Case and research letter
Five Cases of Recalcitrant Plantar Warts Successfully Treated with Imiquimod 5% Cream
Tratamiento eficiente de 5 casos de verrugas plantares recalcitrantes con imiquimod 5%
M.T. López-Giménez
Unidad de Dermatología, Hospital de Barbastro, Huesca, Spain
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López-Giménez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "M.T." "apellidos" => "López-Giménez" "email" => array:1 [ 0 => "mtlopez@salud.aragon.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Dermatología, Hospital de Barbastro, Huesca, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento eficiente de 5 casos de verrugas plantares recalcitrantes con imiquimod 5%" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2354 "Ancho" => 1492 "Tamanyo" => 274008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Patient 2. Very painful wart located on the left arch. B. Patient 2. 10 weeks after treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Plantar warts are caused by infection with human papillomavirus (HPV) types 1, 2, 4, or 57.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Their treatment can be difficult when the lesion is located in a callused site subjected to significant pressure or when several warts are grouped together. Conventional treatments, which are usually destructive, cause pain and are not always effective. Therapy that does not result in scarring, which can remain painful for years, is recommended for plantar warts.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Imiquimod 5% cream is approved for the treatment of genital warts and has also been used successfully on viral warts in other sites.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a> Moreover, there is scientific evidence supporting its efficacy and safety in the eradication of recalcitrant plantar warts without local adverse effects.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,5–7</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the clinical characteristics of 5 patients who had painful plantar warts that made walking difficult. In 4 cases the warts had been resistant to other treatment, but they all responded very positively to imiquimod 5% cream (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). In all cases, imiquimod was applied at night, without occlusion, 3 times a week, until the lesions disappeared. On days when imiquimod was not administered, petrolatum with 17% salicylic acid was applied. The hyperkeratosis associated with warts located in pressure zones was removed mechanically with a scalpel every 2 weeks (cases 2 and 3).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Imiquimod (1-[2methypropyl]-1 <span class="elsevierStyleItalic">H</span>-imidazole [4,5c]quinolin-4amine) is an immune response modifier with antiviral and antitumor activity mediated by the induction of helper T (T<span class="elsevierStyleInf">h</span>) 1 cytokines.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> The exact mechanism of action remains unclear, but activation of the immune system is thought to be responsible for eradicating the virus and curing the warts. This mechanism of action is highly advantageous in the treatment of viral plantar warts, compared with the more destructive traditional methods.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Also recommended is the concomitant use of therapies, such as the application of salicylic petrolatum, cryotherapy, and peeling to eliminate the stratum corneum and facilitate drug absorption in these areas of more keratinized skin. The cream can also be applied under occlusion.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Imiquimod therapy is less traumatic than ablative treatments, which often involve local tissue destruction and pain, and any local inflammatory reactions tend to be mild and transitory. As no adverse local or general reactions were reported in the cases reviewed in the literature or those presented in this study, imiquimod is well tolerated and therefore highly recommendable.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Imiquimod also stimulates immunological memory for HPV and, as a result, wart recurrence after treatment with this drug may be lower than with other therapies.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Moreover, the cream can be applied by the patient at home, thus saving on time and repeated hospital visits.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Imiquimod has been successfully used to treat plantar warts in different regimens: daily application,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> on alternate days, 3 times a week,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> with or without occlusion.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> However, no single therapy has proven to be better than another. Nevertheless, all authors recommend combining imiquimod with keratolytic agents for plantar warts and mechanical removal of the stratum corneum in the case of warts associated with calluses and located on pressure points.