Intralesional tuberculin (PPD) versus measles, mumps, rubella (MMR) vaccine in treatment of multiple warts: a comparative clinical and immunological study

Abstract

Intralesional purified protein derivative (PPD) or mumps, measles, rubella (MMR) were not previously compared regarding their efficacy or mechanism of action in treatment of warts. We aimed to compare their efficacy in treatment of multiple warts and investigate their effect on serum interleukin (IL)-4 and IL-12. Thirty patients with multiple warts were included (10 treated with PPD, 10 with MMR, and 10 with normal saline (control)). Injection was done every 3 weeks until clearance or maximum of three treatments. Clinical response of target and distant warts was evaluated. Serum ILs-4 and -12 were assessed before and after treatment. A significantly higher rate of complete response was found in target and distant warts with PPD (60% each) and MMR (80%, 40%, respectively) compared with controls (0%), with no significant difference between both treatments. After treatment, the control group showed the lowest serum IL-12 and IL-4 levels compared with the MMR- and PPD-treated groups with statistically significant difference in between. MMR resulted in a significantly higher serum IL-12 than PPD. With PPD, IL-4 was increased with statistically significant change compared with pretreat-ment level. Intralesional PPD and MMR show comparable efficacy and safety in treatment of multiple warts. Serum ILs-4 and-12 increase following antigen injection.

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature

“…A total of 80% of the MMR group had complete resolution compared to only 60% in the PPD group; however the difference between the two groups was not statistically significant. No side effects were reported in the PPD group, and only one patient in the MMR group reported erythema .…”

A comparative study between intralesional PPD and vitamin D3 in treatment of viral warts

“…The host immune system is activated to recognize the virus, leading to wart clearance. [13][14][15][16][17][18] According to research conducted earlier Injecting PPD into the HPV-infected tissue generates strong proinflammatory signals and attracts antigen-presenting cells, which recognize HPV particles in the infected tissue leading to a strong adaptive immune response which helps in clearing the infection. The Th1 cytokines such as interleukin-4 (IL-4), IL-5, IL-8, interferons gamma, and tumor necrosis factor-alpha, which activates cytotoxic and natural killer cells that stimulate a strong immune response against HPV are mainly responsible for this process.…”

Intralesional immunotherapy for pediatric warts: A review

“…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%,…”

“…Not all studies stratified treatment response by age. However, Na et al and Shaheen et al did correlate significantly improved treatment response to MMR and PPD with younger age . Three Candida antigen studies examined exclusively pediatric populations, with complete response rates of 47%, 70.9%, and 87%; the study with a response rate of 47% was a combined rate for patients receiving either candida or mumps .…”