الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Warts are the most common clinical manifestation of human papillomavirus (HPV) infection in skin and mucous membranes, mostly found in the hands, feet, face, and genitalia. These benign lesions have different clinical forms. Various treatment methods are used including topical agents, cryotherapy, electrocautery, surgical removal, laser ablation, intralesional injection of various agents such as bleomycin, Candida albicans (C. albicans), purified protein derivatives (PPD), and mumps, measles, rubella (MMR) antigens. Inspite of the various modalities, there is still no single approved method for the treatment of warts The aim of this work is to investigate the efficacy and safety of combining cryotherapy with intralesional (PPD) immunotherapy versus intralesional (PPD) immunotherapy alone for treatment multiple common warts Fifty patients with multiple common warts were enrolled in this study. They were recruited from the outpatient clinic of the Dermatology, Venereology and Andrology department at Assiut University Hospital, EgyptPatients were divided randomly into two groups, group A (25 patients) treated with intralesional (IL) injection of PPD only and group B (25 patients) treated with IL PPD injection plus cryotherapy using liquid nitrogen every two weeks for a maximum of four sessions There was significant reduction in size of mother wart in both groups with no statistically significant difference between them, where complete clearance occurred in 60% patients in group A and 48% patients in group B.Also there was a statistically significant reduction in size and number of all warts in group A (P<0.001) and in group B (P<0.001), with no statistically significant difference between both groups. In group A 44% of patients had complete response, while in group B 40% of patients had complete response.Higher rates of complete to near complete response were achieved after fewer sessions (2-3sessions) with combination treatment (cryotherapy plus PPD) group compared to PPD only group In group A: 19 patients (76%) and group B: 16 patients (64%) were very satisfied or satisfied to the response to treatment (P=0.35) Pain, redness and edema were observed in both groups with no significant difference. None of the patients had fever. There was a significant difference between the two studied groups in the occurrence of the pigmentary changes after treatment (P<0.001), where 8% of patients in group A and 56% of patients in group B developed pigmentary changes mostly in the form of hypopigmentation which resolved gradually.The recurrence rate after treatment was 16 % in group A and 20% in group B with no statistically significant difference between the two groups (P=0.71).