Efficacy and safety of single versus multiple intralesional immunotherapy with purified protein derivative (PPD) in the treatment of multiple verruca vulgaris

Abstract

Background Despite the numerous studies on the use of purified protein derivative (PPD), a protein extracted from Mycobacterium tuberculosis, in verruca vulgaris, there is no standardized regimen, and efficacy of single versus multiple injections has not been compared. Methods This is a randomized, open‐label, superiority trial. Sixty‐six patients with at least three warts in two different anatomic sites were randomized into two groups: a single injection (n = 29) and multiple injection (n = 29) groups. Patients were treated every 2 weeks until a maximum of six sessions. Results Multiple injections (79.3%) showed superior clearance rates compared to a single injection of PPD (58.6%) (P‐value = 0.0236). Multiple injections also exhibited faster clearance at each time point (P = 0.048). Pain was statistically more significant in the multiple injection group (P = 0.0005). There was no statistically significant difference in incidence of adverse events (P = 0.1795). Amongst all cleared patients in both groups, there were no recurrences after 6 months. Conclusion Multiple injections of warts with PPD cleared more patients with multiple common warts than the use of single injections at the end of 12 weeks and were faster in clearing patients at every time point. Single injection was better tolerated than multiple injections. Both treatments exhibited similar safety profiles and recurrence rates.

Efficacy of tuberculin immunotherapy in verruca vulgaris: Our experience from single center from North‐West India and review of literature

“…In this study 5 (12.5%) patients showed recurrences which were similar to previous literature 13,16 . While in other studies, recurrences range between 0% and 2% during follow up 3,10,12,14,15 . The increased recurrences observed in our study may occur because of the longer duration of follow up or could be because of reinfection as three patients had recurrences at different sites.…”

“…13,16 While in other studies, recurrences range between 0% and 2% during follow up. 3,10,12,14,15 The increased recurrences observed in our study may occur because of the longer duration of follow up or could be because of reinfection as three patients had recurrences at different sites. Pass 18 have suggested that even the non-viral antigens which are common to both warts and proliferating epithelial cells may also become target and non-viral specific immunity is being generated by this type of immunotherapy.…”

“…Literature review of published studies reported response rates ranging from 21% to 94% (Table S2). 3,6,[8][9][10][11][12][13][14][15][16] This variation in response to immunotherapy may be due to vast majority of factors affecting the disease pathogenesis and various genotypes of HPV.…”

Comparative study of intralesional tuberculin protein purified derivative (PPD) and intralesional measles, mumps, rubella (MMR) vaccine for multiple resistant warts

“…10 Other studies demonstrated variable degrees of wart regression using tuberculin PPD antigens, and that are dose dependent. [11][12][13][14] MMR intralesional antigen was evaluated earlier and 50% of subjects reported clearance of their warts and 46.7% had their distal warts partially resolved. They demonstrated better response among younger patients.…”

Comparative efficacy of using a combination of intralesional purified protein derivative with low dose isotretinoin in the treatment of recalcitrant common warts

“…This may be explained by the lower number of sessions (three sessions only per course), longer intervals between sessions (3 weeks‐interval), and the difference in warts recalcitrance in Kus et al's work. On the other hand, the clearance rate in group (A) was lower than what was reported by many different authors (Eassa et al, 1 [50%], Abd‐Elazim et al, 16 [75%], Amirnia et al, 1 [77%], Shaheen et al, 13 [60%], Nimbalkar et al, 12 [62%], Abo‐Taleb et al, 14 [72%], Milante et al, 17 [58.6%], Chandra et al, 5 [50%], and Kaimal et al, 18 [45%]). Also, this finding may be attributed to the lack of therapeutic standardization among different studies.…”