Title : A comparative study between efficacy of intralesional MMR vaccine injection and intralesional vitamin D3 injection in treatment of verruca vulgaris
Abstract:
INTRODUCTION: Verruca is a common viral infection of the skin that can occur on almost any site. Treatment of common verruca can be frustrating for both doctors and patients because the best treatment with the highest efficacy and lowest recurrence has yet to be discovered. Currently used destructive techniques can be unpleasant, unsuccessful, and expensive, as well as cause disfiguring scarring and high recurrence rates.
Several immunotherapeutic drugs have been used to treat various forms of Verruca, including common Verruca, with varying degrees of success. Among these drugs is intralesional immunotherapy, which has proven to be a beneficial and safe treatment option. It has the potential for scar-free clearance of both treated and untreated distant Verruca, as well as a low recurrence rate and a high safety profile. As a result, this study was undertaken in order to gather more information about this promising therapy strategy involving MMR vaccine and vitamin D3 in the treatment of multiple recalcitrant Verruca.
MATERIALS AND METHODS: This study included 100 patients presenting with Verruca of different numbers, sizes, sites, and duration presenting in DVL OPD, Government general hospital, Vijayawada from Dec 2019 to June 2021 (18 months). Patients were randomly assigned into two groups of fifty patients each and treated with intra-lesional MMR vaccine and Vitamin D3. A total of 86 patients, 44 from The MMR Group and 42 from The Vitamin D3 Group completed the 8-week schedule of the study and were further followed up for 6 months for detection of any recurrence.
RESULTS: The results revealed 37/44 (84.09%) complete responses in the MMR vaccine group and 32/42 (76.19%) in the Vitamin D3 group. The response in our trial was substantially higher than the placebo group's response in the Cochrane review (22%). Interestingly, there was also complete remission at distant non-injected Verruca 26/44(59.09%) in the MMR group and 26/42(61.90%) in the Vitamin D3 group. There was one recurrence in the Vitamin D3 group. Very minimal side effects like pain at the time of injection, flu-like illness, and pigmentation at the site of injection were observed in both groups.
CONCLUSION: Intralesional immunotherapy with MMR vaccine and Vitamin D3 is a viable treatment option for verruca, especially those that are numerous and stubborn. Both modalities outperformed the placebo in terms of response rates. It also has the benefit of being safe and inexpensive, especially in developing countries like India, Vitamin D3 and MMR vaccines are readily available, and majority of the individuals are vaccinated with these vaccines making them sensitive for the treatment.
In conclusion, intralesional antigen immunotherapy is a promising therapeutic approach that requires more clinical trials to assess its efficacy and clarify its role in the treatment of Verruca.
Audience Take Away Notes:
- The presentation aims to make practicing dermatologists around the globe aware about emerging intralesional immunotherapy in treatment of common but difficult to treat condition, Verruca Vulgaris (Warts)
- Intralesional immunotherapy has proven to be a simple, inexpensive, safe, and effective treatment option. It has the potential for scar-free clearance of both treated and untreated distant Verruca.
- Intralesional immunotherapy plays important role in the reduction of recurrences which is one of the most challenging issues in the treatment of Verruca.
- Therefore, this research can be used by other faculty to further expand their research or teaching along with their practice.
- It provides a practical solution that could simplify dermatologist’s role in treatment of warts and make their job more efficient.
