Journal of Clinical and Aesthetic Dermatology

MAY 2018

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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15 JCAD JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY May 2018 • Volume 11 • Number 5 O R I G I N A L R E S E A R C H w Warts are a common malady that affects people of all ages, male or female. Warts are the cutaneous manifestations of human papilloma virus (HPV) infection. HPV is a double-stranded deoxyribonucleic acid (DNA), non-enveloped virus that belongs to the Papovaviridae family and Papillomavirus genus. They show tropism for epithelial cells, hence causing muco-cutaneous manifestations. 1 This virus tends to remain latent in the host cells for a long period of time, causing recurrences, and can cause benign and malignant infections. Among the resulting benign infections, cutaneous warts are the most common. 2 Cutaneous warts can manifest in various forms—namely, common warts (Verruca vulgaris), plane warts (Verucca plana), plantar warts, and anogenital warts (Condyloma acuminata). To date, more than 200 subtypes of HPV have been characterized. 3 Common types involved in cutaneous warts are HPV Types 1, 2, 7, 27, and 57. 4,5 Extragenital cutaneous warts can be asymptomatic or painful (especially when they are present on the plantar surface) and disfiguring. 6 Warts are highly contagious. They can spread from one person to another and from one site to another site in same patient. They run a chronic course and ultimately disappear after few years. Though these warts show rare malignant potential, cosmetic disfigurement will likely impel patients to seek treatment. Various treatment modalities are available for warts. Treatment can include topical therapies, such as trichloroacetic acid, salicylic acid, podophyllotoxin, and 5-fluorouracil. Radiocautery, cryotherapy, surgical excision, and carbon dioxide laser are other methods of treatment; however, these modalities pose a high risk of scarring. Various systemic modalities have also been used, such as levamisole and zinc sulphate, but none have achieved a complete cure without recurrence. Recently, certain immunotherapeutic agents have gained popularity for the optimal cure of warts. 7 Antigens such as the measles, mumps, and rubella (MMR) vaccine; Candida albicans; Bacillus Calmette–Guérin (BCG), and Mycobacterium indicus pranii are injected intralesionally, with variable responses observed. Results with MMR injection have been encouraging in past studies. In the current study, we attempted to further strengthen the evidence regarding the efficacy and safety profile of this antigen in the treatment of cutaneous warts. MATERIALS AND METHODS This single-blind, randomized, placebo- controlled study (1:1) was conducted from January 2016 to December 2016. Patients who presented to the outpatient department of dermatology with cutaneous warts anywhere on the body other than the anogenital area were included. Before starting the study, A B S T R A C T Background: Various treatment modalities have been described in the literature for treating warts, but none thus far have demonstrated optimal results. Recently, the mumps, measles, and rubella (MMR) antigen has gained popularity because of its proven efficacy in the treatment of warts. Aim: The goal was to evaluate the efficacy and safety of intralesional MMR antigen in the treatment of cutaneous warts. Methods: Patients were divided into an MMR (study) group and a normal saline (control) group. Injections were administered into the single largest wart on each patient every two weeks. Follow-up was done at six weeks and 16 weeks after the last injection for any side effects and/or recurrence. Results: Out of 150 patients, 72 received the MMR injection and 50 received normal saline injections. Twenty-eight patients did not complete the study. A statistically significant (p<0.00001) difference in results was found between the two groups: 68 percent of patients in the MMR group showed complete response compared to 10 percent in the control group. Pain during injection was the most common side effect and was seen in both groups. Conclusion: MMR injection has shown significant results with almost negligible adverse effects. The MMR antigen vaccine has therapeutic potential as a treatment for warts with its demonstrated efficacy, safety profile, and cost-effectiveness. KEYWORDS: Immunotherapy, MMR vaccine, cutaneous warts Therapeutic Outcome of Intralesional Immunotherapy in Cutaneous Warts Using the Mumps, Measles, and Rubella Vaccine: A Randomized, Placebo-controlled Trial by GUNEET AWAL, MBBS, MD, and SIMPLEPREET KAUR, MBBS, MD Drs. Awal and Kaur are with the Department of Dermatology, Venereology, and Leprosy and Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar, India. J Clin Aesthet Dermatol. 2018;11(5):15–20 FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no conflicts of interest relevant to the content of this article. CORRESPONDENCE: Simplepreet Kaur, MBBS MD; Email: simple.warraich@gmail.com

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