Intralesional Antigen Immunotherapy in the Treatment of Periungual Warts

Abstract

Background Intralesional immunotherapy using different types of antigens is considered an effective and safe treatment option for different types of warts. However, there are few studies that illustrate the use of these antigens in the treatment of periungual warts as a distinct type of warts. Objective To evaluate the efficacy and safety of three antigens: measles, mumps, rubella (MMR) vaccine, Candida antigen, and purified protein derivative (PPD) in the treatment of periungual warts. Methods The study included 150 patients who were randomly assigned to 3 groups with 50 patients in each. Each agent was injected intralesionally at a dose of 0.1 mL into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results Complete clearance of warts was observed in 70%, 80%, and 74% in PPD, Candida antigen, and MMR vaccine groups, respectively. There was no statistically significant difference regarding the therapeutic response between the 3 studied groups. Adverse effects were transient and insignificant in the 3 groups. No recurrence of the lesions was reported in any of the studied groups. Conclusions Intralesional antigen immunotherapy seems to be an effective therapeutic option for the treatment of periungual warts.

Successful Treatment in a Child with Refractory Periungual Warts by Local Hyperthermia: A Case Report

“…PW presents as keratotic papules with rough, hard surfaces around or under the nails, which can also involve the nails, making them yellow, thickened, and deformed. 2 Patients with PW usually have no obvious symptoms of discomfort, but this disease deeply affects the psychological health and social activities of patients, especially in children. Traditional treatments for PW include cryotherapy, salicylic acid therapy, photodynamic therapy, antiviral drugs, and herbal treatments.…”

“…Compared to common warts, PW grows in a special location and tends to spread under the nails, making them hard to treat, with a high recurrence rate. 1 , 2 …”

“…Compared to common warts, PW grows in a special location and tends to spread under the nails, making them hard to treat, with a high recurrence rate. 1,2 In this case, the 6-year-old child was diagnosed with refractory PWs based on clinical manifestations and had tried many treatments on PWs but with no effect and even worsened, manifested by an increased number of warts, blisters, and exudation at the lesions. This patient did not respond well to conventional treatments and had a large number of warts, so we tried hyperthermia.…”

“… 1 Traditional treatments for PW include cryotherapy, salicylic acid therapy, photodynamic therapy, antiviral drugs, and herbal treatments. 2 However, these treatments have certain disadvantages, such as cryotherapy and photodynamic therapy, which can produce great pain, and oral medications that have certain side effects. Local hyperthermia is currently applied to skin diseases associated with human papillomavirus (HPV) infection, such as common warts and condyloma acuminate.…”

Nails in older adults

“…Treatment of nail unit verruca is often challenging. Alternative therapies include intralesional (IL) candida antigen or bleomycin [ 45 , 46 ].…”