Modified intralesional aciclovir treatment in the management of recalcitrant palmoplantar and ungual warts: a case series of 14 patients.

In this retrospective study, we evaluated the efficacy and safety of modified intralesional aciclovir for the treatment of recalcitrant palmoplantar and ungual warts in 14 patients (7 men and 7 women) of mean age 24.5 years (SD 8.19). Modified aciclovir (50 mg mL-1) was prepared by mixing 250 mg of lyophilized aciclovir powder with 4 mL of distilled water and 1 mL of 2% lignocaine. Then, this solution was injected into each wart at a dose of 0.1 mL or until blanching occurred. Every 2 weeks, the eschar was pared off and the treatment was repeated until a complete cure was observed, for a maximum of five sessions. After five sessions, 82% (n = 55/67) of warts showed a complete response, and 18% (n = 12/67) showed a partial response. Adverse effects reported included lesional tenderness for 2-3 days following injection in 23% (n = 3/13) of patients. Blistering and nail-plate damage were each seen in one patient. Modifying aciclovir treatment by adding lignocaine resulted in an unaltered concentration of aciclovir while maintaining its efficacy. The efficacy and safety were comparable with those reported for previous studies but with greater patient acceptability.