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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17 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 warts, and in the control group, subjects had a range of 1 to 14 warts. There was no statistically significant differences (p>0.05) between the two groups in terms of demographic data and clinical variables. The most common site of wart presentation in the MMR group was the palmoplantar surface in 23 patients, followed by the hands/upper extremities in 21 patients. In the control group, the most common sites were the upper extremities, including the hands, in 19 patients. The number of patients who presented with distant warts in the MMR group numbered 54 (75%) and, in control group, 37 (74%). The number of injections given in both groups ranged from 2 to 5 (Table 2). Response was observed on the basis of a decrease in size and number of lesions and according to the type of wart. A decrease in size of lesions by less than 50 percent was graded as no or mild response, a decrease of 50 to 75 percent was graded as a moderate response, a decrease of 75 to 99 percent was graded as a good response, and total clearance of all lesions was graded as a complete response (Table 3). A statistically significant difference with p<0.00001 was observed in terms of therapeutic response to MMR injection versus normal saline injection. A clinical response on the basis of type of warts was also observed in the MMR injection group: palmoplantar warts showed the best response, followed by common warts. Complete response in a patient with palmoplantar warts is shown in Figure 2. Figure 3 shows good response in a patient with Verruca plana. Complete clearance FIGURE 2. A case of complete clearance of palmar warts—A) before treatment, B) after second injection, and C) complete clearance after the third injection TABLE 2. Distribution of clinical variables VARIABLES MMR GROUP N=72 NORMAL SALINE GROUP N=50 Duration of warts, range (mean) 1–36 (13.7±9.5) 2–24 (11.8 ± 7.0) Number of warts, range (mean) 1–12 (4.6±3.4) 1–14 (4.2±3.8) Distant warts, n (%) 54 patients (75.0) 37 patients (74.0) Mean number of injections 3.7± 1.0 4.4± 0.7 Recalcitrant warts (patients who did not respond to other treatment modalities), n (%) 38 patients (52.7.0) 28 patients (56.0) INVOLVED SITES Palmoplantar surface, n (%) 23 (31.9) 18 (36.0) Upper extremities/dorsa of hands, n (%) 21 (29.1) 19 (38.0) Lower extremities/dorsa of feet, n (%) 16 (22.2) 9 (18.0) Periungual area, n (%) 8 (11.1) 3 (6.0) Face, n (%) 4 (5.5) 1 (2.0) n: number TABLE 3. Grading of clinical response GRADING OF RESPONSE MMR GROUP N=72 NORMAL SALINE GROUP N=50 Complete response—total clearance of warts, n (%) 49 (68.0) 5 (10.0) Good response—75%–99%, n (%) 12 (16.6) 3 (6.0) Moderate response—50%–75%, n (%) 6 (8.3) 12 (24.0) Mild/no response—1%–50%, n (%) 5 (6.9) 30 (60.0) n: number There is statistically significant difference between response to MMR injection and normal saline injections with value of p <0.00001 and chi-squared = 59.06. A B C

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