Nofal Ahmad, Nofal Eman, Yosef Ayman, Nofal Hager
Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Int J Dermatol. 2015 Jun;54(6):667-71. doi: 10.1111/ijd.12480. Epub 2014 Jul 29.
Recalcitrant warts represent a frustrating challenge for both patients and physicians. Although many destructive and immunotherapeutic modalities are available for the treatment of warts, an ideal, universally effective approach has not been explored to date. Recently, intralesional antigen immunotherapy has shown promising efficacy in the treatment of warts. The aim of the study was to evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine in the treatment of recalcitrant warts.
The study included 70 adult patients with multiple recalcitrant extragenital warts of different sizes and durations, with or without distant warts. They were directly injected, without a pre-sensitization skin test, with 0.3 intralesional MMR vaccine into the largest wart at 2-week intervals until complete clearance or for a maximum of five treatments. Follow-up was made every month for six months to detect any recurrence.
Sixty-five patients, 35 men and 30 women, completed the study, and five patients discontinued for various reasons. Complete clearance of the lesions was observed in 41 patients (63%), partial response in 15 patients (23%), and no response in nine patients (14%). Complete response was demonstrated in 74.5% of those presenting with distant warts. Side effects were mild and insignificant in the form of pain during injection, itching, erythema, and edema at the site of injection and flu-like symptoms. Recurrence was detected in two patients only.
Intralesional immunotherapy by MMR vaccine is a promising, effective, and safe treatment modality for recalcitrant warts.
顽固性疣对患者和医生来说都是一个令人沮丧的挑战。尽管有许多破坏性和免疫治疗方法可用于治疗疣，但迄今为止尚未探索出一种理想的、普遍有效的方法。最近，病灶内抗原免疫疗法在疣的治疗中显示出有前景的疗效。本研究的目的是评估病灶内注射麻疹、腮腺炎和风疹（MMR）疫苗治疗顽固性疣的疗效和安全性。
该研究纳入了70例患有不同大小和病程的多发性顽固性生殖器外疣的成年患者，有或无远处疣。他们在不进行预致敏皮肤试验的情况下，每隔2周将0.3ml病灶内MMR疫苗直接注射到最大的疣中，直至完全清除或最多进行五次治疗。随访六个月，每月进行一次，以检测任何复发情况。
65例患者（35名男性和30名女性）完成了研究，5例患者因各种原因停药。41例患者（63%）观察到病变完全清除，15例患者（23%）部分缓解，9例患者（14%）无反应。有远处疣的患者中74.5%表现为完全缓解。副作用轻微，表现为注射时疼痛、注射部位瘙痒、红斑、水肿以及类流感症状。仅在两名患者中检测到复发。
MMR疫苗病灶内免疫疗法是一种治疗顽固性疣有前景、有效且安全的治疗方式。
