A Comparative Study of Intralesional Vitamin D3, Measles Mumps Rubella Vaccine, and Tuberculin Purified Protein Derivative in the Treatment of Recalcitrant Warts: An Approach to Solve a Therapeutic Conundrum.

BACKGROUND: Human papilloma virus infects and proliferates in skin or mucosal cells to cause warts. Most of the current therapeutic modalities are ablative, act only on treated lesions, and lack a well-defined treatment endpoint. These being blind procedures, recurrence rates are high, owing to the remnant virus. Intralesional immunotherapy plays a significant role, as it potentially acts on treated and distant lesions. OBJECTIVES: We sought to study and compare the efficacy, safety profile, and recurrence rates of intralesional immunotherapy modalities (vitamin D3; measles, mumps, and rubella [MMR] vaccine; and tuberculin purified protein derivative [PPD]) in treating viral warts. METHODS: An open-label interventional study of 60 cases of cutaneous viral warts was performed in a tertiary care center attached to a medical college after obtaining approval from the institutional ethics committee. Each patient was consecutively assigned into Group 1 (vitamin D3: 0.2mL of 15mg/mL), Group 2 (MMR: 0.5mL), or Group 3 (tuberculin PPD: 0.1mL of 10TU). One or two warts were injected per session every two weeks. Response was assessed. Adverse effects were noted. Cases were followed up monthly for three months. RESULTS: The MMR group had the maximum patients with complete response (15 of 20, 75%) followed by tuberculin PPD group (13 of 20, 65%) and vitamin D3 group (12 of 20, 60%). No major adverse drug reactions were reported in any of the groups. CONCLUSION: Immunotherapy offers a safe and promising approach in patients with extensive cutaneous viral warts in difficult to treat sites.