Volume 24, Issue 105, September - October, 2020

Intra-lesional Injection of Tuberculin Skin Test Antigens as an Immunotherapy for Warts: Open Label Placebo Controlled Clinical Trial

Abdulmajeed Alajlan^♦

Dermatology Department, King Saud University, King Saud University Medical City, P.O Box 7805, Riyadh 11472, Saudi Arabia

^♦Corresponding author
Abdulmajeed Alajlan, MD Associate Professor Dermatology Department, King Saud University, King Saud University Medical City, P.O Box 7805, Riyadh 11472, Saudi Arabia; E mail: amajlan@ksu.edu.sa

ABSTRACT

Background: Warts are typically skin growths caused by Human Papilloma virus affecting all age groups. Resistance to conventional therapy is a common characteristic of the lesion. Immunotherapy with variant antigens is effectively used in wart therapy. Purified protein derivative (PPD) of tuberculin is tested. Objective: To determine the efficacy and adverse effects of intra-lesional injection of PPD antigens in treating common warts. Methods: 82 Patients with multiple warts who have not received any treatment for the last 12 weeks have been enrolled in an open labelled, placebo-controlled clinical trial in outpatient dermatology clinics in a tertiary care center. The research has acquired Ethical approval from the IRB in King Saud Medical City and informed consent was signed voluntarily by all patients. Patients were assigned for two groups. Interventional study group for intra-lesional injection of tuberculin skin test antigen, which subdivided in to two different groups: positive PPD skin test (n=40) and negative PPD skin test (n=22). Control group were intra-lesional normal saline was injected (n=20). All patients who lost to follow up 3 months post last injection were excluded from the analysis. We defined success of the injection by complete resolution of one or more warts at injected or none injected sites. Result: Seventy-six percent (31/40) of the positive PPD patients in the active group showed clearance of one or more warts compared to 10% (2/20) of normal saline group (p<0.005) While 82 % (18/22) of negative PPD patients showed clearance of one or more warts. Out of the responders in the positive PPD patients, 38% percent (12/31) cleared anatomically distant warts as well. However, 78% (14/18) of the responders in the negative PPD group cleared anatomically distant wart. Analysis of the two groups (positive and negative PPD test). in the active arm showed significantly that multiple injections at single session is more efficacious for distant wart than single injection (p<0.005). Conclusion: Immunotherapy with intradermal injection of PPD of tuberculin skin antigen is an effective and safe treatment modality for multiple and resistant warts. Multiple PPD injections at one session are more effective than single injection. Positive PPD skin test is not mandatory for its efficacy in our study population.

Keywords: Intra-lesional Injection; Tuberculin Skin Test; Antigens; Immunotherapy; Warts; Purified Protein derivative

Medical Science, 2020, 24(105), 3513-3522

PDF