Abstract
This study presents the case of a 9-year-old girl for whom complete
resolution of recalcitrant warts was achieved with acupuncture and
moxibustion treatment. This result suggests that acupuncture and
moxibustion could be effective therapeutic strategies for plantar warts
in the paediatric patient population.
Keywords : Recalcitrant warts, Plantar warts,
Acupuncture, Moxibustion
Background
Warts are a common viral skin disease, caused by human papillomavirus
infection1, having high prevalence rates ranging
between 5% and 30% in children2. There are numerous
treatments for warts, such as liquid nitrogen, cryotherapy, and
excision. Liquid nitrogen is the most frequently used treatment for
warts; however, the treatment procedure is generally very
painful3. Curettage, topical salicylic acid, and
cryotherapy are often used for plantar warts4.
Excision is not recommended, as it leads to frequent recurrences or
scarring4. Furthermore, in the case of
therapy-resistant lesions, laser and photodynamic therapy approaches
could be used5 but these methods are time-consuming
and costly.
Therefore, in the case of plantar warts, both first- and second-line
treatments are generally still unsatisfactory due to their low efficacy,
low local tolerability, and high recurrence rate6.
Acupuncture is the insertion of fine needles into specific body
sites7. It has been used successfully to treat acute
skin eruptions, acne, atopic dermatitis, psoriasis, warts, and leg
ulcers8, 9. Meanwhile, moxibustion is a procedure that
uses the heat generated by the burning of herbal preparations to
stimulate specific points for treating disease10. It
is used as a treatment for a wide range of conditions, including
osteoarthritis, breech presentation, supportive cancer care, and
cutaneous warts11. Recent research has shown that
moxibustion is effective in the treatment of cutaneous warts, and that
acupuncture is an effective treatment for HPV-related warts through the
modulation of the immune system. However, the use of acupuncture and
moxibustion in the treatment of recalcitrant plantar warts has not been
reported until now. We report a case of recalcitrant plantar wart
successfully resolved after acupuncture and moxibustion treatment.
Case presentation
A 9-year-old healthy Korean girl presented to our department with
recalcitrant plantar warts on her soles, that had been present for over
6 months and had failed to respond to cryotherapy. She complained of
pain while walking, standing, and even wearing shoes. Physical
examination revealed that the lesions were hyperkeratinized and filled
with punctuate black dots. The largest lesion measured 10 × 15 mm (Fig.
1). She had no significant past medical or medication history.
She received acupuncture treatment using hand acupuncture needles (0.18
mm × 8.0 mm stainless steel needle, Dongbang Inc., Chungnam, Korea) and
moxibustion treatment using mini moxa cones made of Artemisia
argyi (Dongbang Inc., Chungnam, Korea). Acupuncture therapy was
directly provided at all the wart lesions. Moxibustion was placed
directly on the lesions, when 80% of moxa cone had burnt off and the
patient could feel the burning, the moxa cone was removed with forceps,
and another cone was placed. We repeated this sequence two times on all
lesions within a single session.
Initially, acupuncture and moxibustion sessions were difficult to
conduct, as the patient expected that she would feel pain, but we could
proceed with the treatment after explaining the need for treatment and
obtaining consent from the patient. At the 8th week of treatment, a burn
occurred on the left toe during moxibustion treatment; it was treated
with a dressing and followed up at every visit.
After 12 weeks of treatment, the hyperkeratotic lesion and black dots
disappeared (Fig. 2.). Eight weeks later, the lesions and pain were
almost completely resolved (Fig. 3). At the 3-month follow-up, the
lesions remained fully resolved (Fig. 4, 5). The patient stated that the
discomfort felt while wearing shoes had disappeared after the treatment,
and she was satisfied with the treatment.
Discussion and Conclusion
In this case report, we
demonstrated the use of acupuncture and moxibustion in the treatment of
therapy-resistant plantar warts, with a high clinical efficacy. It is
remarkable that complete clearance of the wart lesion was achieved with
a 20-week treatment without any pre-treatment curettage or additional
treatments.
Warts have high prevalence rates ranging between 5% and 30% in
children2. Among them, plantar warts account for 30%
of all cutaneous warts12. Spontaneous resolution of
warts within 2 years is common in children. However, recalcitrant cases
can cause considerable morbidity13.
There are numerous treatments for warts, including destructive therapy,
virucidal therapy, antimitotic therapy, and immunotherapy. Epidermal
damage can be produced by chemical means, such as salicylic acid, or by
physical means, including cryotherapy, lasers, photodynamic therapy, or
hyperthermia14. However, some treatment could be very
painful with a long downtime posttreatment period, and the treatment of
plantar wart remains a challenge1. Therefore,
acupuncture and moxibustion treatment are being studied as alternative
therapies. In 2016, Yun et al. reported that 19–22 weeks of moxibustion
treatment can effectively eliminate warts11. According
to Brustin et al., the therapeutic effect of acupuncture on persistent
warts is related to the immune response and anti-inflammatory
effects15. Performing acupuncture and moxibustion
therapy for children is difficult because they are afraid of the
treatment, and there is a risk of burns. Therefore, better measures
should be explored to ensure treatment compliance in children.
The limitation of this case report is that it only dealt with a single
case, and that burns occurred during moxibustion. However, this case
report suggests that acupuncture and moxibustion could be effective
therapeutic strategies in subjects with “difficult-to-treat” plantar
wart lesions.
This report represents a single case study of a recalcitrant plantar
wart treated successfully using acupuncture and moxibustion directly on
the lesions. Further studies are required to fully assess the
effectiveness and safety of this therapy.