Abstract
Background: Verrucae or warts are benign epithelial proliferations that occur due to accumulation of keratinocytes induced by HPV. Immunotherapy is a new promising modality which uses the principle of activation of one’s own immunity against the disease. Materials and methods: The study included 40 patients with multiple cutaneous warts in two groups of 20 each. Assigned treatment was injected into the single largest wart at an interval of 3 weeks until complete clearance or for a maximum of 3 times. Results: A statistically significant difference (p=0.018) was seen in the therapeutic response when compared to that of the BCG. All 20(100%) patients in the MMR group showed >50% clearance while in the BCG group 14(70%) patients showed >50% clearance according to Physician’s Global Assessment scores. Conclusions: Intralesional immunotherapy with MMR and BCG vaccines are both safe and promising whereas the therapy with MMR stands out with statistically significant results.
Highlights
Cutaneous warts or verrucae are benign epidermal proliferations caused by Human Papilloma virus [1]
Patients in the MMR group were in the age group ranging from 18-72 years with a mean of 28.25 years; while the patients in BCG group belonged to the age group of 18-49 years with a mean of 25.25 years; In the MMR group there were 16 (80%) males and 4 (20%) females, whereas in the BCG group, there were 13 (65%) males and 7 (35%) females(Table 2)
In 2010, Nofal and Nofal [4] conducted a case control study taking 135 patients with single and multiple common warts giving intralesional MMR vaccine to the first group and intralesional normal saline to the second group. They found that a highly significant difference was found between the therapeutic response of warts to MMR vaccine and saline control group
Summary
Cutaneous warts or verrucae are benign epidermal proliferations caused by Human Papilloma virus [1]. Different treatment modalities most of which are ablative have been tried over time such as electrocautery, chemical cautery, cryotherapy, carbon dioxide laser ablation, surgical curettage and topical keratolytics. Treating these warts becomes challenging when they are multiple, recalcitrant or recurrent. To address this the immunogenic potential of certain vaccines and chemicals like Diphenylcyclopropenone, Squaric acid dibutyl ester, Tuberculin, Candida antigen, HPV vaccine, Purified Protein Derivative, BCG, Measles Mumps Rubella vaccine have all been explored. This study was undertaken with an intention to compare the safety and efficacy of the two immunotherapies – Measles Mumps Rubella vaccine versus BCG in treating multiple verrucae vulgaris [3]. Conclusions: Intralesional immunotherapy with MMR and BCG vaccines are both safe and promising whereas the therapy with MMR stands out with statistically significant results
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