Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine.
Nofal A, Nofal E.
J Eur Acad Dermatol Venereol. 2010 Feb 25.
Common warts are a nuisance in which they are visible, their cause is known; but despite numerous treatments available, none of them have shown to be 100% effective. As a consequence, several treatments, topical (salicylic acid…) and physical (cryotherapy…) are often tried.
135 patients with warts, multiple or single, recalcitrant or not were included in the study. After randomisation in patient-control groups, 85 patients received intralesional MMR vaccine whereas the remainder (50)(control group) received intralesional saline. MMR injections were done into the warts only after immunoreactivity was demonstrated. Injections were done at 2-weekly intervals for up to 5 times, when complete clearance was observed – whichever came first.
Results show statistically significant results when comparing the patients with the control group. Complete disappearance was observed in 81.4% of patients (27.5% in the control group), partial response in 10% of patients (15% in the control group), no response in 8.6% of patients (57.5% in the control group). Warts tend to recur and it is interesting to note than none of the patients treated (compared to 3 in the control group) developed recurrence 6 months after the treatment.
Viral warts on the feet
The results of this study are very promising and numbers favour the value of this study. It is to be noted though that the proportion of non-reactive patients is not mentioned and that in the absence of a precise definate immunogenic pathogenesis, it could have been interesting to do the injections in patients without local reaction to the MMR vaccine test and see if it is also effective. It is useful because should the results not be reproductible, this could be explained by the “active” substance in the excipient.
Despite the natural evolution, during which most warts disappear on their own (not in all cases), there are significant differences between the treated group and the group treated with saline only. It would be interesting also to see how effective the treatment would be with condlyloma accuminata (which is also due to human papillomavirus). It would also be interesting to compare efficacy with other treatments which have proven to be effective such as cryotherapy.