Warts In Patients Research Articles

Role of Intralesional Vitamin D3 in the Treatment of Cutaneous Warts.

Background:Cutaneous warts are common benign skin lesions caused by human papillomavirus. Various treatment options are available for these but immunotherapy is becoming more and more popular over the past few years. It stimulates cell-mediated immunity causing clearance of warts.Aims and Objectives:The aim is to determine the role of intralesional vitamin D3 in the treatment of warts.Materials and Methods:Consecutive patients with verruca vulgaris attending OPD were included. Around two to three warts were injected first with 0.2 mL of lignocaine (20 mg/mL). After a few minutes, the same warts were injected with 0.2 mL (4 U) of vitamin D3 (15 mg/mL). The injections were given2 weeks apart for a maximum of six sessions, and the patient was followed up 3 months after the last injection.Results:A total of 41 patients of cutaneous warts completed the study. Complete clearance was seen in 27 (65.85%) patients, partial response was seen in 11 (26.83%) patients, and three patients (7.32%) showed no response at all. The mean number of injections required for complete response was four. Recurrence was seen in two patients (4.88%) and one patient had keloid formation at the sight of injection.Limitation:This is a small sample sized study and lacks a control group.Conclusion:Intralesional vitamin D3 is an effective treatment option for common warts.

A Comparative Study of Topical 5% 5-Fluorouracil with Needling versus 30% Trichloroacetic Acid with Needling in the Treatment of Plantar Warts.

Background:Warts are benign proliferations of keratinocytes caused by Human Papilloma Virus (HPV). Plantar warts are caused by HPV types 1, 2, 4, 27 and 57. It is challenging to treat them due to frequent recurrences.Aim:To compare the efficacy and safety of topical 5% 5-Fluorouracil (5-FU) with needling versus 30% Trichloroacetic acid (TCA) with needling in the treatment of plantar warts.Materials and Methods:Sixty consecutive patients of plantar warts were randomly allocated into two groups of 30 each and treated with either 30% TCA with needling or 5% 5-FU with needling once in four weeks, until complete clearance of warts or for a maximum of three sessions. Baseline clinical photographs were taken and subjective response at the end of treatment was recorded. Objective assessment at 4, 8, and 12 weeks was carried out and outcome was evaluated by reduction in number and size of warts. Adverse effects of each group were noted and compared. Follow-up of patients was done at 6 months for clinical assessment of results and to study recurrence.Results:Out of 30 patients in 30% TCA group, 28 patients (93.33%) had complete response and 02 patients (6.66%) had partial response at the end of 12 weeks. In 5-FU group, 26 patients (86.66%) showed complete response, 02 patients (6.66%) had partial response, and 02 patients (6.66%) had no response to treatment. The mean reduction in size and number of warts was better in the TCA group and was significant at 4th week of follow up while at the end of 8th week and 12th week, the response was identical. There was no recurrence of warts in the complete responders at the end of 6 months. The main adverse effect seen in both groups was pain at the needling site.Conclusion:Needling with both topical 5% 5-FU and 30% TCA are highly effective in clearing plantar warts. However, 30% TCA has the advantage of early action and complete clearance of plantar warts with fewer adverse effects.

Evaluation of Interleukin-17 in Viral Warts

Background: Warts are common benign epithelial keratinocytes proliferations caused by human papillomavirus (HPV) infection that may involve the skin and the mucous membranes Interleukin-17A (IL-17A), is a prototypic member of cytokines. It is recognized as an inflammatory cytokine and exerts its function mainly on myeloid cells and mesenchymal cells to induce the expression of certain kinds of chemokines, which in turn increase granulopoiesis and recruit neutrophils to the infectious site. Aim and objectives: The aim of the work was to evaluate the serum level of interleukin 17 in patients with viral warts and its correlation with the disease severity. Subjects and methods: this was a case control study, in which participants were selected from the outpatient clinic of Dermatology, Venereology & Andrology department of Benha University Hospitals, carried on sixty patients of wart and thirty healthy subjects serving as a matched control subjects group. Serum IL17 was detected by ELISA Results: The results of the study revealed that there was high statistically significant difference between groups regarding IL 17 serum level where it was higher in wart patients’ group. Conclusion: This study reported increased IL17 in sera of patients with warts irrespective of their clinical type (plane, plantar or common).This finding may denote that IL17 may have a role in pathogenesis of viral warts.

