Warts (verrucae) are benign skin tumors caused by small, non-enveloped double-stranded DNA viruses called human papilla viruses (HPV) that comprise a family of more than 130 types. 1 A range of types of warts have been identified, varying in shape and site, as well as type of HPV involved. These include common, filiform, plane, palmer, plantar, and genital warts. Many observations have suggested that wart proliferation is controlled by the immune system particularly cell-mediated immunity; besides, recurrence is frequent because HPV persists in perilesional skin. 2 Currently available treatments including cryosurgery, laser, electro-cautery, curettage, and topical keratolytics are generally painful and usually complicated by recurrence. The need for a therapeutic approach targeting remote warts (those which are not intervened with directly) especially in multiple warts and warts at inaccessible sites is mandatory. 3
The scalp is different, unlike any other site in the head and neck, it has the thickest skin in the human body and covers bone that protects the intracranial structures. Due to the special nature of scalp tissue, the reconstruction of defects is a challenging task. Many techniques have been used in scalp reconstruction from a simple approximation of the two edges of the scalp lesion, rotation flaps with their techniques as triple rotation, double-opposing rotation, pinwheel flaps up to utilization of regional flaps and tissue expanders. This study aims to introduce a small alteration in both the design and closure technique of the snail rotation flap used in scalp reconstruction to allow less rotation and easier approximation of the flap. This modified flap was used to manage seven cases three females and four males with scalp defects presented to the Oral and
Background Warts are infections caused by human papillomavirus (HPV). There are new trends towards the use of immunotherapy in treatment of warts. Homologous autoinoculation is a minimally invasive procedure, which treats warts by stimulating a specific immune response against HPV Objective To evaluate the efficacy of autoinoculation therapy in treatment of multiple recalcitrant warts. Methods Under local anesthesia and aseptic condition, inoculum was collected by paring a wart by scalpel and by pressing it between two sterile glass slides. After making a subcutaneous Pocket in non-dominant forearm, the inoculum was introduced in the subcutaneous pocket with forceps and dressed. Follow up for 1,2,12 and 16 weeks was done. Results Fourty patients were included. At 12 weeks of therapy 42.5% showed complete clearance, 27.5% showed moderate clearance, 15% showed mild clearance and 12.5% showed treatment failure. No significant complication was documented after 1 and 2 weeks of follow up except in 3 patients in form of mild inflammation and mild pain. There was no recurrence at16 weeks follow up session. Conclusion Autoinoculation is simple and effective method in treatment of different types of warts including genital wart. It also prevents recurrence.
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