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3,6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Topical imiquimod is not the first-line treatment for plantar warts but can be surprisingly useful for extensive groups of warts, as in patients 1 and 5. It can also produce a beneficial synergistic effect when associated with previously inefficient procedures, as occurred in patients 2 and 3. The results obtained in these 5 patients provide clinical evidence of the therapeutic efficacy of imiquimod 5% cream in the treatment of recalcitrant plantar warts as reported by other authors.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2,5–7</span></a> Patient tolerance and satisfaction were very high, and product efficacy was excellent, each patient only needing one box of imiquimod 5% cream and 2 or 3 hospital visits to solve a problem that had developed over many years and had resulted in very high direct and indirect costs.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-Giménez MT. Tratamiento eficiente de 5 casos de verrugas plantares recalcitrantes con imiquimod 5%. Actas Dermosifiliogr. 2013;104:640–2.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2584 "Ancho" => 1492 "Tamanyo" => 328842 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A, Patient 1. Group of viral warts on the right heel. B, Patient 1. 8 weeks after treatment.</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" => 2354 "Ancho" => 1492 "Tamanyo" => 274008 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A, Patient 2. Very painful wart located on the left arch. B. Patient 2. 10 weeks after treatment.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PET-17 Petrolatum with 17% salicylic acid.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Clinical Data \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Patient 5 \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Time since onset \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2-3 y \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 m \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Location \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right heel \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Left sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right sole \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4th left toe \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Right anterior third \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Symptoms \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Pain \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grouped \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Callus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Callus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fissure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Grouped \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ineffective prior treatments \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CryotherapyKeratolyticsInjections \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CryotherapyKeratolytics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CryotherapyKeratolytics \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No treatment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cryotherapy \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Regimen used \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imiquimod 5%PET-17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CurettageImiquimod 5%PET-17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CurettageImiquimod 5%PET-17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imiquimod 5%PET-17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Imiquimod 5%PET-17 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cure (weeks) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Adverse effects \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Recurrence at6 months \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab367513.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical Data for 5 Patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anecdotal reports of 3 cases illustrating a spectrum of resistant common warts treated with cryotherapy followed by topical imiquimod and salicylic acid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.S. 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Chapman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Cutis" "fecha" => "2001" "volumen" => "68" "paginaInicial" => "397" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11775772" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Plantar wartstreated with an immune response modifier: a report of two cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Zamiri" 1 => "G. 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Ransdell Ba" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Drugs Dermatol" "fecha" => "2003" "volumen" => "2" "paginaInicial" => "124" "paginaFinal" => "126" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12905977" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Imiquimod: cytokine induction and antiviral activity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Miller" 1 => "W. Birmacho" 2 => "J. Gerster" 3 => "S. Gibson" 4 => "L. Imbertson" 5 => "M. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 48 | 19 | 67 |
