Intralesional immunotherapy with tuberculin purified protein derivative for verruca: A study from a teaching hospital in South India

Kerure, Amit Shivaji; Nath, Amiya Kumar; Oudeacoumar, P

doi:10.4103/0378-6323.175910

Cited by 10 publications

(21 citation statements)

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“…This effect was seen in intradermal forearm injections for the treatment of genital warts, clearance of plantar warts from injection in the periungual sites, and clearance of distant warts among patients with multiple warts. Proportions of patients cleared range from 25% to 100% with a time frame of 3 weeks to 4 months …”

Section: Introductionmentioning

confidence: 99%

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

2019

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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.

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Section: Introductionmentioning

confidence: 99%

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

2019

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“…Kerure et al instead used a dosage of 10 IU (0.1 mL) injected into the largest wart every 2 weeks, until wart resolution or a maximum of six treatments. Complete resolution including distant lesions occurred in 94.4% . The generalizability of these studies to pediatric populations in the United States may be limited by decreased M tuberculosis sensitization.…”

Section: Resultsmentioning

confidence: 83%

“…In our review, there were reports of pruritus, flu‐like symptoms, and erythema resulting from MMR injection in some studies; however, no adverse effects were noted in other studies . Adverse effects were rare from PPD treatment . In contrast, BCG studies reported tender papule formation and lesional ulceration; combined with lower efficacy, BCG offers the least favorable profile for wart immunotherapy…”

Section: Discussionmentioning

confidence: 82%

“…Several PPD studies injected the treatment into multiple warts, making evaluation of distant wart resolution difficult. In other PPD studies, Abd‐Elazeim et al reported complete distant wart resolution of 25%, while Kerure et al reported 94.4% complete resolution of all warts including distal lesions …”

Section: Discussionmentioning

confidence: 93%

“…Immunotherapy is efficacious in pediatric and adult patients, particularly in cases of multiple or recalcitrant warts. Studies of Candida antigen, MMR, and PPD provided comparable complete response rates of injected warts, from 39% to 88% for candida, 26.5% to 92% for MMR, and 23.3% to 94.4% for PPD . However, BCG appears to be an inferior treatment choice, with clearance rates limited at 33.3%‐39.7%,…”

Section: Discussionmentioning

confidence: 94%

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Intralesional immunotherapy for pediatric warts: A review

Fields

Saikaly

Schoch

2020

Pediatric Dermatology

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Cutaneous warts are a common pediatric complaint with modest response to first‐line treatments. Warts are a manifestation of human papillomavirus (HPV) infection and are cleared by cell‐mediated immunity (CMI). Intralesional immunotherapy treatments have been studied as alternative therapies, particularly for recalcitrant or multiple warts, including Candida antigen, mumps antigen, the combined measles, mumps, and rubella (MMR) vaccine, tuberculin purified protein derivative (PPD), and bacille Calmette‐Guerin (BCG) vaccine. These treatments are thought to increase HPV recognition by stimulating CMI. In this review, we evaluate and compare the efficacy and adverse effects of intralesional immunotherapy in the treatment of pediatric warts. Articles met inclusion criteria if they specifically evaluated the effects of intralesional immunotherapy (candida, MMR, tuberculin PPD, or BCG) as treatment for cutaneous warts in a pediatric population, and if they quantified treatment effect in a reproducible manner. Twenty‐one studies met criteria. Many studies demonstrated complete clearance of injected common warts in pediatric patients with clearance rates ranging from 23.3% to 95.2%. Distant wart resolution was common. Intralesional immunotherapy is a promising treatment option for cutaneous warts in children.

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Management of Difficult-to-Treat Warts: Traditional and New Approaches

Friedman

2021

Am J Clin Dermatol

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Intralesional immunotherapy with tuberculin purified protein derivative for verruca: A study from a teaching hospital in South India

Cited by 10 publications

References 0 publications

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

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

Intralesional immunotherapy for pediatric warts: A review

Management of Difficult-to-Treat Warts: Traditional and New Approaches

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