A systematic review of the use of topically applied treatment for genital warts in patients with normal immunity

British Journal of DermatologyVolume 183, Issue 1 p. e13-e13 Plain Language SummaryFree Access A systematic review of the use of topically applied treatment for genital warts in patients with normal immunity First published: 01 July 2020 https://doi.org/10.1111/bjd.19183AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract The aim of this paper was to analyse the results of published studies looking at the use of topically applied medications (meaning they are applied to the skin) to treat warts on the external genitalia, to see if there was enough evidence to favour one or more treatments on the basis of good results and safety. The investigators selected 41 studies, which together involved 6371 patients. The main treatments analysed where topical podophyllotoxin (a cytotoxic agent - meaning it kills cells - applied to the surface of warts) in different strengths, sinecatechin (a product, again, used topically and derived from green tea extract), cidofovir gel and idoxuridine cream (both antiviral medications applied directly to warts), imiquimod (a topically applied medication used to increase immunity). Of the two most commonly used treatments, podophyllotoxin in a 0·5% solution was more effective than imiquimod 5% cream although it also caused more side effects such a stinging and irritation. By contrast sinecatchin was not as effective as imiquimod. The antiviral medications, idoxuridine and cidofovir, produced very similar results to those seen with imiquimod and podophyllotoxin. Generally, the rates of recurrence after therapy were similar whichever treatment was applied. The investigators concluded that there was little difference to be found between the different treatments and that selection of the most suitable in each individual case should also take into account factors such as the likelihood of irritation at the site to be treated or the length of time required to achieve cure, as some, such as imiquimod, take longer to produce results than others. Linked Article: Jung et al. Br J Dermatol 2020; 183:24–36. Volume183, Issue1July 2020Pages e13-e13 RelatedInformation

A study on the efficacy of intralesional bleomycin for the treatment of periungual and palmoplantar warts

<p class="abstract"><strong>Background:</strong> Amongst the different modalities for the treatment of warts, not a single modality is fully effective. While treating warts, the possibility of spontaneous regression must also be kept in mind. The aim of treating warts is to induce long term immunity without recurrences. To study the efficacy and safety of intralesional bleomycin for the treatment of twenty patients with periungual and palmoplantar warts.</p><p class="abstract"><strong>Methods:</strong> We conducted a prospective study of twenty patients of resistant periungual and palmoplantar warts between the age group of 15-50 years. Three injections of bleomycin were given at an interval of 2 weeks for a maximum of 3 injections (or less if the resolution occurred earlier).<strong></strong></p><p class="abstract"><strong>Results:</strong> After three sessions, complete clearance of palmoplantar warts was 71.42% and that of periungual warts was 90.90%. lesions were seen in 82% patients and incomplete resolution was seen in 15% patients. Bleomycin has antibacterial, antiviral and cytotoxic activity. Commonest side effect after bleomycin injection was pain seen in 40% (8) patients followed by pigmentary change and Raynauds phenomenon seen in 5% (1) patient each.</p><p class="abstract"><strong>Conclusions:</strong> Bleomycin is an effective and promising treatment of recalcitrant warts especially in palmoplantar and periungual.</p><p class="abstract"> </p>

Prevalence of Cervico-vaginal High-risk HPV Types and Other Sexually Transmitted Pathogens in Anogenital Warts Patients.

