Role of autoinoculation in the management of cutaneous warts: a comparison study with 100% tricholoroacetic acid application

Abstract

<p class="abstract"><strong>Background:</strong> Persistent and recurrent warts pose a challenge to physicians despite the availability of multiple treatment options. Autoinoculation exposes HPV antigens to the dermis and vasculature thereby activating a delayed hypersensitivity response, facilitating clearance of both local and distant warts. The aim of this study was to assess the efficacy of autoinoculation and compare it with chemical cautery using 100% trichloroacetic acid.</p><p class="abstract"><strong>Methods:</strong> A non-blinded interventional study was conducted at Goa Medical College, a tertiary care centre. Non-immunocompromised patients with 5 or more non-genital warts were included. Group 1: a wart was removed by punch biopsy, minced and implanted in the dermis. The procedure was repeated at 4 and 8 weeks. Group 2: weekly trichloroacetic acid (100%) application. Response was assessed at 4, 8 and 12 weeks in terms of percentage reduction in the number of warts. Statistical correlation with respect to age, sex, duration, number and type of warts was assessed using Welch ANOVA.<strong></strong></p><p class="abstract"><strong>Results:</strong> In group 1, 63 patients and in group 2, 54 patients completed the study. Post autoinoculation, complete clearance was seen in 46.0% and 3.2% had partial clearance. With TCA application, 33.3% patients had complete and 13% had partial clearance. Response differed with the type of warts. Palmoplantar, periungual warts and verruca vulgaris showed better response to autoinoculation. Filiform and plane warts showed better response to TCA.</p><p class="abstract"><strong>Conclusions:</strong> Autoinoculation is an efficacious treatment modality which can be performed routinely especially for palmoplantar and periungual warts which are particularly challenging to treat with other modalities.</p>