There two main types of verrucae vulgaris and Plantaris both types share the same pathogenesis as both are caused by the Human Papillomavirus HPV. The HPV enters the body via any small opening. Once the parasite is in the tropism of the cell the viral DNA is released penetrating the host cells membrane traveling to the nucleus of the host cell. Reverse transcriptase an enzyme that converts the viral RNA into DNA enables conversion of host cell DNA that now produces viral antigens thus continuing replication of abnormal cells. The genetic material is released in the basal layer which then travels and the actual replication procedure occurs in the spinosum layer and gathering of viral cells in the granular layer, hence it moves from deepest to superficial layer the attack is on the deepest layer of the epidermis is because cells are still alive and can still replicate to cause a tumor. Two different proteins assist the complete takeover of squamous cells early E1 E7 and late L1and L2 proteins their birth is controlled by 7 9 codons determined by subtypes E1 E7 activate the gene in the DNA for replication.
Protein E4 disrupts the degradative process in keratinization for keratinocytes leading to gene mutation and making it a koilocyte L1 and L2 form external structures of the infected cell such as a capsid the virus turns malignant into a high-risk HPV as E6 and E7 oncoproteins reinforcing replication leading to greater proliferation and no apoptosis by lymphocytes. As tumor suppressors like TP53 are silenced tumors form into hemorrhages so occurring in a capillary resulting in thrombosing, it displays black dotes on the surface of the foot in verruca plantaris. Both types of Verrucae are more commonly found in children than adults. The first difference in the two types is that plantaris occur on the bottom of the foot and vulgaris on hands and fingers plantaris is caused by type 1and 4 and Vulgaris is type 1 2 and 7 of HPV classifying both as cutaneous HPV and categorized as low risk.
However, sometimes Vulgaris grows in other anatomical areas therefore it is important to differentiate them for a correct treatment plan. Hyperkeratosis in plantaris has inflammatory features that have a perimeter of raised edges. However vulgaris possess hyperkeratosis in pale papules other features include parakeratosis on exposed epidermis thus displaying an epidermal nevus. The epidermis is thickened and clumping is experienced in the granular layer excessively Both types have malignancy but Vulgaris only causes hemorrhage in the stratum corneum. Plantaris forms thrombosis in capillaries and these bleed due to pressure thus occur in weight-bearing areas. In Vulgaris abnormal cells are constantly seen however being present in plantaris they do not continue. Plantaris possess Vacuoles large and red in color that emerge from corneocytes in the epidermis. As there is a lack of tumor suppressors the epidermis has hyperplasia and allot of clumping of cells in the granule layer. Cryotherapy and salicylic acid have been designated treatments for verrucae over a decade This journal uses empirical methods to determine which cryotherapy or 50 salicylic acid shows complete eradication of plantar warts after 12 weeks with 240 participants ages 12 and over Cryotherapy was applied by professional and salicylic acid by participants. From Nov 2006 to Jan 2010 randomized sampling occurred after obtaining informed consent eligibility for participation was determined participants should be free of all characteristics resulting in a bad immune system.
A blind Observation occurred a still image showing lesion only this reduced bias as the external factors would affect observer less still meaning minor important details could be found increasing the reliability. The first line of treatment over the counter medicine e.g Salicylic acid is only 15 26 concentration this appears to be more effective than the second line which is 50 acid or cryotherapy as the reoccurrence rate for first-line 19 and second line 30. Indicating that concentration becomes a factor too suggesting that perhaps different concentrations should be tested to see optimum in curing verrucae. The concentration is more in the second line meant that perhaps it was damaged more than it was curing also the amount patients applied was subjective so having precise measurements may help in patient education and so improve it. Furthermore, cryotherapy had increased visits to the GP compared to salicylic acid meaning its time consuming thus increasing professional time and increasing expense After 12 weeks mean cost of cryotherapy 150 and salicylic acid 49 per patient. Therefore cryotherapy was 101 17 more expensive than salicylic acid. To begin with, the cost-utility analysis showed usage of a resource based on the quality of life however an invalid way of measuring the cost of utility as the value of life measured so not measuring the cost of cryotherapy and salicylic acid.
Allot of data missing from the usage of each treatment 30 for cryotherapy and 28 for acid demonstrated that the final results were not very reliable, meaning this trail would have to be repeated. The limitation with cryotherapy itself was the usage of nitrogen. As nitrogen has a low boiling point dewars were needed to contain it. Despite being contained evaporation occurred so every 3 months 25 liters were added. Perhaps using a different element with higher boiling points would help. On the other hand that salicylic acid too evaporated but less. Another, the mean number of visits to GP for cryotherapy was 359 whereas acid 194 showing cryotherapy as less effective and expensive than acid. It is in a verrucas nature to reoccur sometimes thus the time frame was a limitation meaning that reliability for effectiveness was decreased.