To investigate the prevalence of cervico-vaginal co-infection with high-risk (HR) HPV types and other sexually transmitted pathogens (STPs) in women with anogenital warts (AGWs). In this cross-sectional study, cervico-vaginal smears of women with AGWs were examined with real-time polymerase chain reaction for the presence of HR-HPV types and common STPs. Women with recent cervical HPV infection and general population were used for comparisons. A total of 689 women participated in the study. Among the examined groups, higher rates of cervico-vaginal co-infection with HR-HPV types and other STPs collectively were recorded in women with AGWs (p=0.0049 and p<0.004, respectively). Within the AGWs group, cervical co-infection with HR-HPV types was detected more often in women with recurrent disease (p<0.001). The higher rates of cervico-vaginal co-infection with HR-HPV types and common STPs in women with AGWs may affect their risk for cervical carcinogenesis and the natural course of their disease.

Increased risk of dementia in patients with genital warts: A nationwide cohort study in Taiwan.

Genital warts are a common sexually transmitted disease caused by human papillomavirus (HPV) infections. The prevalence of dementia is 4-8% in those aged 65years or older in Taiwanese community studies, with a high social and economic burden for patients, family caregivers, the community and society. Previous studies have shown that viral infections such as herpes simplex and herpes zoster were associated with dementia. This study aimed to investigate the association between dementia and HPV infections. A population-based cohort study using data from Taiwan's National Health Insurance Research Database was conducted. Fine and Grays's survival analysis was employed to estimate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between genital warts and dementia. From all of the potential participants aged 50years or more, a total of 16116 patients were enrolled, including 4029 genital warts-infected patients, with 12087 sex-, age- and indexed date-matched controls (1:3). The cumulative incidences of dementia were 10.72 per 103 person-years and 6.43 per 103 person-years in the genital warts and control group, respectively. There were 475 dementia cases from the genital warts cohort during the follow-up period of 15years. The adjusted HR for dementia was 1.485 (95% CI, 1.321-1.668; P<0.001) for genital warts patients after adjusting for all of the covariates. Our study indicates that genital warts infection may increase the risk of dementia.

Comparison of Intralesional Measles, Mumps, Rubella Vaccine and Needling in the Treatment of Recurrent Warts.

Context:Warts constitute 21% of all the cases in a dermatology clinic. Their causative agent is the human papillomavirus (HPV). Most of the cutaneous warts are cosmetically disfiguring and their treatment requires patience by both the practitioner and the patients.Aim:This study aimed to compare the efficacy of intralesional measles, mumps, rubella (MMR) vaccine and needling in the treatment of recurrent warts.Settings and Design:This was a prospective, comparative, and interventional study.Subjects and Methods:This hospital-based study was conducted in a tertiary health-care center from September 2017 to August 2019. Overall 40 patients of recurrent warts were included in the study.Statistical Analysis:Fisher test, Student t test, and chi-square test were used for statistical analysis.Results:Improvement was noted in patients belonging to both the groups. However, after applying chi-square test, it was found that results were statistically significant in the needling group only. When both the groups were compared using chi-square test, needling showed statistically significant results after 4 and 6 weeks.Conclusion:Needling was observed to be a better treatment modality as compared to intralesional MMR vaccine at the end of 4 and 6 weeks. More number of sessions were required in the intralesional MMR vaccine group for complete clearance of the lesions as compared to needling. Hence, the response was better and faster in the needling group as compared to the intralesional MMR group.

