JCDSA  Vol.6 No.5 , December 2016
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 (23.33%). Regarding the lesions treated with intralesional distilled water, 25 patients showed no response, 3 patients showed minimal response, 2(6.66) patients showed good response and no patient showed complete cure of their warts. Of the 14 responder patients to intralesional tuberculin, 10 patients were tuberculin tested positive, and 4 patients were tested negative, and of the 16 non responder patients to intralesional tuberculin, 3 patients were tuberculin tested positive, and 13 patients were tuberculin tested negative which was statistically significant difference. No side effects reported from tuberculin therapy apart from mild pain at site of injection. Conclusion: Intralesional injection of tuberculin is an effective therapy for viral warts when compared with control, possibly through its local immunological action and had no systemic immunological response. Patients with previous BCG vaccine showed better response to tuberculin injection.
Cite this paper: Sharquie, K. , Al-Rawi, J. , Noaimi, A. , Majly, W. (2016) Tuberculin as Intralesional Therapy for Viral Warts—Single-Blind, Split, Placebo, Controlled Study. Journal of Cosmetics, Dermatological Sciences and Applications, 6, 191-198. doi: 10.4236/jcdsa.2016.65024.

[1]   Androphy, E.J. and Lowy, D.R. (2008) Warts. In: Wolf, K., Goldsmith, L.A., Katz, S.I., Gilchrest, B.A., Paller, A.S. and Leffel, D.J., Eds., Fitzpatricks Dermatology in General Medicine, 7th Edition, McGraw-Hill Book Company, New York, 196, 1914-22.

[2]   Sterling, J.C. (2010) Virus Infections. In: Burns, T., Breathnach, S., Cox, N. and Griffiths, C., Eds., Rook’s Textbook of Dermatology, 8th Edition, Willy-Blackwell Publishing Company, Hoboken, 33, 1-81.

[3]   Kirnbauer, R., Lenz, P. and Okun, M.M. (2003) Human Papillomavirus. In: Bolognia, J.L., Jorizzo, J.L. and Rapini, R.P., Eds., Dermatology, 1st Edition, Mosby Publishing Company, Maryland Heights, 1217-1233.

[4]   Sharquie, K.E., Al-Rawi, J.R., Al-Nuaimy, A.A. and Radhy, S.H. (2008) BCG Immunotherapy of Viral Warts. Saudi Medical Journal, 29, 589-593.

[5]   James, W.D., Berger, T.G. and Elison, D.M. (2006) Viral Diseases. In: Andrew’s Diseases of the Skin, Clinical Dermatology, 10th Edition, WB Saunders Company, Canada, 19, 403-413.

[6]   Raviglione, M.C. and O’Brien, R.J. (2008) Tuberculosis. In: Fauci, A.S., Braunwald, E., Kasper, D.L., Hauser, S.L., Longo, D.L., Jameson, J.L. and Loscalzo, J., Eds., Harrison’s Principle of Internal Medicine, 17th Edition, McGraw-Hill Company, New York, 158, 1006-1020.

[7]   Majewski, S. and Jablonska, S. (1998) Immunology of HPV Infection and HPV-Associated Tumors. International Journal of Dermatology, 37, 81-95.

[8]   Naylor, M.F. (1988) Contact Immunotherapy of Resistant Warts. J Am AcadDermato, 19, 679.

[9]   Reichman, R.C., Oakes, D. and Bonnez, W. (1990) Treatment of Condylomaacuminatum with Three Different Interferon-α Preparations Administered Parenterally: A Double Blind, Placebo-Controlled Trial. The Journal of Infectious Diseases, 162, 1270-1276.

[10]   Buckley, D.A., Keane, F.M. and Munn, S.E. (1999) Recalcitrant Viral Warts Treated by Diphencyprone Immunotherapy. British Journal of Dermatology, 141, 292-296.

[11]   Silverberg, N.B., Lim, J.K. and Pallor, A.S. (2000) Squaric Acid Immunotherapy for Warts in Children. Journal of the American Academy of Dermatology, 42, 803-808.

[12]   Orlow, S.I. and Pallor, A. (1993) Cimitidine Therapy for Multiple Warts in Children. Journal of the American Academy of Dermatology, 18, 794-796.

[13]   Mario, M. (2002) Imiquimod 5% Cream: A Topical Immune Response Modifier. International Journal of Dermatology, 41, 1-2.

[14]   Johnson, S.M., Roberson, P.K. and Horn, T.D. (2001) Intralesional Injection of Mumps or Candida Skin Test Antigens: A Novel Immunotherapy for Warts. Archives of Dermatology, 137, 451-455.

[15]   Krogh, C.M.E. (1994) CPS Compendium of Pharmaceuticals and Specialties. 29th Edition, Canadian Pharmaceutical Association, Ottawa, 142-413.

[16]   Mackie, R.M. (1992) Melanocytic Naevi and Malignant Melanoma. In: Wilkinson, A. and Ebling, F.J., Eds., Rook’s Text Book of Dermatology, 5th Edition, Blackwell Scientific Publications, Oxford, 1525-1560.

[17]   Naraynn, P. (1995) Immunology of Genitourinary Tumors. In: Macaninch, J.W. and Tanagho, E., Eds., Smith’s General Urology, 14th Edition, Lang Medical Book, Connecticut, 234-348.

[18]   Sharquie, K.E., Lafta, R.K. and Al-Sammarrai, A. (2003) BCG Immunotherapy in Patients with Alopecia Areata. Yemeni Journal for Medical Sciences, 3, 1-2.

[19]   Sharquie, K.E. and Hayani, R.K. (2004) BCG as a New Therapeutic and Prophylactic Agent in Patients with Severe Oral Aphthosis. Clinical and Experimental Rheumatology, 22, 120.

[20]   Hennessey, L.R. and Baker, J.R. (1994) Immunomodulators. In: Stites, D.P., Terr, A.L. and Parslow, T.G., Eds., Basic and Clinical Immunology, 8th Edition, Lange Medical Books, Stamford, 781-785.