Clinical and Dermoscopic Study of Intra-lesional Injection of Acyclovir Versus Candida Antigen in Treatment of Plantar Warts

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Abstract Background: Plantar wart is a common viral infection occurring in the plantar aspect of the foot, caused by human papillomavirus (HPV). Intra-lesional immunotherapy has emerged as a front-runner treatment option for plantar warts. Objectives: This study aimed to compare the efficacy and tolerability of intra-lesional injections of acyclovir versus candida antigen in patients with plantar warts. Methods: This randomised-controlled clinical trial was conducted on 40 patients with plantar warts. The included patients were randomly assigned into two groups: Group 1 (n = 20) was treated with intra-lesional injections of acyclovir. Group 2 (n = 20) was treated by intra-lesional injections of candida antigen. Injections were every 2 weeks for 5 sessions. All the patients were evaluated before and after treatment through clinical, photographic, and dermoscopic assessments. All side effects (local and systemic), during or after injections were recorded. Results: In acyclovir intra-lesional injected warts, a score of 3 (complete clearance clinically, and dermoscopically) was achieved in 65% of target warts, 15% had a score of 2 (patients’ dermoscopy confirmed the persistence of warts despite the fact that the warts had disappeared clinically), 20% had a score of 1 (warts were smaller and thinner but not completely gone upon clinical or dermoscopic examination). In candida intra-lesional injected warts, a score of 3 was achieved in 70% of target warts and 25% had a score of 1. Conclusion: Both intra-lesional acyclovir and candida antigen appear to be effective and tolerated treatment modalities for plantar warts. Although there were similar reports of side effects for both treatments, the success rate of curing warts using intra-lesional candida antigen was slightly greater.