Comparison of cryotherapy versus intralesional measles, mumps, rubella vaccine versus their combination therapy in Indian patients with cutaneous wart: a single centre prospective observational study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Need for more effective and less time consuming therapeutic method is current necessity for treatment of cutaneous warts. The objective of the study was to evaluate and compare the efficacy, safety of cryotherapy versus intralesional measles, mumps, rubella (MMR) vaccine versus combination of cryotherapy and intralesional MMR vaccine in Indian patients with cutaneous wart.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective observational study was conducted in 60 patients of cutaneous warts. Patients were divided into three groups viz., group A, group B and group C. Group A was treated with cryotherapy alone, Group B received intralesional injection 0.1 to 0.3 ml of MMR vaccine alone and Group C received combination of group A and group B therapy. In each group treatment was repeated at 3 week interval for a maximum of 4 sittings. Percentage of improvement was evaluated using visual analogue scale (VAS) for local as well as distant (non-inoculated) warts. Follow-up was made every 2 months till 4 months to detect any recurrence.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; For local warts in second half of treatment (12&lt;sup&gt;th&lt;/sup&gt; week) patients of Group B and Group C showed significantly better response than patients in Group A. For distant warts in first half of treatment session patients showed significantly better response to Group C than as compared to Group B therapy (p&amp;lt;0.039).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Immunotherapy with MMR is superior treatment than cryotherapy for cutaneous warts with minimum side effects but the combination of cryotherapy with intralesional MMR has shown to have complementary effect in treatment response.&lt;/p&gt;

Estimating the burden of illness related to genital warts in the Philippines: a nationally representative cross-sectional study

BackgroundThis study estimated genital warts prevalence, genital-warts-related healthcare resource use and costs, and self-reported human-papillomavirus-related psychosocial impact among male and female patients aged 18–60 years in the Philippines.MethodsPrevalence was estimated using daily logs numbering genital warts patients treated by participating physicians in 4 Philippine regions over a 5-week period (09JUL2011-24SEP2012). Physicians also completed a survey assessing patient referral patterns, healthcare resource use, treatment, and follow-up care. Psychosocial impact was estimated using the human papillomavirus impact profile and the EQ-5D questionnaires. HIP and EQ-5D scores were compared according to the presence of GW (males) and HPV disease (females). CECA scores were also compared by gender and age groups.ResultsOverall genital warts prevalence was estimated at 4.78% (95% confidence interval [CI]: 4.58–4.98%) for men and women aged 18–60 years. Genital warts prevalence was 3.39% (95% CI: 3.13–3.65%) and 8.0% (95% CI: 7.69–8.31%) among women and men, respectively. Prevalence estimates were highest in infectious disease specialist practices 18.67% (95% CI: 18.66–18.69%). Two thirds of the 233 (69.14%) male and 166 (67.20%) female patients were newly-diagnosed genital warts cases. Median costs for genital warts diagnosis and treatment reached 7121 and 7000 Philippine pesos among men and women, respectively. In the Cuestionario Específico para Condiloma Acuminado questionnaire, no statistically significant differences between patients were observed. In the EQ-5D questionnaire, male genital warts patients reported lower mean visual analogue scale scores than those without genital warts (78.20 vs 86.34, p < 0.0001). Mean visual analogue scale score values and utility values were lower for women with human-papillomavirus-related diseases than those without (77.98 vs 78.93, and 0.84 vs 0.88, respectively).ConclusionsGenital warts is prevalent in the Philippines; more than 60% of cases were newly diagnosed, contributing to high genital-warts-related healthcare resource costs. Diagnosis of genital warts and human papillomavirus negatively impacted psychosocial indices such as patient well-being and health-related quality of life.

Risk factors for cutaneous warts and the influence factors of curative effect of 5-flurouracil therapy in southern China

Background To systematically explore the risk factors of cutaneous warts and influence factor for the effectiveness of 5-fluorouracil (5-FU). Methods This is a case-control study of 408 cutaneous warts patients and 408 controls of Chinese Han population in southern China. In addition, 244 patients who presented with an initial episode of warts without treatment were treated with intralesional 5-FU. The influence factors of 5-FU therapeutic effects were analyzed. Results After adjustment, we found age (≤14 years old), lower education attainment, alcohol intake, smoking, less daily sleeping hours, severe psychological stress, hyperhidrosis, living in house or apartment, having cutaneous warts roommates, and sharing personal items with other persons to be risk factors for warts. Importantly, physical fitness played a protective role against warts. Two hundred and twenty-seven patients in 244 (93.03%) were successfully treated with 5-FU. Multivariate analysis indicated that smoking, alcohol intake, severe psychological stress, more than six months’ duration of cutaneous warts, lesions on foot and warts diameter ≥5 mm adversely affected the effectiveness of 5-FU. Conclusions The newly identified risk factors for cutaneous warts and influence factors for efficacy of 5-FU provided clues for warts prevention and treatment of Chinese Han population.

