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Intralesional immunotherapy with purified protein derivative (PPD) for cryotherapy‐resistant warts
Author(s) -
Kaimal Sowmya,
Gopinath Hima,
Premalatha Venkatesh
Publication year - 2020
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/ijd.14839
Subject(s) - cryotherapy , medicine , purified protein derivative , immunotherapy , common warts , dermatology , complete response , plantar warts , human papillomavirus , surgery , immune system , chemotherapy , immunology , pathology , tuberculosis , tuberculin
Background Cryotherapy and immunotherapeutic modalities elicit nonspecific immune response against the human papillomavirus. There is a paucity of literature on the effects of a sequential shift to immunotherapy in cryotherapy‐resistant warts. Aim To study the efficacy of intralesional purified protein derivative (PPD) immunotherapy in cryotherapy‐resistant warts. Methods Patients with cryotherapy‐recalcitrant cutaneous warts were given intralesional injections of PPD into the index warts (oldest or largest) at 2‐week intervals until complete clearance or up to a maximum of six injections. The response in the treated index and distant warts was defined as complete, partial, and no response (<25%). Complete responders were followed up for another 3 months to check for recurrence. Results Twenty‐eight patients completed the study protocol. Of the eight patients with single warts, four (50%), one (12.5%), and three (37.5%) patients had complete, partial, and no response, respectively. Of the 20 patients with multiple warts, nine (45%) had complete clearance of all warts, two (10%) each had complete and partial response in the index wart, respectively, with no response of the distant warts, and seven (35%) had no response in all warts. Complete response was seen in an average of 3.1 injections (range 1–5). There was no recurrence at the follow‐up visit. Conclusion Immunotherapy with PPD has potential in producing regional and remote wart regression even in cryotherapy‐resistant warts. It is a safe and economical modality in children, multiple warts, and difficult‐to‐treat warts.