Spontaneous Regression of a Recalcitrant Wart after Bivalent Papillomavirus Vaccination

Abstract

A 10-year-old girl presented with a wart located on the right finger of her hand that had appeared 9 months before (Figure, A). It had been refractory to multiple topical treatments used, including cryotherapy (6 sessions), salicylic acid, and cantharidin. Ten days after receiving the first dose of the human papillomavirus (HPV) bivalent vaccine, total remission of the wart was noted (Figure, B). Regression of common warts has been reported anecdotally after the administration of both tetravalent and bivalent vaccines against specific HPV.1Venugopal S.S. Murrell D.F. Recalcitrant cutaneous warts treated with recombinant quadrivalent human papillomavirus vaccine (types 6, 11, 16, and 18) in a developmentally delayed, 31-year-old white man.Arch Dermatol. 2010; 146: 475-477Crossref PubMed Scopus (52) Google Scholar, 2Moscato G.M. Di Matteo G. Ciotti M. Di Bonito P. Andreoni M. Moschese V. Dual response to human papilloma virus vaccine in an immunodeficiency disorder: resolution of plantar warts and persistence of condylomas.J Eur Acad Dermatol Venereol. 2016; 30: 1212-1213Crossref PubMed Scopus (9) Google Scholar, 3Kreuter A. Waterboer T. Wieland U. Regression of cutaneous warts in a patient with WILD syndrome following recombinant quadrivalent human papillomavirus vaccination.Arch Dermatol. 2010; 146: 1196-1197Crossref PubMed Scopus (31) Google Scholar, 4Abeck D. Fölster-Holst R. Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.Ann Dermatol Venereol. 2015; 95: 1017-1019Crossref Scopus (28) Google Scholar, 5Martin J.M. Escandell I. Ayala D. Jordá E. Spontaneous remission of recalcitrant warts in girls after human papillomavirus vaccination.Actas Dermosifiliogr. 2016; 107: 533-535PubMed Google Scholar The bivalent vaccine was authorized for immunization against HPV types 16 and 18, and it is indicated in patients from years of age 9 onward for the prevention of premalignant cervical, vulvar, and vaginal lesions and cervical cancer. It is intramuscularly administered and contains extracts of L1 protein from the types it protects against. The immune response to HPV is strongest after 7 months and optimal for girls aged 9-11 years.4Abeck D. Fölster-Holst R. Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.Ann Dermatol Venereol. 2015; 95: 1017-1019Crossref Scopus (28) Google Scholar, 5Martin J.M. Escandell I. Ayala D. Jordá E. Spontaneous remission of recalcitrant warts in girls after human papillomavirus vaccination.Actas Dermosifiliogr. 2016; 107: 533-535PubMed Google Scholar Laboratory studies and clinical observations have shown that HPV vaccines induce a potent activation of the immune response, with antibody titers up to 11-fold greater than those achieved spontaneously. Moreover, vaccines provide a different degree of cross-protection against other types of HPV that are not covered for the vaccine.5Martin J.M. Escandell I. Ayala D. Jordá E. Spontaneous remission of recalcitrant warts in girls after human papillomavirus vaccination.Actas Dermosifiliogr. 2016; 107: 533-535PubMed Google Scholar It is possible that this immune cross-protection would be related to the similar molecular structure shared by the more than 150 types of HPV that are known. All are small DNA viruses with a genome of about only 8000 base-pairs that is contained in a protein capsid that contains 2 structural proteins (L1 and L2). In addition to an immune response to the L1 capsid protein, a nonspecific effect related to locally released chemokines could also be involved. HPV vaccination may be a useful option for the management of some recalcitrant warts in prepubertal girls.