Evaluation of serum interleukin 17 and zinc levels in recalcitrant viral wart.

Warts are benign epithelial proliferations of the skin and mucosa caused by infection with HPV. Low IL-17 levels may contribute in occurrence, maintenance, severity, and recurrence of different types of cutaneous wart that depend mainly on the cell-mediated immunity defect. In a majority of the patients, zinc deficiency was associated with persistent, progressive, or recurrent viral warts. A careful dose of oral zinc sulfate may be helpful in the management of such patients. Zn deficiency negatively affects the Th17 cells. IL 6 induced STAT3 activation during chronic inflammation and Th17 development suppressed by Zn via attenuating this activation critically controls Th17-cell development. To evaluate the role of interleukin 17 and zinc in recalcitrant warts. All studied patients were subjected to history taking and dermatological examination. The evaluation of serum IL-17 level was done by ELISA in 25 recalcitrant wart patients and 25 wart patients. The measurement of serum zinc level was determined by colorimetric methods, using Au 480 Beckman coulter chemistry analyzer. The results revealed a significant decrease in serum IL-17 and zinc levels in recalcitrant wart patients. Both IL-17 and zinc deficiency have a role in the pathogenesis of recalcitrant warts through the imbalance of immune system and deficiency of immune cells. There is no significant correlation between serum levels of IL-17 and zinc, suggesting that they have different mechanisms in affecting the immune system.

Distribution of human papillomavirus genotypes in genital warts in patients attended a tertiary care hospital in Dhaka, Bangladesh

Introduction: Human papillomavirus (HPV) association in genital wart is well known, however, data are mostly from developed countries and no data from Bangladesh is yet available. Methods: In order to see the HPV association and type distribution in genital warts in Bangladeshi patients, we screened DNA from warts and checked presence of HPV by real time polymerase chain reaction (PCR). Results: Out of 44 wart specimens from 44 patients, 30(68.18%) were found positive for HPV. Out of these 30 positive patients low risk HPVs were 25 (83.33%) and high risk HPVs were 3(10%) and co-infection with low risk and high risk HPVs were 2(6.66%). Among the low risk HPVs, type 6 was found in 23(85.18%) and type 11 was found in 4(14.8%) indicating high dominance of HPV type 6. Among the high risk HPVs, type 16 was found in one, type 18 was found in one and HPV other than type 16 and 18 was found in three patients. Though the number of male patients in this study was smaller than female patients (10 vs 34) type distribution of HPVs in warts from male and female are similar. Conclusion: Although it is accepted that HPV 6 and 11 genotypes are main causes of warts, our findings show non-negligible incidence of multiple infections and high-risk genotypes in both male and female with benign HPV manifestations (warts). This is the first report of HPV documentation and type distribution in genital warts in Bangladesh and hence demand further large scale study.

Efficacy of inosine pranobex as an adjuvant oral therapy in anogenital warts

Background: Human papillomavirus (HPV) causes the most prevalent sexually transmitted infection and is an important etiological factor in genital cancer. HPV infection manifests in broad spectrum, from genital warts to cervical intraepithelial neoplasia and cancers. Genital warts remain a frequent problem in primary care. Current modalities provide unsatisfactory result in curing genital warts completely. To date, there are many convincing studies encouraging oral inosine pranobex as an adjuvant therapy to improve post-conventional therapy cure-rate. Aim: To assess the efficacy of inosine pranobex as an adjuvant oral therapy in anogenital warts. Methods: Literature search was performed using Pubmed, Ebsco and Science Direct database. Inclusion criteria were human subjects, randomized controlled trial on patients with genital warts, and inosine pranobex as adjuvant therapy. The studies were appraised and findings were formulated to find the best evidence for collating recommendations in treating genital warts patients. Results: There were three articles related to the clinical questions. All articles were found to be valid after selection based on exclusion and inclusion criteria. Discussion: All articles recommended the addition of oral inosine pranobex as an adjuvant therapy in treating patient with genital warts. Based on the critical appraisal performed previously, addition of oral inosine pranobex may minimize conventional therapy failure. Conclusion: Based on the best evidence available, we would recommend the addition of oral inosine pranobex as adjuvant for treating genital warts, except in special conditions, such as for patients with financial problem as this therapy was not covered by national health insurance. Keywords: effectiveness, genital warts, inosine pranobex

