Intralesional immunotherapy of plantar warts: Report of a new antigen combination

Background: Treatment of plantar warts represents a continuing challenge for dermatologists because many of the available therapeutic modalities are associated with unsatisfactory results and high recurrence rates. Several clinical trials have proved the efficacy of intralesional immunotherapy by different antigens in the treatment of different types of warts. Objective: To evaluate the efficacy and safety of a new antigen combination mumps, measles, and rubella (MMR) vaccine in the treatment of plantar warts. Methods: The study included 40 patients with single or multiple, recalcitrant or nonrecalcitrant plantar warts. MMR vaccine was injected into single lesions or largest wart in case of multiple lesions at 3-week intervals until complete clearance or for a maximum of 3 treatments. Follow-up was done every 3 months for 9 months to detect any recurrence. Results: Only 23 patients completed the study. The results revealed complete clearance of the warts in 20 patients (87\%), partial response in one patient (4.3\%), and no response in two patients (8.7\%). Complete response was achieved in 75\% of patients with recalcitrant plantar warts and 83.3\% of patients with warts at sites other than the soles. Recurrence was observed in only one patient (4.3\%). A significant relationship was found between therapeutic response and wart duration, but not with other clinical variables. Side effects include pain during injection (82.6\%) and flu-like symptoms (4.3\%). No erythema, edema, or scarring has been reported. Limitations: Small study sample and absence of control. Conclusions: intralesional immunotherapy by MMR vaccine seems to be a simple, effective, and safe treatment modality for plantar warts. (J Am Acad Dermatol 2010;63:40-3.)