Tuberculin as Intralesional Therapy for Viral Warts—Single-Blind, Split, Placebo, Controlled Study

Abstract

Background: BCG vaccine as an antigen has proved its effectiveness as an immunotherapy for viral warts. Tuberculin is an antigenic extract of M. tuberculosis capable of eliciting an immunological skin reaction. Objective: To assess the efficacy of tuberculin intralesional injection in the treatment of viral warts. Patients and Methods: This single ,blind, placebo controlled study was conducted at the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2010 to July 2011.Forty-one patients with different types of viral warts were enrolled in this study; tuberculin test was done to patients prior to instillation of intralesional treatment. Then the patients treated by intralesional tuberculin in each lesion located on the right side of the body, and intralesional distilled water in each lesion located on the left side of to a maximum of 3 injections, at 2 weeks interval or until full resolution of these lesions. Patients were evaluated every 2 weeks to assess the regression of their lesions and to record any local and systemic adverse effects. The response to treatment was evaluated by decrease in size and reduction in number of warts. Scoring of response to treatment was as follow: 1) Responders: including patients who showed complete cure or those with good response (>50% reduction). 2) Non responders: including patients who showed minimal response (<50% reduction), or those with no improvement (stable disease and disease progression). The follow up period lasted up to 2 months after the last dose. Results: Thirty out of 41 patients had completed the study, of them 14 (46.66%) patients showed response of their lesions on the right side of the body that were treated with tuberculin; 15 patients showed no response, 1 patient showed minimal response, 7 patients showed good response and 7 patients showed complete cure (23.

Intralesional immunotherapy for pediatric warts: A review

“…In our review, there were reports of pruritus, flu‐like symptoms, and erythema resulting from MMR injection in some studies; however, no adverse effects were noted in other studies . Adverse effects were rare from PPD treatment . In contrast, BCG studies reported tender papule formation and lesional ulceration; combined with lower efficacy, BCG offers the least favorable profile for wart immunotherapy…”

“…Immunotherapy is efficacious in pediatric and adult patients, particularly in cases of multiple or recalcitrant warts. Studies of Candida antigen, MMR, and PPD provided comparable complete response rates of injected warts, from 39% to 88% for candida, 26.5% to 92% for MMR, and 23.3% to 94.4% for PPD . However, BCG appears to be an inferior treatment choice, with clearance rates limited at 33.3%‐39.7%,…”

“…Lesions on the left side of the body in the same patients were injected with distilled water, and no patients had complete cure. Injection site pain was the only reported side effect …”

“…Studies of Candida antigen, MMR, and PPD provided comparable complete response rates of injected warts, from 39% to 88% for candida, [11][12][13][14][15][16][17][18] 26.5% to 92% for MMR, [19][20][21][22][23]32 and 23.3% to 94.4% for PPD. 23,[25][26][27][28][29] However, BCG appears to be an inferior treatment choice, with clearance rates limited at 33.3%-39.7%, 30,31 Due to reports of distant wart resolution, a systemic immune response resulting from intralesional immunotherapy has been pro-…”

“…[19][20][21][22][23]32 Adverse effects were rare from PPD treatment. 23,[25][26][27][28][29] In contrast, BCG studies reported tender papule formation and lesional ulceration; combined with lower efficacy, BCG offers the least favorable profile for wart immunotherapy. 30,31 Given the novelty of intralesional immunotherapy in the treatment of common warts, there is limited information regarding absolute and relative contraindications to its use.…”