Immunotherapy with PPD in treatment of warts: An open labelled study from western Uttar Pradesh

Immunotherapy with PPD in treatment of warts: An open labelled study from western Uttar Pradesh - IJCED- Print ISSN No: - 2581-4710 Online ISSN No:- 2581-4729 Article DOI No:- 10.18231/2581-4729.2019.0010, IP Indian Journal of Clinical and Experimental Dermatology-IP Indian J Clin Exp Dermatol

Stereophotogrammetric three-dimensional photography is an accurate and precise planimetric method for the clinical visualization and quantification of human papilloma virus-induced skin lesions.

BackgroundThe quantification of human papilloma virus (HPV)‐induced skin lesions is essential for the clinical assessment of the course of disease and the response to treatment. However, clinical assessments that measure dimensions of lesions using a caliper do not provide complete insight into three‐dimensional (3D) lesions, and its inter‐rater variability is often poor.ObjectiveThe aim of this study was to validate a stereophotogrammetric 3D camera system for the quantification of HPV‐induced lesions.MethodsThe camera system was validated for accuracy, precision and interoperator and inter‐rater variability. Subsequently, 3D photographs were quantified and compared to caliper measurements for clinical validation by Bland–Altman modelling, based on data from 80 patients with cutaneous warts (CW), 24 with anogenital warts (AGW) patients and 12 with high‐grade squamous intraepithelial lesions of the vulva (vulvar HSIL) with a total lesion count of 220 CW, 74 AGW and 31 vulvar HSIL.ResultsTechnical validation showed excellent accuracy [coefficients of variation (CV) ≤ 0.68%] and reproducibility (CVs ≤ 2%), a good to excellent agreement between operators (CVs ≤ 8.7%) and a good to excellent agreement between different raters for all three lesion types (ICCs ≥ 0.86). When comparing 3D with caliper measurements, excellent biases were found for diameter of AGW (long diameter 5%), good biases were found for diameter of AGW (short diameter 10%) and height of CW (8%), and acceptable biases were found for the diameter of CW (11%) and vulvar HSIL (short diameter 14%, long diameter 16%). An unfavourable difference between these methods (bias 25%) was found for the assessment of height of AGWs.ConclusionStereophotogrammetric 3D imaging is an accurate and reliable method for the clinical visualization and quantification of HPV‐induced skin lesions.

Cell wall fraction of Mycobacterium indicus pranii shows potential Th1 adjuvant activity

Very few adjuvants inducing Th1 immune response have been developed and are under clinical investigation. Hence, there is the need to find an adjuvant that elicits strong Th1 immune response which should be safe when injected in the host along with vaccines. Mycobacterium indicus pranii (MIP), a non-pathogenic vaccine candidate, has shown strong immunomodulatory activity in leprosy/tuberculosis/cancer and in genital warts patients where its administration shifted the host immune response towards Th1 type. These findings prompted us to study the components of MIP in detail for their Th1 inducing property. Since mycobacterial cell wall is very rich in immunostimulatory components and is known to play important role in immune modulation, we investigated the activity of MIP cell wall using Ovalbumin antigen (OVA) as model antigen. ‘Whole cell wall’ (CW) and ‘aqueous soluble cell wall fractions’ (ACW) induced significant Th1 immune response while ‘cell wall skeleton’ (CWS) induced strong Th2 type of immune response. Finally, functional activity of fractions having Th1 inducing activity was evaluated in mouse model of melanoma. CW demonstrated significant anti-tumor activity similar to whole MIP. Anti-tumor activity of CW could be correlated with enhanced tumor antigen specific Th1 immune response observed in tumor draining lymph nodes.

