الفهرس 
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Human papilloma virusOnly 14 pages are availabe for public view
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Abstract
Warts are epidermal tumors caused by human papilloma virus (HPV) which are epitheliotropic non-enveloped small double stranded DNA viruses (Sapp and Bienkowska-Haba, 2009). Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or veridical. Aims of the treatments are to cure the patient’s physical and psychological discomfort, and to prevent the spread. The treatment is challenging and there is no single therapy established as completely curative (Semprimoznik et al., 2012) The aim of this work is to determine the efficacy of intralesional immunotherapy with MMR versus cryotherapy in multiple common or plantar warts. Forty patients complaining from multiple common or plantar warts were enrolled in this study. They were selected from the attendants of out patient’s clinics of dermatology (Assiut University Hospital). The patients were divided into two groups, group A (20 patients) treated with MMR injection and group B (20 patients) treated with cryotherapy using liquid nitrogen Among patients in group A, 70 % of the patients showed complete response while 5% of patients showed partial response and 25% no response to treatment. There was significant reduction in size of the lesions (0.001), as the mean size ± SD before treatment was (1.89 ± 1.94 cm2) and after treatment reached to (0.45 ± 1.37 cm2) with a mean percentage of improvement of 70.69 ± 46.02 %. There was also statistically significant reduction in number of warts after treatment (0.001) as the mean number of warts was (10.45 ± 8.49) before treatment and became (3.40 ± 7.35) after treatment, with mean percentage of improvement 71.50 ± 45.11%. Regarding common warts in group A our results showed that 8 patients (80%) had complete response, 1 patient (10%) partial response and 1 patient (10%) no response to therapy. Regarding planter warts 6 patients (60%) had complete response to treatment, and 4 patients (40 %) had no response to treatment. Among patients in group B, 45 % of the patients showed complete response to cryotherapy while 35% of patients showed partial response and 20% no response to treatment. There was significant reduction in size of the lesions (0.001), as the mean size ± SD before treatment was (2.14 ± 2.84 cm2) and after treatment reached to (0.67 ± 1.02 cm2) with a mean percentage of improvement of 67.89 ± 42.84 %. There was also statistically significant reduction in number of warts after treatment (0.001) as the mean number of warts was (7.75 ± 3.84) before treatment and became (2.75 ± 3.06) after treatment, with mean percentage of improvement 56.11 ± 44.33 %. Regarding common warts in group B our results showed that 7 patients (70%) had complete response, 3 patients (30%) had partial response to therapy. Regarding planter warts 2 patients (20%) had complete response to treatment, 4 (40%) patients had partial response, and 4 patients (40 %) had no response to treatment. There was statistically significant difference between warts size before and after treatment in both groups (0.001). There was statistically significant difference between warts number before and after treatment in both groups (0.001). The complete response was higher at MMR group (70%) as compared to CRYO group (45%), but the difference between the two groups wasn’t statistically significant while the partial response was significantly higher at CRYO group. Planter warts response to treatment showed statistically significant difference between the two groups (0.050) ; the complete response was higher at MMR group while partial response was higher at CRYO group Common warts response to treatment doesn’t show statistically significant difference between the two groups. Some complications were recorded after treatment in first group as pain and flu like symptoms, while recorded complications in second group included pain, erosions and hypopigmentation,. There was no statistically significant difference in patient satisfaction between the two groups. There was no statistically significant relation between response to treatment and sex, number, duration and type of warts in both groups. There was no statistically significant difference between two groups regarding size of warts before treatment, after treatment and percentage of improvement. There was no statistically significant difference between two groups regarding number of warts before treatment, after treatment and percentage of improvement. Conclusion:< There was significant reduction in the size of warts in both groups. There was significant reduction in the number of warts in both groups. The complete response shows no statistically significant difference between two groups but it was higher at MMR group. The partial response was statistically higher at CRYO group. Planter warts response to treatment showed statistically significant difference between the two groups ; the complete response was higher at MMR group while partial response was higher at CRYO group. Pain was the most common side effect at both groups. No relation between response to treatment and sex, number, duration and type of warts in both groups.