| 2024 Octubre | 427 | 96 | 523 |
| 2024 Septiembre | 464 | 102 | 566 |
| 2024 Agosto | 601 | 121 | 722 |
| 2024 Julio | 741 | 97 | 838 |
| 2024 Junio | 446 | 84 | 530 |
| 2024 Mayo | 426 | 83 | 509 |
| 2024 Abril | 369 | 54 | 423 |
| 2024 Marzo | 497 | 70 | 567 |
| 2024 Febrero | 473 | 53 | 526 |
| 2024 Enero | 505 | 103 | 608 |
| 2023 Diciembre | 434 | 47 | 481 |
| 2023 Noviembre | 485 | 51 | 536 |
| 2023 Octubre | 571 | 65 | 636 |
| 2023 Septiembre | 565 | 68 | 633 |
| 2023 Agosto | 464 | 43 | 507 |
| 2023 Julio | 372 | 103 | 475 |
| 2023 Junio | 328 | 71 | 399 |
| 2023 Mayo | 396 | 84 | 480 |
| 2023 Abril | 367 | 77 | 444 |
| 2023 Marzo | 268 | 61 | 329 |
| 2023 Febrero | 211 | 76 | 287 |
| 2023 Enero | 249 | 69 | 318 |
| 2022 Diciembre | 129 | 108 | 237 |
| 2022 Noviembre | 85 | 85 | 170 |
| 2022 Octubre | 74 | 69 | 143 |
| 2022 Septiembre | 72 | 89 | 161 |
| 2022 Agosto | 48 | 148 | 196 |
| 2022 Julio | 44 | 126 | 170 |
| 2022 Junio | 61 | 117 | 178 |
| 2022 Mayo | 281 | 100 | 381 |
| 2022 Abril | 395 | 76 | 471 |
| 2022 Marzo | 501 | 89 | 590 |
| 2022 Febrero | 539 | 77 | 616 |
| 2022 Enero | 355 | 104 | 459 |
| 2021 Diciembre | 278 | 87 | 365 |
| 2021 Noviembre | 268 | 108 | 376 |
| 2021 Octubre | 309 | 118 | 427 |
| 2021 Septiembre | 233 | 135 | 368 |
| 2021 Agosto | 284 | 125 | 409 |
| 2021 Julio | 265 | 221 | 486 |
| 2021 Junio | 278 | 246 | 524 |
| 2021 Mayo | 240 | 260 | 500 |
| 2021 Abril | 271 | 494 | 765 |
| 2021 Marzo | 174 | 249 | 423 |
| 2021 Febrero | 141 | 189 | 330 |
| 2021 Enero | 103 | 177 | 280 |
| 2020 Diciembre | 108 | 145 | 253 |
| 2020 Noviembre | 67 | 112 | 179 |
| 2020 Octubre | 84 | 93 | 177 |
| 2020 Septiembre | 70 | 116 | 186 |
| 2020 Agosto | 73 | 162 | 235 |
| 2020 Julio | 75 | 155 | 230 |
| 2020 Junio | 72 | 125 | 197 |
| 2020 Mayo | 57 | 142 | 199 |
| 2020 Abril | 63 | 106 | 169 |
| 2020 Marzo | 55 | 75 | 130 |
| 2020 Febrero | 5 | 43 | 48 |
| 2020 Enero | 3 | 48 | 51 |
| 2019 Diciembre | 6 | 17 | 23 |
| 2019 Noviembre | 4 | 18 | 22 |
| 2019 Octubre | 0 | 34 | 34 |
| 2019 Septiembre | 1 | 41 | 42 |
| 2019 Agosto | 9 | 31 | 40 |
| 2019 Julio | 4 | 44 | 48 |
| 2019 Junio | 4 | 25 | 29 |
| 2019 Mayo | 4 | 32 | 36 |
| 2019 Abril | 3 | 28 | 31 |
| 2019 Marzo | 2 | 13 | 15 |
| 2019 Febrero | 0 | 8 | 8 |
| 2019 Enero | 4 | 4 | 8 |
| 2018 Diciembre | 0 | 9 | 9 |
| 2018 Noviembre | 1 | 3 | 4 |
| 2018 Octubre | 2 | 1 | 3 |
| 2018 Septiembre | 3 | 0 | 3 |
| 2018 Junio | 0 | 31 | 31 |
| 2018 Mayo | 0 | 131 | 131 |
| 2018 Abril | 0 | 45 | 45 |
| 2018 Marzo | 8 | 68 | 76 |
| 2018 Febrero | 157 | 236 | 393 |
| 2018 Enero | 161 | 179 | 340 |
| 2017 Diciembre | 185 | 56 | 241 |
| 2017 Noviembre | 159 | 86 | 245 |
| 2017 Octubre | 136 | 184 | 320 |
| 2017 Septiembre | 125 | 166 | 291 |
| 2017 Agosto | 119 | 121 | 240 |
| 2017 Julio | 99 | 106 | 205 |
| 2017 Junio | 121 | 178 | 299 |
| 2017 Mayo | 87 | 159 | 246 |
| 2017 Abril | 51 | 161 | 212 |
| 2017 Marzo | 68 | 189 | 257 |
| 2017 Febrero | 38 | 190 | 228 |
| 2017 Enero | 102 | 141 | 243 |
| 2016 Diciembre | 94 | 144 | 238 |
| 2016 Noviembre | 114 | 137 | 251 |
| 2016 Octubre | 137 | 260 | 397 |
| 2016 Septiembre | 253 | 290 | 543 |
| 2016 Agosto | 425 | 315 | 740 |
| 2016 Julio | 172 | 198 | 370 |
| 2016 Junio | 7 | 119 | 126 |
| 2016 Mayo | 10 | 162 | 172 |
| 2016 Abril | 3 | 47 | 50 |
| 2016 Marzo | 3 | 26 | 29 |
| 2016 Febrero | 5 | 21 | 26 |
| 2016 Enero | 7 | 1 | 8 |
| 2015 Diciembre | 18 | 20 | 38 |
| 2015 Noviembre | 21 | 2 | 23 |
| 2015 Octubre | 28 | 2 | 30 |
| 2015 Septiembre | 3 | 4 | 7 |
| 2015 Agosto | 4 | 5 | 9 |
| 2015 Julio | 115 | 17 | 132 |
| 2015 Junio | 54 | 24 | 78 |
| 2015 Mayo | 74 | 43 | 117 |
| 2015 Abril | 65 | 26 | 91 |
| 2015 Marzo | 54 | 19 | 73 |
| 2015 Febrero | 72 | 18 | 90 |
| 2015 Enero | 54 | 31 | 85 |
| 2014 Diciembre | 53 | 20 | 73 |
| 2014 Noviembre | 55 | 21 | 76 |
| 2014 Octubre | 64 | 22 | 86 |
| 2014 Septiembre | 50 | 12 | 62 |
| 2014 Agosto | 69 | 15 | 84 |
| 2014 Julio | 59 | 17 | 76 |
| 2014 Junio | 53 | 15 | 68 |
| 2014 Mayo | 65 | 17 | 82 |
| 2014 Abril | 62 | 10 | 72 |
| 2014 Marzo | 58 | 19 | 77 |
| 2014 Febrero | 50 | 10 | 60 |
| 2014 Enero | 52 | 19 | 71 |
| 2013 Diciembre | 35 | 7 | 42 |
| 2013 Noviembre | 32 | 24 | 56 |
| 2013 Octubre | 39 | 20 | 59 |
| 2013 Septiembre | 45 | 12 | 57 |
| 2013 Agosto | 1 | 1 | 2 |
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