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Treatment-refractory warts associated with fingolimod
  1. Nitin Sahi1,
  2. Sarmad A Al-Araji1,
  3. Olga Ciccarelli1,
  4. Declan T Chard1,2,
  5. S Anand Trip1,2
  1. 1Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
  2. 2University College London Hospitals (UCLH) Biomedical Research Centre, National Institute for Health Research (NIHR), London, UK
  1. Correspondence to Dr Nitin Sahi, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK; n.sahi{at}nhs.net

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Case 1

A 54-year-old woman developed periungual digital warts. She had relapsing–remitting multiple sclerosis (MS) and had taken fingolimod since 2018. She had previously switched from natalizumab, due to John Cunningham (JC) virus seropositivity, and had relapsed on interferon beta-1a. Although her warts persisted despite topical salicylic acid, she wished to continue fingolimod (figure 1A).

Figure 1

(A) Periungual wart on left little finger of case 1 with coexistent onychomycosis. (B) Persistent common digital wart on right index finger of case 2.

Case 2

A 54-year-old woman with relapsing–remitting MS started fingolimod in 2014, following relapse on interferon beta-1a. She developed digital warts in 2016, which became widespread despite salicylic acid and cryotherapy. The warts improved following a dose reduction in 2019 but have persisted (figure 1B).

Cutaneous warts are caused by the human papilloma virus (HPV).1 2 Their prevalence varies markedly, but is highest during childhood (~5%–30%) and falls significantly after the second decade of life.1 2 Salicylic acid or cryotherapy are the most evidence-based treatments with cure rates around 50%, but there are many treatments available and spontaneous resolution is common.1 However, in immunocompromised people, warts …

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Footnotes

  • Contributors NS was involved in the patients’ care, collected data and obtained patient consent. He was responsible for writing the first draft and final manuscript. SA-A was involved in data collection, review and editing of the manuscript. OC was involved in data collection, review and editing of the manuscript. DTC was involved in the patients’ care and was responsible for conceptualisation of the article, review and editing of the manuscript. SAT was in charge of the patients’ care and was responsible for conceptualisation of the article, review and editing of the manuscript.

  • Funding This project was supported by researchers at the National Institute for Health Research University College London Hospitals Biomedical Research Centre.

  • Competing interests The author(s) declared the following potential competing interest with respect to the research, authorship and/or publication of this article: NS is a clinical fellow at the National Hospital for Neurology and Neurosurgery, London, in a post which is supported by Merck. OC receives research funding from the National Institute for Health Research (NIHR), UK and National MS Societies, Rosetrees trust and NIHR University College London Hospitals (UCLH) Biomedical Research Centre; she has received speaker honoraria from Biogen and Merck during the past 12 months; and is the Deputy Editor of Neurology. DTC is a consultant for Biogen and Hoffmann-La Roche. In the last three years he has received research funding from Hoffmann-La Roche, the International Progressive MS Alliance, the MS Society, and the National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Centre, and speaker’s honorarium from Novartis. He co-supervises a clinical fellowship at the National Hospital for Neurology and Neurosurgery, London, which is supported by Merck. SAT receives support from the UCLH Biomedical Research Centre and has received honoraria from Roche, Merck, Novartis, Sanofi-Genzyme and Biogen in the last 3 years. He cosupervises a clinical fellowship at the National Hospital for Neurology and Neurosurgery, London, which is supported by Merck.

  • Provenance and peer review Not commissioned. Externally peer reviewed by Waqar Rashid, London, UK and Emma Tallantyre, Cardiff, UK.

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