Intralesional Versus Intramuscular Hepatitis B Virus Vaccine in the Treatment of Multiple Common Warts

Abstract

BACKGROUNDHepatitis B virus (HBV) vaccination is associated with stimulation of humoral and cell-mediated immunity. Intralesional HBV vaccine has been recently used as an immunotherapy of common warts with relatively low success rate.AIMTo assess the efficacy and safety of intralesional versus intramuscular (IM) HBV vaccine in the treatment of multiple common warts.PATIENTS AND METHODSThe study included 60 patients with multiple common warts who were randomly assigned to 2 groups: intralesional HBV vaccine or IM HBV vaccine. In the intralesional HBV vaccine group, the vaccine was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Intramuscular HBV vaccine group received 3 injections in the deltoid muscle at 0, 1, and 6 months.RESULTSComplete wart clearance was reported in 7 patients (23.3%) of the intralesional HBV vaccine group and 15 patients (50%) of the IM HBV vaccine group. The difference was statistically significant in favor of the IM group (p = .0479). Adverse effects were mild and insignificant in the 2 groups.CONCLUSIONHBV vaccine, particularly the IM form seems to be a promising, well-tolerated therapeutic option for the treatment of warts.LIMITATIONSShort follow-up period and small sample size.

Intralesional acyclovir versus intralesional Hepatitis-B vaccine in treatment of resistant plantar warts: a randomized controlled trial

“…Hepatitis-B vaccine (HBV) is a very recently introduced immunotherapeutic line for treating warts being safe, readily available, exceedingly stable and linked to promoting a strong immune response [ 8 , 16 ]. The proven efficacy of acyclovir against DNA viruses strongly recommends it as a potential antiviral line in treating warts [ 6 ].…”

“…Using second generation HBV, Nofal et al in 2021 achieved a complete response in only 20.7% of patients with common warts treated with intralesional HBV [ 16 ]. In 2022, he reported compete wart clearance in 23.3% and 50% of patients with common warts using intralesional and intramuscular HBV respectively [ 8 ].…”

“…All patients enrolled for intralesional acyclovir injection underwent kidney function tests to exclude any renal disorder. All patients enrolled for intralesional HBV had no prior vaccination with HBV to omit the notion of enhanced clinical response in previously vaccinated patients [ 8 ].…”

“…Being non-live, it’s also theoretically safe for elderly and immunocompromised. Three generations have been introduced into the market, the second of which is developed by recombinant DNA technology and is most widely used [ 8 , 9 ].…”

“…Hepatitis-B vaccine is known to promote both a humoral and a cellular immune response. It has recently been investigated as a new immunotherapeutic option for common warts with a low rate of complete response being injected intra-lesionally [8.9] and a relatively higher response rate when injected intra-muscularly [ 8 ].…”