Intralesional immunotherapy with purified protein derivative (PPD) for cryotherapy‐resistant warts

Kaimal, Sowmya; Gopinath, Hima; Premalatha, Venkatesh

doi:10.1111/ijd.14839

Cited by 14 publications

(32 citation statements)

References 11 publications

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“…Additionally, at the end of the follow up period, which extended for 6 months, no patients showed recurrence of lesion that is matching with Abo-Taleb et al (10) and Kaimal et al (15) results. Induction of longterm cell-mediated immunity, which allows the body to recognize HPV, stimulates the production of memory Tcells against the virus, and intensifies effector response mechanisms of memory T-cells against the virus (17) .…”

Section: A B Csupporting

confidence: 88%

Intralesional Injection of Purified Protein Derivative in the Treatment of Viral Warts: A Pilot Study

Atef¹,

Diab²,

Salah³

2021

The Egyptian Journal of Hospital Medicine

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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.

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Section: A B Csupporting

confidence: 88%

Intralesional Injection of Purified Protein Derivative in the Treatment of Viral Warts: A Pilot Study

Atef¹,

Diab²,

Salah³

2021

The Egyptian Journal of Hospital Medicine

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“…for the use of PPD in cryotherapy resistant warts and the results were encouraging. 5 Their study outcomes also matches our observations. Jaiswal et al, report clearance in over 68.6% patients.…”

Section: Kaimal Et Al Conducted An Open Labelled Uncontrolled Trialsupporting

confidence: 88%

“…This is the basis for lesion clearance at not only the injection site but also at distant sites. 4,5 We have tried to make use of purified protein derivative in context of Indian population for the management of multiple warts as this treatment modality is easily available and most importantly cost effective.…”

Section: Introductionmentioning

confidence: 99%

Intralesional immunotherapy with purified protein derivative antigen in the treatment of multiple cutaneous warts: an open label study in an urban teaching hospital

et al. 2020

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Background: Viral warts caused by human papilloma virus are a group of oncogenic viruses that result in verrucous growths on the skin and mucosae. Intralesional immunotherapy has been tried in recent years with success with the use of a variety of antigens to non-specifically stimulate the cell mediated immune response. Similarly, we undertook a study to evaluate the efficacy and safety of tuberculin purified protein derivative as an immunotherapeutic modality.Methods: A total of 25 patients were included in the study. Each patient was injected with 2.5 TU of tuberculin PPD (0.04 ml) intralesionally into most of the warts at 2 weekly intervals for a maximum of six sessions. It is an interventional study with follow-up upto 6 months. Descriptive analysis was done with use of SPSS version 23 tool. Complete resolution of warts was considered as the clinical end point. Response was graded as excellent response (>80% resolution), good response (50-80%), fair response (20-50%) and no response (<20%).Results: Out of the 25 patients, 14 patients showed excellent response (56%), 4 patients showed good response (16%), 5 patients showed fair response (20%) and 2 patients did not show any response (8%). Over 22 patients (88%) showed features of pain, erythema and inflammation at the injection site, whereas 3 patients (12%) developed itching at the site. The ‘faces’ pain rating scale was used to measure pain tolerance. An overall response rate (fair/good/ excellent) was given by 23 out of the 25 patients (92%), which proved satisfactory.Conclusions: Intralesional immunotherapy with PPD effectively cures warts which are present locally and also at distant sites. It is safe, economic and efficacious.

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“…Amirnia et al reported significantly higher occurrence of blisters with cryotherapy compared with tuberculin immunotherapy 13 . Blister formation is a well‐recognized side effect of cryotherapy as freezing and thawing induces epidermal necrosis with resultant cell oedema and apoptosis 10 . Our rate of this complication was comparable to other studies 8,17 …”

Section: Discussionsupporting

confidence: 75%

“…Non‐responders to immunotherapy might have been included in our cohort as positive skin test was not an inclusion criterion. Immunotherapy response rates of 50% to 62.2% were reported in studies that did not perform skin test as a prerequisite for enrollment 10,11 . Several studies showed that regardless of skin test induration diameter, a standard dose of immunotherapy could be used 11,17,19 and the induration diameter of the skin test was not associated with overall therapeutic response 8 …”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of intralesional tuberculin purified protein derivative versus cryotherapy in the treatment of warts: An assessor‐blinded, randomized controlled trial

Kammal

Jamil

Nor

2021

Dermatologic Therapy

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Cryotherapy is a standard treatment for warts. Tuberculin immunotherapy is a novel therapeutic option. We compared the efficacy and safety of cryotherapy versus tuberculin immunotherapy in a randomized, assessor‐blinded study. 15 patients were treated with intralesional tuberculin and 15 patients received cryotherapy every 2 weeks until complete wart resolution or a maximum of six sessions. Wart diameter, total number of warts and adverse effects were documented. Complete clearance of treated warts was achieved in 13(86.7%) and 11(73.3%) of patients with immunotherapy and cryotherapy respectively. Immunotherapy showed greater wart size reduction (51.88 ± 89.36 mm) than cryotherapy (32.99 ± 36.19 mm), (p = 0.46). Immunotherapy resulted in 64% reduction in total number of warts compared to 23.2% with cryotherapy, p < 0.01. More blisters developed with cryotherapy (46.7%) than immunotherapy (6.7%), (p = 0.01). Compartment syndrome‐like features complicate immunotherapy in 1 patient. Tuberculin immunotherapy and cryotherapy are equally effective in treating warts. Immunotherapy has added benefit with resolution of distant warts. Safety profiles were similar except for blisters which were more common with cryotherapy.

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Intralesional immunotherapy with purified protein derivative (PPD) for cryotherapy‐resistant warts

Cited by 14 publications

References 11 publications

Intralesional Injection of Purified Protein Derivative in the Treatment of Viral Warts: A Pilot Study

Intralesional Injection of Purified Protein Derivative in the Treatment of Viral Warts: A Pilot Study

Intralesional immunotherapy with purified protein derivative antigen in the treatment of multiple cutaneous warts: an open label study in an urban teaching hospital

Efficacy and safety of intralesional tuberculin purified protein derivative versus cryotherapy in the treatment of warts: An assessor‐blinded, randomized controlled trial

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