Evaluation of serum interleukin-12 and interferon-γ in patients with multiple warts treated with intralesional tuberculin injection

Elkot

J of Cosmetic Dermatology

et al. 2018

Summary Background Treatment of recalcitrant warts represents a continuing therapeutic challenge. Combination therapies can help improve treatment response, decrease adverse effects, and reduce recurrence. Objective To compare the efficacy, safety and immunological effects of a combined acitretin‐intralesional Candida antigen against acitretin alone and Candida antigen alone for intractable warts. Methods Sixty adult patients with intractable warts were included in this study. Patients were subdivided into three groups, each containing 20 patients. Acitretin alone was taken by patients of group I, Candida antigen alone was injected in patients of group II, and group III received a combination of intralesional Candida antigen and acitretin. Serum cytokine levels of IL‐10 and IFN‐γ were measured before and after therapy in the studied groups. Results Total resolution of warts was achieved in 8 patients (40%) of the acitretin alone group, 9 patients (45%) of the Candida antigen alone group and 15 patients (75%) of the combination therapy group. The therapeutic response was statistically higher in the combined acitretin‐Candida antigen group as compared with either agent alone. Adverse effects were non‐significant in the three groups. There were no statistically significant differences in the serum levels of IFN‐γ and IL‐10 between responders and non‐responders after therapy in the three studied groups. Conclusion The combination therapy of acitretin + Candida antigen is superior to either agent alone. Serum cytokine levels of IL‐10 and IFN‐γ were not associated with clearance or persistence of warts in any of the studied groups.

Section: Discussionsupporting

confidence: 93%

Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study

Elkot

J of Cosmetic Dermatology

et al. 2018

“…A total of 54 studies of 3,446 enrolled patients was deemed finally eligible [Table 2]. Overall, 13 studies with 747 patients in the MMR group [10][11][12][13][14][15][16][17][18][19][20][21][22] ; 12 studies with 436 patients in the Candida group [23][24][25][26][27][28][29][30][31][32][33][34] ; nine studies with 311 patients in the Vitamin D group 25,[35][36][37][38][39][40][41][42] ; six studies with 235 patients in the PPD group 38,[43][44][45][46][47] ; six studies with 197 patients in the interferon-α group [48][49][50][51][52][53] ; four studies with 127 patients in the Mw group [54]…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…The overall complete response rate was 60.6% (95% confidence interval: 54.8-66.5%) among 53 studies with 2,548 patients [Figure 2a]. The complete response ratio of the Mw group was 73.1% (95% confidence interval: 55.6-90.6%) in four studies, [54][55][56][57]63 the Candida group was 62.6% (95% confidence interval: 53.3-71.9%) in 11 studies, 23,24,[26][27][28][29][30][31][32][33][34] MMR group was 63.2% (95% confidence interval: 53.1-73.4%) in 13 studies, [10][11][12][13][14][15][16][17][18][19][20][21][22] PPD group was 62.7% (95% confidence interval: 42.4-83.0%) in six studies, 38,[43][44][45][46][47] Vitamin D group was 54.2% (95% confidence interval: 32.7-76.0%) in eight studies, [35][36][37][38][39][40][41][42] interferon-α group was 51.9% (95% confidence interval: 27.0-76.9%) in six studies, [48]…”

Section: Treatment Response Of Injected and Nearby Lesionsmentioning

confidence: 99%

Intralesional immunotherapy for non-genital warts: A systematic review and meta-analysis

Ju¹,

Park²,

Kim³

et al. 2022

IJDVL

Background Intralesional immunotherapy has been reported to be effective for warts and to show good safety profiles, but this has not yet been systematically studied. Aims To determine the efficacy and safety of intralesional immunotherapy for treating non-genital warts. Methods We comprehensively searched the MEDLINE, Embase, Web of Science and Cochrane Library databases from the times of their inception to January 3, 2020. The primary outcome was the rate of complete response of all lesions. The distant complete response rate of warts located in an anatomically different body part and the recurrence rate were also analyzed. Results A total of 54 prospective studies was ultimately included. The immunotherapeutic agents used were Mycobacterium w vaccine, measles, mumps and rubella vaccine, purified protein derivative, Candida antigen, interferon, bacillus Calmette-Guérin vaccine and others. The pooled rate of complete response among all patients with non-genital warts treated using intralesional immunotherapy was 60.6% (95% confidence interval 54.8–66.5%). The pooled recurrence rate was 2.0% (95% confidence interval, 1.1–2.9%). All reported adverse events were mild and transient. Limitations The heterogeneity among studies Conclusion Intralesional immunotherapy is suggested for use in patients with multiple warts, given its promising results, good safety profile and low recurrence rate.

J of Cosmetic Dermatology

“…In the present study, intralesional injection of PPD was associated with complete clearance of all warts in 81.7% of patients. This was higher than the resolution rates reported by Moubasher et al 7 (73.9%), Saoji et al 8 (76%), Amirnia et al 9 (77.1%), Ahmed et al 10 (66.6%) Nimbalkar et al 11 (62.2%), and El‐Samahy et al 12 (56%). All of them included both adults and children.…”

Section: Discussionmentioning

confidence: 58%

Intralesional purified protein derivative versus zinc sulfate 2% in the treatment of pediatric warts: Clinical and dermoscopic evaluation

Awad

Ismael

Sallam

et al. 2022

Background Warts are common in children and can be difficult to treat. Many treatments for warts are destructive and painful in contrast to intralesional immunotherapy using different types of antigens. Aim To evaluate the efficacy, safety, and tolerability of intralesional purified protein derivative (PPD) versus intralesional zinc sulfate 2% in the treatment of pediatric warts. Methods This randomized clinical trial included 120 children with multiple warts divided into two equal groups. Group Ⅰ received intralesional 10 IU (0.1 ml) of PPD, group Ⅱ received intralesional zinc sulfate 2% in the largest wart every 2 weeks till improvement or for a maximum five treatment sessions. The follow‐up period was 6 months after the last treatment session. Results The overall response was equal in both groups (81.7%), but the response of the injected wart was higher in the zinc sulfate group (93.4%) versus PPD group (83.3%) with no significant difference. The highest cure rates were after the 5th session in the PPD group and the 1st session in the zinc sulfate group with slightly lower numbers of sessions needed for cure in the zinc sulfate group (3 sessions) versus the PPD group (4 sessions). The zinc sulfate group showed statistically significant higher rates of complications (pain, inflammation, necrosis, and scar) than PPD group. The zinc sulfate group showed non‐significant higher rates of recurrence during the follow‐up period. Conclusion Both intralesional PPD and zinc sulfate 2% are effective in pediatric warts with higher safety profile of PPD.