Tratamiento intralesional de verrrugas recalcitrantes
Intralesional vs Intramuscular Bivalent HPV Vaccine in the Treatment of Recalcitrant Common Warts
TAKE-HOME MESSAGE
- In this pilot study, the authors treated 44 adults with recalcitrant warts with either intralesional bivalent human papillomavirus (HPV) 16, 18 vaccine at 2-week intervals for a maximum of 6 sessions or intramuscular bivalent HPV vaccine at 0, 1, and 6 months. Of the 22 patients in the intralesional group, 81.8% experienced complete clearance of warts compared with 63.3% of those in the intramuscular group, although this was not a statistically significant difference (P=.287). The clearance rate of warts was significantly faster in the intralesional group (3.22 months vs 4.75 months; P=.005). Adverse effects, which were transient, primarily included tolerable pain at the injection site and localized itching.
- While this study lacks a control group, it demonstrates the potential use of the bivalent HPV 16, 18 vaccine to treat recalcitrant warts in adults. Further studies are warranted to compare the efficacy of this therapy with other existing methods as well as to study the effects of the quadrivalent and nine-valent HPV vaccines on warts.
– Margaret Hammond, MD
Treatment modalities for recalcitrant common warts have had limited efficacy in the past; however, recent studies with topical and intralesional immunotherapies and chemotherapies have shown promising results. This study demonstrates the efficacy of the bivalent HPV vaccine as a therapy for common warts, persisting for more than 2 years, in both intralesional and intramuscular vehicles in patients who have failed previous therapies. As noted by the authors, this study has a few key limitations, which make it difficult to assess the true advantage of each therapy due to varied treatment intervals, and the lack of a control group to measure spontaneous resolution, which is known to take over 2 years for adults. Even more so, the viability of this treatment option becomes hazy for future patients because the HPV vaccine has become a routine childhood immunization. Multiple studies on HPV-associated diseases, such as genital warts, have demonstrated that patients with preexisting disease have not benefitted from post-exposure vaccination, nor have post-vaccination titers correlated with increased immunity. Although this study does suggest that the HPV vaccine would be a useful treatment option for common warts, a large-scale, controlled study with long-term follow-up is warranted
Abstract:
BACKGROUND
Despite the availability of different therapeutic modalities, treatment of recalcitrant common warts is still challenging. Cervarix, a recombinant bivalent human papillomavirus (HPV) vaccine, has shown promising efficacy in the treatment of warts.
OBJECTIVES
To evaluate the beneficial effects and tolerability of intramuscular versus intralesional bivalent HPV vaccine in the treatment of recalcitrant common warts.
METHODS
The study included 44 adult patients with multiple recalcitrant common warts; 22 patients were injected with intramuscular bivalent HPV vaccine at 0, 1, and 6 months or until complete clearance of warts and the other 22 patients were intralesionally injected with 0.1 to 0.3 ml of bivalent HPV vaccine into the largest wart at 2-week intervals until complete clearance or for a maximum of six sessions.
RESULTS
Complete clearance of warts was observed in 18 patients (81.8%) of the intralesional group and in 14 patients (63.3%) of the intramuscular group; however, the difference was not statistically significant. Adverse effects were transient and insignificant and no recurrence was reported in both groups.
LIMITATIONS
Small study sample and different dosing schedule.
CONCLUSIONS
Bivalent HPV vaccine, particularly by intralesional injection, seems to be a potential therapeutic option for the treatment of multiple recalcitrant common warts.
Journal of the American Academy of Dermatology
Intralesional Versus Intramuscular Bivalent Human Papillomavirus Vaccine in the Treatment of Recalcitrant Common Warts
J Am Acad Dermatol 2019 Jul 29;[EPub Ahead of Print], A Nofal, A Marei, AM Ibrahim, E Nofal, M Nabil
Skin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
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