Abstract:Background
Warts are common in children and can be difficult to treat. Many treatments for warts are destructive and painful in contrast to intralesional immunotherapy using different types of antigens.
Aim
To evaluate the efficacy, safety, and tolerability of intralesional purified protein derivative (PPD) versus intralesional zinc sulfate 2% in the treatment of pediatric warts.
Methods
This randomized clinical trial included 120 children with multiple warts divided into two equal groups. Group Ⅰ received int… Show more
“… 23 2022 (Egypt) RCT PPD (A) Cryo-therapy + PPD (B) A: 25 B: 25 Simple, recalcitrant; common Group A: Test dose: 0.1 mL PPD-5TU, intradermal on forearm Treatment: volume injected determined by the size of skin test reactivity according to Kus et al 13 (intralesion on largest wart) Group B: cryotherapy applied for all lesions using liquid nitrogen spray at a distance of 1 cm, margin 1–2 mm (single freezing cycle) followed by intralesional PPD injection into the largest wart 2-weeks interval, max. 4 sessions A: 48 B: 44 A: 20 B: 0 2 Both groups: pain, redness, edema B: blistering, hypopigmentation Awad et al 24 2022 (Egypt) RCT PPD (1) Zinc sulfate 2% (2) 1: 60 2: 60 (pediatric) Simple, recalcitrant; common, plantar, anogenital Group 1: 0.1 mL PPD, intralesion on largest wart Group 2: Zinc sulfate 2%, intralesion on largest wart 2-weeks interval, max. 5 sessions Target warts: 1: 83.3 2: 93.4 Distant warts: 1: 81.7 2: 81.7 1: 1.7 2: 10 6 1: pain, itching, fever, acute urticaria 2: pain, inflammation, necrosis, ulceration, necrosis, scar, itching, fever, scarring alopecia Azab et al 15 2022 (Egypt) RCT PPD (1) Control (2) 1: 63 2: 50 Simple, recalcitrant; ano-genital Test dose: 0.1 mL PPD, intradermal on forearm Group 1: PPD-10TU, intralesion on largest wart, 2-weeks interval for 6 sessions Group 2: included healthy individuals, no treatment given Measurements of IL-17 in all patients before and after PPD injection in group 1, and to all control subjects in group 2 …”
Section: Resultsmentioning
confidence: 99%
“…Rare AEs in the form of acute urticaria were reported in 3 studies. 8 , 24 , 45 The mechanisms underlying such events are still unknown. Figure 4 Systemic adverse events following Purified Protein Derivative injection.…”
Introduction
Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV.
Objective
To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts.
Materials and methods
A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common
Mycobacterium tuberculosis
infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population.
Conclusion
Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.
“… 23 2022 (Egypt) RCT PPD (A) Cryo-therapy + PPD (B) A: 25 B: 25 Simple, recalcitrant; common Group A: Test dose: 0.1 mL PPD-5TU, intradermal on forearm Treatment: volume injected determined by the size of skin test reactivity according to Kus et al 13 (intralesion on largest wart) Group B: cryotherapy applied for all lesions using liquid nitrogen spray at a distance of 1 cm, margin 1–2 mm (single freezing cycle) followed by intralesional PPD injection into the largest wart 2-weeks interval, max. 4 sessions A: 48 B: 44 A: 20 B: 0 2 Both groups: pain, redness, edema B: blistering, hypopigmentation Awad et al 24 2022 (Egypt) RCT PPD (1) Zinc sulfate 2% (2) 1: 60 2: 60 (pediatric) Simple, recalcitrant; common, plantar, anogenital Group 1: 0.1 mL PPD, intralesion on largest wart Group 2: Zinc sulfate 2%, intralesion on largest wart 2-weeks interval, max. 5 sessions Target warts: 1: 83.3 2: 93.4 Distant warts: 1: 81.7 2: 81.7 1: 1.7 2: 10 6 1: pain, itching, fever, acute urticaria 2: pain, inflammation, necrosis, ulceration, necrosis, scar, itching, fever, scarring alopecia Azab et al 15 2022 (Egypt) RCT PPD (1) Control (2) 1: 63 2: 50 Simple, recalcitrant; ano-genital Test dose: 0.1 mL PPD, intradermal on forearm Group 1: PPD-10TU, intralesion on largest wart, 2-weeks interval for 6 sessions Group 2: included healthy individuals, no treatment given Measurements of IL-17 in all patients before and after PPD injection in group 1, and to all control subjects in group 2 …”
Section: Resultsmentioning
confidence: 99%
“…Rare AEs in the form of acute urticaria were reported in 3 studies. 8 , 24 , 45 The mechanisms underlying such events are still unknown. Figure 4 Systemic adverse events following Purified Protein Derivative injection.…”
Introduction
Various treatments available today for anogenital and cutaneous warts have limitations, including time-consuming, challenging to perform, and the risk of scarring. A new treatment using tuberculin purified protein derivative (PPD) has been developed, which is expected to generate cellular immunity against HPV.
