Tuberculin Purified Protein Derivative Immunotherapy in the Treatment of Viral Warts

Abstract

Introduction: Viral warts are caused by human papillomavirus. Although various treatment modalities are available, many of them result in the partial clearance of warts or recurrence. Immunotherapy has been tried in the recent times with variable success rates. We undertook a study to evaluate the safety and efficacy of immunotherapy using tuberculin purified protein derivative (PPD) for the treatment of viral warts. Materials and Methods: A total of 45 patients were included in the study. Each patient was injected with 10 TU of tuberculin PPD (0.1 ml) intralesionally in the largest wart at 2 weekly interval. A total of maximum six treatment sessions were conducted. Resolution of viral warts was considered as the clinical end point of the study. The clinical assessment was done by photographic measurements at baseline, before each treatment session, and 3 weeks after the completion of treatment. Results: A total of 62.2% patients (28 out of 45) showed complete clearance at injected and distant warts, eight patients (17.8%) showed partial clearance, and nine patients (20%) showed no improvement. No significant side effects were observed except for localized hair loss around injected viral wart over the scalp. Conclusion: Tuberculin PPD immunotherapy was found to be a safe and effective treatment modality for the treatment of viral warts.

Role of physiotherapy in palliative care

“…Few other studies with PPD have reported local side effects like abscess formation, alopecia areata, immediate hypersensitivity reaction and post inflammatory hyperpigmentation. 17 The target and distant warts resolved without any scarring and hyperpigmentation in our study.…”

“…This in in contrast to another study that showed complete clearance in 84% of filiform warts, 67% of common warts and 80% of palmoplantar warts, and no improvement in periungual warts. 17 Immunotherapy with tuberculin PPD in this study was well tolerated. Pain and swelling was noted in one patient at the injection site following the first injection.…”

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

“…Purified protein derivative is used in immunotherapy to eliminate warts. While still being incompletely understood, immunotherapy is hypothesized to mount a type 1 cytotoxic T cell‐mediated and delayed‐type hypersensitivity response to the antigen used and HPV . This leads to a strong adaptive immune response not only to M. tuberculosis but also to HPV, ultimately leading to the destruction of the virus and eventual clearance of the wart …”

“…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 …”

“…Extensive literature review showed several case series, open‐label, and superiority clinical trials versus placebo demonstrating field effect after intralesional and intradermal injection of PPD . These studies were conducted in countries with mandatory BCG injections (Turkey, Thailand, Egypt and India) hence they would exhibit similar herd immunity as the Philippine population.…”