Comparison of cryotherapy versus intralesional measles, mumps, rubella vaccine versus their combination therapy in Indian patients with cutaneous wart: a single centre prospective observational study
Keywords:MMR vaccine, Cutaneous wart, Cryotherapy
Background: Need for more effective and less time consuming therapeutic method is current necessity for treatment of cutaneous warts. The objective of the study was to evaluate and compare the efficacy, safety of cryotherapy versus intralesional measles, mumps, rubella (MMR) vaccine versus combination of cryotherapy and intralesional MMR vaccine in Indian patients with cutaneous wart.
Methods: This prospective observational study was conducted in 60 patients of cutaneous warts. Patients were divided into three groups viz., group A, group B and group C. Group A was treated with cryotherapy alone, Group B received intralesional injection 0.1 to 0.3 ml of MMR vaccine alone and Group C received combination of group A and group B therapy. In each group treatment was repeated at 3 week interval for a maximum of 4 sittings. Percentage of improvement was evaluated using visual analogue scale (VAS) for local as well as distant (non-inoculated) warts. Follow-up was made every 2 months till 4 months to detect any recurrence.
Results: For local warts in second half of treatment (12th week) patients of Group B and Group C showed significantly better response than patients in Group A. For distant warts in first half of treatment session patients showed significantly better response to Group C than as compared to Group B therapy (p<0.039).
Conclusions: Immunotherapy with MMR is superior treatment than cryotherapy for cutaneous warts with minimum side effects but the combination of cryotherapy with intralesional MMR has shown to have complementary effect in treatment response.
Lynch MD, Cliffe J, Morris- Jones R. Management of cutaneous viral warts. BMJ. 2014;348:3339.
Bacelieri R, Johnson SM. Cutaneous warts: an evidence-based approachto therapy. Am Fam Physician. 2005;72:647–52.
Logan RA, Zachary CB. Outcome of carbon dioxide laser therapy for persistant cutaneous viral warts. Br J Dermatol.1989;121:99-105.
Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: A novel immunotherapy for warts. Arch Dermatol 2001;137:451-5.
Rowson KEK, Mahy BWJ. Human paporva (wart) virus. Bacteriol Rev 1967;31:110–31.
Miller RAW. The Koebner phenomenon. Int J Dermatol. 1982;21:192-7.
Yong M, Parkinson K, Goenka N, O'Mahony C. Diabetes and genital warts: an unhappy coalition. International J STD AIDS. 2010;21:457-9.
Hon TD, Johnson SM, Helm RM, Roberson PK. Intralesional immunotherapy of warts with mumps, Candida and trichophyton skin test antigens: a single-blinded, randomized and controlled trial. Arch Dermatol. 2005;141:589–94.
Gamil H, Elgharib I, Nofal A, Abd-Elaziz T. Intralesional immunotherapy of plantar warts: report of a new antigen combination. J Am Acad Dermatol. 2010;63:40–3.
Khozeimeh F, Jabbari Azad F, Mahboubi Oskouei Y, Jafari M, Tehranian S, Alizadehsani R, et al. Intralesional immunotherapy compared to cryotherapy in the treatment of warts. Int J Dermatol. 2017;56:474-8.
Nofal A, Nofal E. Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol. 2010;24:1166-70.
Dochez C, Bogers JJ, Verhelst R, Rees H. HPV vaccines to prevent cervical cancer and genital warts: an update. Vaccine. 2014;32:1595-601.
Castle SC. Clinical relevance of age-related immune dysfunction. Clin Infect Dis. 2000;31:578-85.
Girard JP, Paychere M, Cuevas M, Fernandes B. Cell-mediated immunity in an ageing population. Clin Exp Immunol. 1977;27:85-91.
Karavitis J, Kovacs EJ. Macrophage phagocytosis: effects of environmentalpollutants, alcohol, cigarette smoke, and other external factors. J Leukoc Biol. 2011;90:1065–78.
Nofal A, Nofal E, Yosef A, Nofal H. Treatment of recalcitrant warts with intralesional measles, mumps, and rubella vaccine: a promising approach. Int J Dermatol. 2015;54:667-71.
Wilkes TD, Fraunfelder FT. Principles of cryosurgery. Ophthalmic Surg. 1979;10:21–30.
Gupta S, Kumar B. Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids. Int J Dermatol. 2001;40:349-53.
Asilian A, Sadeghinia A, Faghihi G, Momeni A, Amini Harandi A. The efficacy of treatment with intralesional meglumine antimoniate alone, compared with that of cryotherapy combined with the meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of cutaneous leishmaniasis. Ann Trop Med Parasitol. 2003;97:493-8.
Xu KC, Niu LZ, Hu YZ, He WB, He YS, Li YF, et al. A pilot study on combination of cryosurgery and 125iodine seed implantation for treatment of locally advanced pancreatic cancer. World J Gastroenterol. 2008;14:1603-11.
Chandrashekar L. Intralesional immunotherapy for the management of warts. Indian J Dermatol Venereol Leprol. 2011;77:261-3.
Salman S, Ahmed MS, Ibrahim AM, Mattar OM, El-Shirbiny H, Sarsik S, et al. Intralesional immunotherapy for the treatment of warts: A network meta-analysis. J Am Acad Dermatol. 2019;80:922-30.