Objective
To assess the evidence for the efficacy and safety of PPD treatment for cutaneous and anogenital warts.
Materials and methods
A literature search was performed with the keyword-based search on digital libraries, including the National Library of Medicine, Cochrane Controlled Register of Trial, and Google Scholar, using the following terms: anogenital warts, condyloma acuminata, cutaneous warts, human papillomavirus, immunotherapy, and tuberculin purified protein derivative. Original studies on treating cutaneous or anogenital warts with PPD were included. The results were 47 clinical trials and 4 case reports. Most of the research was done in countries with common
Mycobacterium tuberculosis
infection. The treatment showed good efficacy. Comparative studies showed that the treatment has similar efficacy with other immunotherapies. No significant side effects were reported, with evidence of the safety use on the pregnant population.
Conclusion
Based on good efficacy and safety, PPD can be considered an alternative therapy, especially in countries where tuberculosis is frequent.
“…Nine (36%) patients showed partial resolution of warts. Indeed, according to various studies, 3,[14][15][16] increasing the number of immunotherapy injections and the follow-up period may have increased the number of responders. Interestingly, responding patients had significantly fewer warts than non-responding patients indicating that an increased HPV load of infection may result in viral resistance to intralesional PPD immunotherapy.…”
Section: Discussionmentioning
confidence: 99%
“…The response was evaluated as follows: responders who had complete eradication of both injected and distant warts with restoration of normal skin, partial response who had 50%–99% decrease in either size or number of warts, and non‐responders who showed 0%–49% decrease in either size or numbers of warts 14 …”
Section: Methodsmentioning
confidence: 99%
“…The response was evaluated as follows: responders who had complete eradication of both injected and distant warts with restoration of normal skin, partial response who had 50%-99% decrease in either size or number of warts, and non-responders who showed 0%-49% decrease in either size or numbers of warts. 14 Only one patient had a negative PPD skin test and was thus excluded. Two patients were dropped from the study due to noncompliance with follow-up visits.…”
Background
Several studies demonstrated the efficacy of intralesional purified protein derivative (PPD) immunotherapy in warts eradication. Nevertheless, the precise induced immune mechanisms are undetermined. Injected PPD is hypothesized to induce a delayed hypersensitivity reaction associated with cytokines release. Interleukin (IL)‐18 has a major role in defense against viral infection via inducing interferon‐γ release from T‐helper 1 and natural killer (NK) cells. Moreover, IL‐18 triggers Fas ligand expression on cytotoxic T cells and NK cells enhancing their cytotoxicity against virally infected cells.
Aim
The aim of this study was to assess the role of IL‐18 in the response to intralesional PPD injection in patients with warts.
Methods
The study included 25 patients with warts and 25 HCs. Patients underwent PPD skin test, and only patients with positive tests were included and received intralesional PPD injections starting 72 h after the test then every 2 weeks until wart clearance or a maximum of 3 sessions. Serum IL‐18 level was measured via enzyme‐linked immune‐sorbent assay in patients (pre‐treatment and 2 weeks after the last injection) and HCs.
Results
After 3 sessions of injection, six (24%) patients were designated responders, nine (36%) patients showed partial response, and 10 (40%) patients were designated non‐responders. Serum IL‐18 level, post‐treatment, was significantly higher than pre‐treatment level (p = 0.025) and level in HCs (p = 0.036). Furthermore, the post‐treatment level was significantly higher in responders than non‐responders (p = 0.025).
Conclusion
IL‐18 is probably implicated in the immune mechanisms induced by PPD injection that cause eradication of warts.
Introduction Intralesional antigen immunotherapy represents a promising therapeutic approach for the treatment of different types of warts, particularly if multiple and/or recalcitrant. Aim to investigate the efficacy and safety of combined cryotherapy with intralesional purified protein derivative (PPD) immunotherapy in the treatment of multiple common warts. Methods Fifty patients were randomly divided into two groups (25 patients each): Group A: receiving intralesional PPD immunotherapy for the largest wart, while group B: receiving cryotherapy for all warts plus intralesional PPD for the largest wart. Treatments were performed every 2 weeks for a maximum of four sessions. Photographs were taken at baseline and at each visit and clinical response was evaluated by the reduction in number and size of warts. Adverse effects were recorded. Results There was a significant reduction in size and number of warts in both groups ( P < .001), with no significant difference between the two groups. Complete clearance of the lesions was observed in 48% of patients in group A and 44% in group B ( P = .39). Higher rates of near complete/complete response were achieved after fewer sessions (2, 3 sessions) in group B ( P = .002). Blistering was common after cryotherapy. Higher rate of hypopigmentation was noticed after combined treatment than after PPD monotherapy (56%, 8% respectively; P < .001), which resolved gradually. Conclusion Both intralesional PPD alone and combined cryotherapy with PPD are safe and effective in clearing of common warts. Cryotherapy may be a successful adjunct to intralesional PPD immunotherapy that helps in reducing the number of treatment sessions. The study protocol was registered at ClinicalTrials.gov with ID: NCT04288817
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