Treatment of periungual warts: comparison of topical 5% 5-fluorouracil and intralesional purified protein derivative in a South Indian teaching hospital


  • Durgadevi S. Assistant Professor, Department of STD, Madurai Medical College & Government Rajaji Hospital, Madurai
  • Shridharan P. Assistant Professor, Department of Medicine, Madurai Medical College & Government Rajaji Hospital, Madurai



Periungual warts, Purified protein derivative, 5 fluorouracil, Resistant warts, Immunotherapy


Background: Verrucae or warts are common skin lesions caused by the human papilloma virus. Treatment of warts, particularly those in the periungual region is usually difficult, exhibiting resistance. Available conventional treatment modalities offer little hope in curing periungual warts. Thus, there is a need for a simple, reliable, non-expensive treatment for periungual warts. Aim was to determine and compare the efficacy of intralesional immunotherapy using purified protein derivative (PPD) and topical 5-fluorouracil (5-FU) under tape occlusion for the treatment of periungual warts.

Methods: In this prospective comparative study, Group 1 (PPD) patients, intralesional injection of PPD is given in a randomly selected lesion every 3 weeks for a maximum of six sittings. For Group 2 (topical 5% 5-FU under tape occlusion), patients are advised to apply 5% 5-FU under occlusion on the lesion(s) selected for study during the night and left for 12 hours. This is done for 3 months. After completion of the treatment and after the declaration of the cure – follow-up is done for the next three months to look for recurrence.

Results: Intralesional PPD had a significantly higher cure rate (88%) than that of topical 5-fluorouracil under occlusion (20%). The mean time taken for the resolution of the periungual warts was 6.6 weeks for intralesional PPD compared to 9.8 weeks for topical 5-fu under tape occlusion.

Conclusions: The cure rate of intralesional PPD group (88%) was much higher than that of topical 5% 5-fluorouracil under tape occlusion group (20%). In the PPD group, the younger patients responded well and faster. There was no difference in cure rate among age groups in 5 FU group.


Michelle M. Lipke, An Armamentarium of wart treatments. Clin Med Res. 2006;4(4):273–93.

More Y, Khatu S, Gokhale N, Chavan D. Treatment of Recalcitrant Warts by Contact Immunotherapy Using Diphenylcyclopropenone (Dpcp). Int J Sci Res. 2012;3(2):386-8.

Focht DR 3rd, Spicer C, Fairchok MP. The efficacy of duct tape vscryptherapy in the treatment of verruca vulgaris. Arch Pediatr Adolesc Med. 2002;156(10):971-4.

Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012;(9):CD001781.

Rook A, Griffiths C, Barker J, Bleiker T, Chalmers R, Creamer D. Rook's textbook of dermatology. Chichester etc.: Wiley Blackwell; 2016.

Chandrashekar L. Intralesional immunotherapy for the management of warts. Indian J Dermatol Venereol Leprol. 2011;77:261-3.

Siriwan Wananukul, Susheera Chatproedprai, Pornpat Kittiratsacha. Intralesional immunotherapy using tuberculin PPD in the treatment of palmoplantar and periungual warts. Asian Biomed. 2009;3(6):739-43.

Elela IMA, Elshahid AR, Mosbeh AS. Intradermal vs intralesional purified protein derivatives in treatment of warts. Gulf J Dermatol Venereol. 2011;18(2).

Dogra A, Gupta SK, Bansal A. Comparative efficacy of topical 5% 5-fluorouracil with electrosurgery in treatment of warts. Indian J Dermatol. 2006;51:108-10.

Williams H. Duct tape occlusion treatment increased resolution in common paediatric warts. Evidence-Based Med. 2003;8(2):58-8.

Litt JZ. Don't excise--exorcise. Treatment for subungual and periungual warts. Cutis. 1978;22(6):673-6.






Original Research Articles