Abstract:

Background: The immune system plays an essential role in the clearance of warts, and thus recently there is a trend to use immunotherapy in wart treatment. Tuberculin-purified protein derivatives (PPDs) and zinc sulfate 2% were not previously compared regarding their efficacy in the treatment of warts.

Objective: The aim of this study was to determine the efficacy and safety of intralesional (IL) immunotherapy with tuberculin PPD versus zinc sulfate 2% in multiple recalcitrant palmar and/or plantar warts.

Patients and methods: Forty-five patients who presented with resistant palmar and/or plantar warts were divided randomly into two groups: the first group included 23 patients treated with IL tuberculin PPD, and the second group included 22 patients treated with IL zinc sulfate 2%.

Results: The target wart in the tuberculin-PPD-treated group showed a statistically nonsignificant higher rate of complete clearance compared with the zinc sulfate 2%-treated group (87 vs. 72.7%, respectively). Partial response was seen in 13 versus 13.6% and no response was seen in 0 versus 13.6%. In untreated distant warts, the tuberculin-PPD-treated group showed statistically significant higher rates of complete response compared with the zinc sulfate 2%-treated group (73.9 vs. 40.9%, respectively); the partial response was 13 versus 36.4% and no response was 13 versus 22.7%, respectively.

Conclusion: IL immunotherapy with tuberculin PPD was more effective than zinc sulfate 2% in the treatment of cutaneous warts. It is a simple, effective, safe procedure, with tolerable pain, and it may represent an alternative treatment for multiple resistant palmar and/or plantar warts.

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