Efficacy of Intralesional MMR Vaccine Versus Cryotherapy in the Treatment of Viral Warts

Abstract

Background:Viral warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid, immunotherapy and cryotherapy using liquid nitrogen being two of the most common forms of treatment. Objective:To determine the efficacy of intralesional MMR vaccine versus cryotherapy in the treatment of viral warts. Material and Methods: Patients were randomly allocated in to two groups by lottery method. Group A, having 32 patients, was injected with intralesional MMR vaccine (0.3ml) into the largest wart using an insulin syringe. The injection was given on alternate weeks for maximum of 5 sessions. Group B, also having 32 patients, was given cryotherapy by applying liquid nitrogen with a cotton tip applicator for 10 to 30 seconds until the ice ball formation spreads to involve 1mm margin of surrounding normal skin, at weekly interval for maximum of 8 sessions. Patients of both groups were followed up at 2^nd, 4^th, 6^th, 8^th, 10^th and 12^th week. Those who cleared their warts on follow up visits were not given further treatment. At the end of 12 weeks both groups were evaluated for treatment efficacy. Results: Of these 64 study cases, 26 (40.625%) were males and 38 (59.375%) were females. Mean age of our study cases was 27.59 ± 3.99 years (with minimum age was 20 years while maximum age was 35 years). Mean age of our study cases in patients treated with intraleisonal MMR was 28.19 ± 3.95 years while patients treated with cryotherapy was 27.00 ± 4.07 years. Mean weight of our study cases was 64.06 ± 6.16 kilograms (with minimum weight was 54 kilograms and maximum was 78 kilograms). Mean weight in group A was 65.19 ± 6.52 kilograms while in Group B was 62.94 ± 5.67 kilograms. Majority of our study cases i.e. 46 (71.875%) were having weight over 60 kilograms. Size of lesion was less than 1 cm in 36 (56.25%) of our study cases while in remaining 28 (43.75%) was in the range of 1 to 1.5 centimeters. In 40 (62.5%) of our study cases, number of lesions was 5-6. Mean no. of lesions was 2.48 ± 1.35. Mean no. of lesions in group A was 6 ± 0.88 while in group B was also 6 ± 0.88. Mean duration of disease was 1.844 ± 0.67 months (with minimum duration was 1 month while maximum duration was 3 months). Our study results have indicated that majority of our study cases i.e. 44 (68.75%) were having disease for more than 1.5 months. Mean duration of disease in group A was 1.94 ± 0.67 months while in group B was 1.75 ± 0.67 months. In group A efficacy was noted in 22 (68.75%) of our study cases, while in group B efficacy was seen in 20 (62.5%) of our study cases. Majority of our overall study cases were in middle socioeconomic group. While in Group A 50% were in high, 43.75% in middle and 6.25% in low socioeconomic group. In Group B 50% was in middle, 31.25% in low and 18.75 in high socioeconomic group.Conclusion: Efficacy of intraleisonal MMR injection is more than cryotherapy. It can be safely used for the treatment of viral warts, as no serious side effects were observed in our study. Being cost effective, it provides cheaper treatment option compared with cryotherapy which is quite expensive. Early treatment can help patients to maintain routine daily lives and physical activities such as sports without any pain and side effects.

Keywords: Intraleisonal MMR, Salicylic acid, Cryotherapy, warts.