Molecular study on genital wart patients in Babylon province-Iraq

The aim of this study was to molecular identification of HPV genotypes in genital wart patients in their blood samples in Babylon province-Iraq. This work was applied on (40) genital wart patients admitted to the outpatient department of Dermatology and Venereology in Merjan Medical City, Hilla-Iraq and private clinic during the period from November (2013) to March (2014). The patients consist of (16 males and 24 females) with their age range (2-48) years, while (20) apparently health controls which consist of (males and females) with age range approximately matched to genital wart patients. Blood samples were collected from both patients and controls to identify the genotypes of HPV by molecular methods by polymerase chain reaction (PCR). The results of this study showed (15%) positive for HPV genotypes. The positive results of HPV genotypes were (high risk group) for this virus.

A Randomized double Blind Controlled Study Comparing the Efficacy of Intralesional MMR Vaccine with Normal Saline in the Treatment of Cutaneous Warts.

Background:Recently, with better understanding of the immunology of warts, immunotherapeutic approaches have emerged as an effective treatment option for the management of cutaneous warts. Intralesional immunotherapy with MMR vaccine is one such modality but there are still lack of enough placebo-controlled studies.Aim:To evaluate the efficacy of intralesional MMR in patients of extragenital warts in a double-blinded manner using normal saline as control.Patients and Methods:One hundred patients of extragenital cutaneous warts were randomly allocated into two groups, the interventional (MMR) group and control (normal saline) group. MMR vaccine was injected intralesionally in the patients belonging to interventional group, a similar volume of normal saline (NS) was injected in the control group. The outcome in terms of treatment response, adverse effects, and recurrences were evaluated and compared.Results:Eighteen of thirty (60%) patients in the interventional group achieved complete response as against 7 (23.3%) in the control group (P = 0.01). Distant warts cleared in 69.5% patients in the interventional groupcompared to none in the control group. Adverse effects seen in both groups were injection site pain and mild erythema. A total of 57.1% patients showed recurrences in the control group compared to 16.6% in the interventional group.Conclusion:Intralesional MMR vaccine is an effective treatment option in patients with multiple extragenital warts. It is suggested that it should be used as first-line therapy for multiple warts and a second-line therapy for warts recalcitrant to standard therapies.

A Study on the Efficacy of Immunotherapy with Purified Protein Derivative for the Treatment of Recalcitrant Warts

Introduction: There are many treatment modalities of warts, but most of them are destructive therapies which have propensity to cause scarring. Many antigens especially purified protein derivative (PPD) of tuberculin bacilli are being used for the regression of warts.Aims: To study the efficacy of purified protein derivative of tuberculin bacilli in the treatment of warts.Methods A randomized controlled trial was done in which 25 patients of recalcitrant warts were taken up for the study. In all the patients, 2.5 units of PPD was injected in each wart and upto maximum of 25 units PPD was given and the injections were given every 3 weeks for a total of 3 sessions.Results: Commonest type of wart seen in our study was verruca vulgaris in 15(60%) patients, verruca plana in 5(20%) patients, palmoplantar warts in 3 (12%) patients and genital warts in 2 (8%) patients. Regarding the number of warts 15 (60%) patients had more than 20 warts, 5 (20%) patients had number of lesions between 11 – 20 and another 5(20%) patients had lesions between 1 – 10. Complete clearance of lesions after 3 sessions was seen in 18 (72%) patients, partial clearance of lesions was seen in 4 (16%) patients and no response was seen in 3 (12%) patients.Conclusion: Immunotherapy with PPD causes boosting up of the cell mediated immunity of the patients which causes spontaneous regression of the warts.