Intralesional human papillomavirus vaccine for the treatment of recalcitrant cutaneous warts

Abstract

Human papillomavirus (HPV) is ubiquitously distributed in the population worldwide and its most frequent clinical presentation is cutaneous warts. Despite various treatment options currently available, many patients experience persistent and refractory disease. We sought to evaluate the clinical effectiveness and safety profile of intralesional HPV 9‐valent vaccine for the treatment of recalcitrant warts. A retrospective study was performed for all cases of cutaneous warts treated with intralesional 9‐valent HPV vaccine between January 2017 and March 2021. Epidemiologic, clinical, and treatment data, including safety and effectiveness scores, were reviewed. Our cohort was composed of 20 patients: 13 adults and seven children. Twelve patients (60%) displayed a complete response whereas 8 patients (40%) showed a partial response. Older age was associated with a better response to treatment, while a history of laser therapy was associated with a worse prognosis. Adverse events were local, transient, and negligible. No systemic adverse effects were reported. Intralesional 9‐valent HPV vaccine may be considered for the treatment of recalcitrant cutaneous warts. Controlled studies are required to confirm these results.

Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases—A Comprehensive Review

“…Additionally, it was recently reported that the 9vHPV vaccine as an intralesional treatment led to 60% of patients achieving complete resolution of the disease. Intriguingly, unlike intramuscular vaccination, where a younger age was linked to a more favorable response, the intralesional administration showed that advanced age was associated with an improved score ( p < 0.05, β of −0.044 [confidence interval, −0.083 to −0.004]) for wart clearance [ 4 ] ( Table 1 ).…”

“…HPV vaccines consist of noninfectious particles that resemble HPV and originate from the L1 capsid protein, which is unique to each subtype of HPV. Notably, there is homology between the L1 capsid proteins found in HPV subtypes associated with common warts, such as HPV subtypes 1–4, and those present in HPV vaccines [ 4 , 10 ]. This similarity may potentially trigger cross-immunity, eliciting an immune response against a broad range of HPV subtypes, including those leading to AGW.…”

“…This similarity may potentially trigger cross-immunity, eliciting an immune response against a broad range of HPV subtypes, including those leading to AGW. Furthermore, HPV vaccines include adjuvants that enhance immune responses, as demonstrated by more robust vaccine antibody responses compared to those induced by natural infection [ 4 , 23 , 70 ]. These vaccines have been shown to upregulate levels of Th1 cytokines, including TNF-α and IL-2, along with proinflammatory cytokines, such as IL-1α, IL-1β, and IL-6 [ 27 ].…”

“…The intralesional administration of either of the HPV vaccines was well-tolerated, with only transient pain and induration at the injection site and a low occurrence of erythema and contact dermatitis (36.4%) [ 4 , 23 , 24 ].…”

“…Recently, the highly recommended HPV vaccine has demonstrated its utility beyond its originally intended prophylactic purpose, being postulated as a treatment option for HPV-induced lesions, ranging from benign warts to dysplastic and neoplastic lesions [ 4 , 5 , 6 , 7 , 8 ]. Subsequently, our aim is to scrutinize the recent literature that has surfaced concerning the therapeutic applications of HPV vaccines in diverse cutaneous lesions.…”