Background: Human papilloma virus (HPV) could contribute to warts and prevalence of warts is estimated to be from 7 to 10 percent of population. Immunity system could recognize bacterial, fungal as well as viral antigens. Researchers got benefit of this through development of antigen immunotherapy intralesional management. Purified protein derivative (PPD) is an intralesional immune-treatment for warts that has shown promising results. Objective: To determine whether intralesional PPD is effective and safe in common warts management. Patients and methods: The study involved twenty patients. History taking, general exam, and complete dermatological exam were performed on each patient to determine the type and number of warts, as well as the size and location of each wart in every patient. Without any pre-sensitization, all patients were then given PPD injection of 0.1 ml into the largest wart every two weeks for a maximum of six treatment sessions, or until the wart was completely cleared. The effectiveness of the treatment was determined by the size and number of warts. PPD injections were also evaluated for patient satisfaction and side effects. There was a follow-up evaluation for wart recurrence six months after the end of the treatment. Results: After 1/3 sessions, the mean of wart size reduction was 11.25 ± 14.67 whereas after 2/3 sessions the mean was 29.80 ± 28.72. After all sessions, the wart size reduction ranged from 0 -100 with a mean of 55.55 ± 42.65. 35% of patients had complete wart clearance, 20% had a moderate response, and 40% had an inadequate response, 5% showed marked response. Conclusion: Common warts can be treated with intralesional immunotherapy using PPD, which is a safe, effective, and tolerable treatment modality.

Intralesional immunotherapy with purified protein derivative (PPD) is an effective and tolerable therapeutic modality for the treatment of common warts. However, the complete clearance rates are still unsatisfactory. We thought to evaluate the efficacy and safety of adding low dose isotretinoin to intralesional PPD versus PPD monotherapy for viral warts. The study included two groups: Group (A) was treated by intralesional PPD at 2-week intervals until complete clearance or for a maximum of six sessions in addition to an oral placebo. Group (B): was treated with both intralesional PPD and low dose isotretinoin for a 3-month course. There was no statistically significant difference between both groups regarding the therapeutic response. In common warts, the low dose of isotretinoin did not add a true therapeutic value in the studied groups. Perhaps higher doses of isotretinoin could provide a better response, which warrants further investigation.