 2019 Diciembre | 8 | 34 | 42 |
| 2019 Noviembre | 4 | 23 | 27 |
| 2019 Octubre | 0 | 3 | 3 |
| 2019 Septiembre | 4 | 6 | 10 |
| 2019 Agosto | 4 | 9 | 13 |
| 2019 Julio | 4 | 23 | 27 |
| 2019 Junio | 6 | 37 | 43 |
| 2019 Mayo | 5 | 61 | 66 |
| 2019 Abril | 2 | 60 | 62 |
| 2019 Marzo | 4 | 21 | 25 |
| 2019 Febrero | 0 | 22 | 22 |
| 2019 Enero | 3 | 9 | 12 |
| 2018 Diciembre | 2 | 15 | 17 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 2 | 31 | 33 |
| 2018 Agosto | 0 | 47 | 47 |
| 2018 Julio | 0 | 18 | 18 |
| 2018 Junio | 0 | 17 | 17 |
| 2018 Mayo | 0 | 15 | 15 |
| 2018 Abril | 0 | 3 | 3 |
| 2018 Marzo | 8 | 3 | 11 |
| 2018 Febrero | 172 | 7 | 179 |
| 2018 Enero | 187 | 10 | 197 |
| 2017 Diciembre | 210 | 6 | 216 |
| 2017 Noviembre | 168 | 7 | 175 |
| 2017 Octubre | 128 | 14 | 142 |
| 2017 Septiembre | 159 | 10 | 169 |
| 2017 Agosto | 189 | 13 | 202 |
| 2017 Julio | 171 | 6 | 177 |
| 2017 Junio | 182 | 34 | 216 |
| 2017 Mayo | 145 | 22 | 167 |
| 2017 Abril | 144 | 9 | 153 |
| 2017 Marzo | 129 | 44 | 173 |
| 2017 Febrero | 104 | 14 | 118 |
| 2017 Enero | 109 | 20 | 129 |
| 2016 Diciembre | 136 | 8 | 144 |
| 2016 Noviembre | 127 | 8 | 135 |
| 2016 Octubre | 174 | 21 | 195 |
| 2016 Septiembre | 273 | 8 | 281 |
| 2016 Agosto | 246 | 14 | 260 |
| 2016 Julio | 125 | 26 | 151 |
| 2016 Junio | 23 | 19 | 42 |
| 2016 Mayo | 12 | 15 | 27 |
| 2016 Abril | 4 | 13 | 17 |
| 2016 Marzo | 7 | 31 | 38 |
| 2016 Febrero | 4 | 23 | 27 |
| 2016 Enero | 4 | 4 | 8 |
| 2015 Diciembre | 9 | 5 | 14 |
| 2015 Noviembre | 19 | 2 | 21 |
| 2015 Octubre | 15 | 3 | 18 |
| 2015 Septiembre | 11 | 6 | 17 |
| 2015 Agosto | 12 | 7 | 19 |
| 2015 Julio | 52 | 11 | 63 |
| 2015 Junio | 51 | 13 | 64 |
| 2015 Mayo | 80 | 21 | 101 |
| 2015 Abril | 65 | 11 | 76 |
| 2015 Marzo | 49 | 14 | 63 |
| 2015 Febrero | 40 | 7 | 47 |
| 2015 Enero | 43 | 9 | 52 |
| 2014 Diciembre | 47 | 9 | 56 |
| 2014 Noviembre | 35 | 7 | 42 |
| 2014 Octubre | 52 | 17 | 69 |
| 2014 Septiembre | 44 | 9 | 53 |
| 2014 Agosto | 45 | 16 | 61 |
| 2014 Julio | 66 | 17 | 83 |
| 2014 Junio | 79 | 12 | 91 |
| 2014 Mayo | 75 | 19 | 94 |
| 2014 Abril | 59 | 13 | 72 |
| 2014 Marzo | 72 | 16 | 88 |
| 2014 Febrero | 41 | 12 | 53 |
| 2014 Enero | 64 | 15 | 79 |
| 2013 Diciembre | 79 | 13 | 92 |
| 2013 Noviembre | 38 | 7 | 45 |
| 2013 Octubre | 26 | 2 | 28 |
| 2013 Septiembre | 11 | 9 | 20 |
| 2013 Agosto | 18 | 8 | 26 |
| 2013 Julio | 10 | 12 | 22 |
| 2013 Junio | 10 | 9 | 19 |
| 2013 Mayo | 14 | 7 | 21 |
| 2013 Abril | 8 | 10 | 18 |
| 2013 Marzo | 18 | 16 | 34 |
| 2013 Febrero | 38 | 5 | 43 |
| 2013 Enero | 39 | 5 | 44 |
| 2012 Diciembre | 11 | 3 | 14 |
| 2012 Noviembre | 3 | 1 | 4 |
| 2012 Octubre | 2 | 2 | 4 |
| 2012 Julio | 1 | 0 | 1 |
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