Plane warts on the back of the hand successfully treated with oral isotretinoin

A 31-year-old female was admitted to the Dermatology Clinic because of fine, skin-colour, shiny surface papules on the back of both hands (Figure 1 A). These skin lesions were present for several months, and periodically were associated with pruritus. The pathology exacerbated following an acute sinusitis treated with antibiotic – cefuroxime. Plane warts were diagnosed based on the medical history and the clinical presentation. The patient was initially treated with cryosurgery and laser therapy. Subsequently, topical pharmacotherapy was applied: imiquimod cream, podophyllotoxin liquid, fluorouracil ointment, tretinoin liquid and monochloride acetic acid liquid in a few weeks’ time period. Dissemination of fresh dermatological changes was observed peripherally and in vicinity of lesions treated with monochloride acetic acid and laser therapy (Figure 2 A). Afterwards, the patient received isoprinosine at a daily dose of 4 g, with no evident improvement. Considering the exacerbation of dermal changes and lack of any improvement, a decision was made to introduce the oral form of isotretinoin at a daily dose of 0.5 mg/kg b.w. After three weeks of this treatment a complete remission was achieved. Only scars left by previously applied treatments were observed (Figures 1 B, 2 B). Adverse effects of the treatment included dryness and exfoliation of the red zone of lips and dryness of conjunctiva of eyes. The treatment was continued for 3 months. At present the patient is followed-up