Role of autoinoculation in the management of cutaneous warts: a comparison study with 100% tricholoroacetic acid application

Abstract

<p class="abstract"><strong>Background:</strong> Persistent and recurrent warts pose a challenge to physicians despite the availability of multiple treatment options. Autoinoculation exposes HPV antigens to the dermis and vasculature thereby activating a delayed hypersensitivity response, facilitating clearance of both local and distant warts. The aim of this study was to assess the efficacy of autoinoculation and compare it with chemical cautery using 100% trichloroacetic acid.</p><p class="abstract"><strong>Methods:</strong> A non-blinded interventional study was conducted at Goa Medical College, a tertiary care centre. Non-immunocompromised patients with 5 or more non-genital warts were included. Group 1: a wart was removed by punch biopsy, minced and implanted in the dermis. The procedure was repeated at 4 and 8 weeks. Group 2: weekly trichloroacetic acid (100%) application. Response was assessed at 4, 8 and 12 weeks in terms of percentage reduction in the number of warts. Statistical correlation with respect to age, sex, duration, number and type of warts was assessed using Welch ANOVA.<strong></strong></p><p class="abstract"><strong>Results:</strong> In group 1, 63 patients and in group 2, 54 patients completed the study. Post autoinoculation, complete clearance was seen in 46.0% and 3.2% had partial clearance. With TCA application, 33.3% patients had complete and 13% had partial clearance. Response differed with the type of warts. Palmoplantar, periungual warts and verruca vulgaris showed better response to autoinoculation. Filiform and plane warts showed better response to TCA.</p><p class="abstract"><strong>Conclusions:</strong> Autoinoculation is an efficacious treatment modality which can be performed routinely especially for palmoplantar and periungual warts which are particularly challenging to treat with other modalities.</p>

Homologous autoimplantation; an effective modality in the treatment of multiple warts; a non-randomized interventional study at a tertiary care hospital in North-Eastern India

“…14 We found a 100% response to autoinoculation therapy in plantar warts and 66.7% response in palmar warts. These findings are similar to other studies done by Shivkumar et al and Faleiro et al 11,13 Our findings were however not statistically significant.…”

“…These findings were similar to a study done by Faleiro et al where there was a decreasing response to autoinoculation therapy with longer duration of warts. 13 This is contrast to a study done by Lal NR et al where it was found that the patients whose warts cleared completely had had them for a longer duration than those with partial improvement. 9 Malison et al reported that in all patients with condylomas accuminatum for up to 1 year, the cure rate with autogenous vaccine was 86% compared with 0% for those with disease more than a year.…”

“…Complete clearance has been reported as much as 20-74.1% in various studies on autoinoculation. 13 21.1% of the patients had partial resolution at the end of 3 months. Similar findings were seen in a study done by Srivastava et al where 22.64% had partial resolution.…”

Effectiveness of autoinoculation in viral warts: A single arm, open‐label, and clinical trial

“…Another similar study by Faleiro et al 15 reported complete clearance in 50% patients with periungual warts and 80% patients with plantar warts.…”

“…In our study, 4 of 7 (57%) patients with plantar and periungual warts had complete clearance by 12th week. Another similar study by Faleiro et al 15 reported complete clearance in 50% patients with periungual warts and 80% patients with plantar warts.…”