Two focal features of the study increased reliability. Method of sampling eliminating the bias of selection and Controlled precisely measured testing. Confounding variables such as the type of warts or any interfering with the independent variable were controlled producing standardized procedures Standard deviation as the measure of dispersion for the duration of warts was adequate as it is precise and accurate than other methods so reliable. The method of blinded assessment was to observe the clearance reliability increased as perception bias would not affect the observer. The primary Clinical application was cryotherapy still causing discomfort Although at first patient satisfaction rate was 67 3 for cryotherapy by the 3rd week that changed going up by 7 Primary assumptions for a practitioner would be that by the end acid caused damage to surrounding tissues. For a practitioner-patient education is quite important thus the amount of acid applied would be well monitored However issue of pain was not deflected. 68 people in cryotherapy and 71 with acid still felt pain at the 12th week. Patients were safer when cryotherapy was applied to the area around the lesion as it was covered 50 Acid concentration was mundane so generalizable to real predicaments increasing ecological validity. However, no solitary concentration of acid was found the most suitable thus needs more research to be used in the clinic. The duration of cryotherapy lasted 183 days per patient, whereas salicylic acid took 3 weeks showing that the acid is a time-consuming treatment. Systematic reviews showed that although verrucae were eliminated the etiology remained unclear as different types of verrucae were tested that lowered reliability. Results show Salicylic acid was equally effective as cryotherapy on verrucae.
The clearance for the acid 14 and cryotherapy 14 the difference was 0 65 and p 0 89 overall the measured value was insignificant as the probability of 0 05 was exceeded. Self-report showed the acid cure rate 31 and cryotherapy 34 again an insignificant difference in two indicating that both have equal effectiveness. Limitations were uncovered first was the sample size if it was larger generalisability to the population would increase. Secondly self-report and observation was not appropriate for this study because both are extremely subjectivity and can be social bias lowering reliability. Associative data used rather than differential made causation unclear and less reliable to follow. This study showed determinism as the salicylic acid application only lasted for 8 weeks showing everyone as equal ignoring individual differences, thus degrading free will so external reliability decreased concluding that cryotherapy is better. This study measures the cost-effectiveness of cryotherapy against 50 salicylic acid and their efficacy. A randomized controlled trial is a robust method as it eliminates the bias of selecting participants and sets standardized procedures so replicability shows similar results thus increasing reliability. Being a primary study meant that internal validity increases thus confounding variables e.g evaporation of nitrogen which could interfere with the independent variable the use of the treatment are controlled. Empiricism was experienced via the statically testing test this made the trail scientific and reliable. 230 Participants were selected aged 12 and above from universities NHS and schools making the sample generalisable to the population as data came from different backgrounds. Self-report and observation were done although both are subjective they produced qualitative data e.g duration of the wart.
Topical medicines are preferred than herbal in western countries. The study aims to see which the smoke of Euphratica leaves or cryotherapy is more effective in curing cutaneous warts. Randomized picking of participants eliminated the bias of selection thus increasing reliability Reliability increased as the stratified sampling was representative of the population so replicable for more studies. Ethical requirements were met as written informed consent was taken proving it's genuine. Participants selected did not have any systemic disease thus generalisability to normal population increased. For the application precise measurements were taken 4 g of leaves 2mm circumference of cryotherapy, thus replicability facilitated for further analysis increasing reliability. The study lacked gender bias as 34 participants were females and 26 increasing ecological validity generalisability to population. Reliability was greater in the study as less determinism was expressed as although study lasted 10 weeks patients with reoccurrence were not classified as completely healed showing individual factors were not ignored For a practitioner this treatment proving to be effective would be beneficial as firstly leaves being natural meant, that it is sufficient for the population. The method used to apply smoke is easy and simple not needing too many pieces of equipment and less time consuming resulting in it being inexpensive. Salicylic acid is in the structure of the leaves thus its healing abilities and thus should be used worldwide. Although the application of smoke was done through a chamber leading to the lesion the surrounded area was tightly covered there could be tissue maceration making the patient susceptible to infection. However, the leaves are inexpensive lack pain with a reoccurrence rate of 4 showing that it is effective on plantar warts so it could be used in the clinic. Group A had pruritus where lesions reside however only in 3 patients thus classified as anomalies but still discomfort. Group B had 11 patients with blisters and pain suggesting that instead of letting wart freeze until ice ball less should be used meaning unreliable methods are used thus unreliable results. After 10 weeks patients 7 40 years had complete cures of 66 7 in A and B 46 4 reoccurrence rate of A 4 2 and B 32 2 leaves were more effective than cryotherapy. However the amount of treatment needed for group A 8 6 and b 6 9 that indicated that reliability decreased as not the same amount of treatments given Primary failures in A 20 8 and B 7 1 showing cryotherapy as a reliable treatment than the leaves The t-test was used a value of p has to be above 5 but it was 0 024 thus difference between the two was insignificant. The sample size was made of 60 people not representative of the population thus study not generalizable. Friedman test was used to assess the biochemical markers however these were pictured by experimenters, thus they were subjective and not generalizable. Finally, this was a pilot study thus suggesting that it was not a full-scale study thus less reliable so needed to be repeated until that the treatment with Euphratica leaves is dominated by cryotherapy.
