A Prospective Clinical Study for Safety and Efficacy of Intralesional Tuberculin Purified Protein Derivative in Treatment of Palmoplantar Verruca

Abstract

Background: Multiple treatment options are available for verruca, however none is completely effective. Conventional modalities such as salicylic acid, cryotherapy have inconsistent treatment efficacies. Newer modalities such as immunotherapy, bleomycin and lasers have shown higher clearance rates of warts in recent studies. Immunotherapy is an innovative approach to treat warts which relies on the principle of enhancement of cell-mediated immunity. This study was done to evaluate the efficacy of immunotherapy with Tuberculin Purified Protein Derivative injection in palmoplantar verruca in our context.
 Materials and Methods: This is an open labelled, prospective interventional study. Patients with palmoplantar verruca enrolled in the study were injected with purified protein derivative intralesionally by an insulin syringe at a dose of 10 IU (0.1 mL) in the largest wart every 2 weeks until all lesions disappeared or for a maximum of six sessions. They were followed up for 3 months after final treatment session.
 Results: A total of 54 patients, 34 males and 20 females, were enrolled in the study. Commonest distribution of palmoplantar verruca was in plantar distribution (48.1%). Among them, 12 (22.2%) patients had periungual warts. Complete clearance of warts without any scarring was seen in 66.7% (36) patients with palmoplantar verruca at the end of 6th session whereas 33.3% (18) patients did not respond. Adverse effects noted were erythema, edema and pain at injection site.
 Conclusion: Intralesional injection of purified protein derivative is an effective and inexpensive treatment option for palmo-plantar verruca with good outcome.

Efficacy and Safety Profile of Tuberculin Protein Purified Derivative Injection As Immunotherapy For the Treatment of Cutaneous and Anogenital Warts: A Review Article

“…In this study, patients received an intralesional injection of 0.1 mL PPD into the most prominent wart every two weeks, with a maximum of 6 sessions. 14 In a study by Nimbalkar et al, abscess and localized hair loss at the injection site were noted in 1 patient each. Patients in this study received PPD-10TU injected intralesionally into the most prominent wart every two weeks for a maximum of 6 sessions.…”

“…6 sessions 50 0 3 Pain, edema Milante et al 40 2019 (Philip-pines) Randomized, open-label, superiority trial Single injection PPD (1) Multiple injection PPD (2) 1: 29 2: 29 Simple, recalcitrant; common Test dose: 0.1 mL PPD-5TU, intradermal on forearm Group 1: PPD-5TU, volume injected determined by by the size of skin test reactivity according to Kus et al 13 intralesion on largest wart Group 2: PPD–5TU, intralesion on all lesions, volume injected determined as maximum 88 TU or 1.76 mL 2-weeks interval, max. 6 sessions 1: 58.6 2: 79.3 0 in all groups 6 1: pain, fever, malaise, edema, pain 2: fever, malaise, edema, vesiculation, more painful than group 1 Mishra et al 14 2022 (Nepal) Open label study PPD 54 Simple, recalcitrant; palmo-plantar, periungual 0.01 mL PPD, intralesion on the largest wart 2-weeks interval, max. 6 sessions 66.7 11 3 2 cases of local site reaction: intense swelling, pain, and edema requiring therapy discon-tinuation Other: mild erythema, edema, pain Moham-med et al 41 2020 (Egypt) RCT PPD (A) MMR (B) Saline (C) A: 30 B: 30 C: 30 Recalcitrant; common, plane, plantar, periungual, ano-genital Test dose: PPD 0.1 mL or MMR 0.1 mL, intradermal on forearm Group A: 0.2 mL PPD (10 TU), intralesion on largest wart Group B: 0.2 mL MMR (20 IU), intralesion on largest wart Group C: 0.2 mL saline, intralesion on largest wart 2-weeks interval, max.…”

“…Injection of antigen to which the patient was previously sensitized induces the elicitation phase of the immune response to recognize HPV antigens. 14 Intralesional PPD is known to stimulate the production of T helper 1 cytokines, such as interleukin IL-4, 5, 8, 12, IFN-γ and tumor necrosis factor (TNF)-α which drive cytotoxic and natural killer cells to develop an immune response against HPV. A study by Azab et al 15 documented an increase in the serum level of IL-17 after PPD injection.…”

A Case of Genital and Extragenital Warts Unresponsive to Immunotherapy Using Measles, Mumps, Rubella Vaccine

“…30 In immunotherapy, the injection of antigen to which the patient was previously sensitized induced the elicitation phase of the immune response to recognize HPV antigens. 34 Although the previous vaccination status was not confirmed, evidence showed that the https://doi.org/10.2147/IMCRJ.S426665…”