**7.8 Levamisole**

Levamisole, an antihelminthic agent, is found to have immunomodulatory effects, making it effective in various dermatological disorders including viral warts at a dose of 2.5–5 mg/kg/day for 3 consecutive days every 2 weeks for 4–5 months [180–182]. The response to levamisole was approximately 60%. Side effects are rash, nausea, abdominal cramps, taste alteration, alopecia, arthralgia and a flu-like syndrome and rarely cause myopathy, leukocytoclastic vasculitis, lichenoid eruptions and leukoencephalopathy [183, 184].

### **7.9 HPV vaccines**

Since 2006, two vaccines against Human papillomavirus (HPV) have been licenced in more than 100 countries [185]. Both vaccines target HPV types 16 and 18, which account for about 70% of all cervical cancer cases, and the quadrivalent vaccine also targets HPV types 6 and 11, associated with 90% of genital warts (GWs) [186]. In Denmark, the quadrivalent HPV vaccine was introduced into the children's vaccination programme in January 2009 for 12-year-old girls. In 2014 the European Medicines Agency and the World Health Organisation Strategic Advisory Group of Experts recommended a two-dose schedule for 9–13-year-old girls. However, threedose schedule offers better protection against genital warts than a two-dose schedule in a nationwide study. But, if the dosing interval extends (about six months), the two dose schedule came as effective as three. The quadrivalent HPV vaccine that comprises the L1 protein of HPV types 6, 11, 16 and 18 has been in use on a large scale

**47**

**8. Others**

wart with less recurrence [195].

warts.

for warts.

improve warts.

*Human Papillomavirus Infection: Management and Treatment*

digital warts are good candidates for DCP therapy [193].

Historic folk remedies have included many variants.

46–52% has been noticed in various studies [197].

in countries like Denmark with a decline in the prevalence of genital warts [187]. Similar decline in genital warts has been noticed in the UK and Australia [188, 189].

Autowart inoculation by means of homologous autoimplantation helping to induce specific cell-mediated immunity has been proposed as a treatment option for recalcitrant, extensive and genital wart [190]. About 83 patients with all types of wart lesions were included in a study. At 16 weeks of therapy, 69.5% of patients recovered completely, and more than 75% improvement occurred in another 8.5% patients. No significant complication was documented. There was no recurrence within study period [191]. Another study also had noticed 73.3% total clearance of warts, with a majority of them (91%) within 2 months [190]. Inoculation site infection and postinflammatory hyperpigmentation and hypopigmentation are the side effects.

Contact sensitizers are a mode of inducing a type IV hypersensitivity reaction, thus making them a form of topical immunotherapy [28]. Diphencyprone (DCP) is the preferred compound. DCP 2% solution is applied after every 10–14 days, on the medial side of upper arm—till there is appearance of local erythema and vesiculation—and this may be repeated up to three times. Warts were then first pared followed by application with stepwise concentration of DCP: 0.01, 0.05, 0.10, 0.25, 0.50, 1.0, 1.5, 2.0, 3.0, 4.0 and 6.0%. Treatments are applied every 1–4 weeks. Resistant palmoplantar warts treated with DCP over 8 years [192] exhibited 88% clearance rate. However, a large percentage of patients developed adverse effects (56%), including painful blistering at the site of sensitization and near warts, pompholyx-like or generalised eczematous eruption, influenza-like symptoms, vesiculation elsewhere due to passive transfer of DCP and inguinal lymphadenopathy. They concluded that patients with recalcitrant palmar, plantar, periungual and

There are various other agents being tried infrequently in the management of

Duct tape occlusion therapy involves placing a piece of duct tape over the wart.

Components of garlic (*Allium sativum*) have been shown to have antiviral activity and to inhibit cellular proliferation of virally infected cells, resulting clearance of

Application of paste made of baking powder and castor oil is age old technique

Herbal preparations such as Echinacea and propolis are reported to boost the immunity when administered orally [196], act as immunomodulators and

Sinecatechins are derived from green tea extract (*Camellia sinensis*) and are marketed as a 10% ointment, containing around eight catechins. A clearance rate of

Glycyrrhizic acid, obtained from the root of *Glycyrrhiza glabra*, has antiviral, anti-inflammatory and antiulcerative properties. When used with an

The mechanism of action of this technique still remains unknown [194].

*DOI: http://dx.doi.org/10.5772/intechopen.92397*

**7.10 Autoimplantation therapy**

**7.11 Contact sensitizers**

in countries like Denmark with a decline in the prevalence of genital warts [187]. Similar decline in genital warts has been noticed in the UK and Australia [188, 189].
