Korean journal of dermatology (대한피부과학회지)

Korean Dermatological Association (대한피부과학회)
권호 표지

Clinical Study of Intralesional Immunotherapy Using Measles, Mumps, and Rubella Vaccine in Various Warts

다양한 사마귀에서 Measles, Mumps, and Rubella 백신을 이용한 면역치료 효과에 대한 임상적 고찰

  • Kim, Min Sung (Department of Dermatology, Chosun University Medical School) ;
  • Youn, Sang Ho (Department of Dermatology, Chosun University Medical School) ;
  • Na, Chan Ho (Department of Dermatology, Chosun University Medical School) ;
  • Shin, Bong Seok (Department of Dermatology, Chosun University Medical School)
  • 김민성 (조선대학교 의학전문대학원 피부과학교실) ;
  • 윤상호 (조선대학교 의학전문대학원 피부과학교실) ;
  • 나찬호 (조선대학교 의학전문대학원 피부과학교실) ;
  • 신봉석 (조선대학교 의학전문대학원 피부과학교실)
  • Received : 2014.01.11
  • Accepted : 2014.04.10
  • Published : 2014.05.31
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Abstract

Background: Although several methods have been attempted in the treatment of warts, the traditional destructive method may be painful or ineffective and induce disfiguring scars. Therefore, a more tolerable method with fewer drawbacks is needed. Objective: We studied the therapeutic effect of intralesional immunotherapy using the Measles, Mumps, and Rubella (MMR) vaccine and factors affecting it in patients with warts. Methods: A retrospective study was performed in 207 patients with various types of warts, who did not meet the exclusion criteria for treatment and were followed-up from January 2011 to December 2013. Patients with warts were treated at 2-week intervals, and the therapeutic effect was evaluated 1 month after the final treatment. Results: Overall, 123 (59.5%) patients experienced a greater than half reduction in the size and number of warts. In addition, younger patients (under the age of 20) (p=0.008) and those with common warts (including periungual warts) (p=0.02) showed significantly higher treatment responses. All patients complained of transient mild pain during the intralesional injections, but other side effects were rarely observed. Only 3.2% of patients who experienced a complete response had a recurrence more than 6 months after the final treatment. Conclusion: We suggest that intralesional immunotherapy with MMR vaccine can be considered as a primary remedy for patients who are sensitive to pain, especially children with multiple lesions, are concerned about serious side effects, or have common warts, and that treatment response will be improved by increasing the number of applications.

Keywords

Acknowledgement

Supported by : 조선대학교

References

  1. Nofal A. Nofal E. Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol 2010;24: 1166-1170 https://doi.org/10.1111/j.1468-3083.2010.03611.x
  2. Clifton MM, Johnson Sm, Roberson PK, Kincannon J, Horn TD. Immunotherapy for recalcitrant warts in children using intralesional mumps or candida antigens. Pediatr Dermatol 2004;20:268-271
  3. Horn TD, Johnson SM, Helm RM, Roberson PK. Intralesional immunotherapy of warts with mumps, Candida, and trichophyton skin test antigens: a single-blinded, randomized, and controlled trial. Arch Dermatol 2005;141:589-594
  4. Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: a novel immunotherapy for warts. 2001;137:451-455
  5. Ahn SI, Chung MK, Yoo JS, hung HJ, Hur JK, Shin YK, et al. The safety and immunogenicity of a trivalent, live, attenuated MMR vaccine, PriorixTM. Korea J Pediatr 2005; 48:960-968
  6. Micali G, DallʼOqlio F, Nasca MR. An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts. J Dermatolog Treat. 2003;14:233-236 https://doi.org/10.1080/09546630310016763
  7. Buckley DA, Du Vivier AW. The therapeutic use of topical contact sensitizers in benign dermatoses. Br J Dermatol 2001;145:385-405 https://doi.org/10.1046/j.1365-2133.2001.04399.x
  8. Park CO, Chung KY, Chung WG. Treatment of verruca plana with high dose cimetidine therapy. Kor J Dermatol 2005;43:475-479
  9. Harada S. Clinical application of fungus extracts and its culture filtrate in the treatment of skin diseases; (3) Candida vaccine in the treatment of warts. Nippon Hifuka Gakkai Zasshi. 1979;89:397-402
  10. Signore RJ. Candida albicans intralesional injection immunotherapy of warts. Cutis 2002;70:185-192
  11. Kus S, Ergun T, GunD, Akin O. Intralesional tuberculin for treatment of refractory warts. 2005;19:515-516 https://doi.org/10.1111/j.1468-3083.2004.01176.x
  12. King M, Johnson SM, Horn TD. Intralesional immunotherapy for genital warts. Arch dermatol 2005;141:1606-1607
  13. Gupta S, Malhotra AK, Verma KK, Sharma VK. Intralesional immunotherapy with killed Mycobacterium w vaccine for the treatment of ano-genital warts: an open label pilot study. J Eru Acad Dermatol Venereol 2008;22:1089-1093 https://doi.org/10.1111/j.1468-3083.2008.02719.x
  14. Maronn M, Salm C, Lyon V, Galbraith S. One-year experience with candida antigen immunotherapy for warts and molluscum. 2008;25:189-192 https://doi.org/10.1111/j.1525-1470.2008.00630.x
  15. Kim KH, Horn TD, Pharis J, Kincannon J, Jones R, OʼBryan K, et al. Phase 1 clinical trial of intralesional injection of candida antigen for the treatment of warts. Arch Dermatol 2010;146:1431-1433 https://doi.org/10.1001/archdermatol.2010.350
  16. Chandrashekar L. Intralesional immunotherapy for the management of warts. Indian J Dermatol Venereol Leprol 2011;77:261-263 https://doi.org/10.4103/0378-6323.79694
  17. Lee H, Kim HW, Cho HK, Park EA, Choi KM, Kim KH. Reappraisal of MMR vaccines currently used in Korea. Pediatr Int 2001;53:374-380
  18. Haolla FA, Claser C, de Alencar BC, Tzelepis F, de Vasconcelos JR, de Oliveira G, et al. Strain-specific protective immunity following vaccination against experimental Trypanosoma cruzi infection. Vaccine 2009;27:5644-5653 https://doi.org/10.1016/j.vaccine.2009.07.013
  19. Jablonska S, Majewski S, Obalek S, Orth G. Cutaneous warts. Clin Dermatol 1997;15:309-319 https://doi.org/10.1016/S0738-081X(96)00170-8
  20. Kim MS, Choi H, Na CH, Shin BS. Two-Year Experience with Measles, Mumps, and Rubella Vaccine Intralesional Immunotherapy for Warts. Clinical and Experimental Dermatology - In press 2014
  21. Lichon V, Khachemoune A. Plantar warts: a focus on treatment modalities. Dermatol Nurs 2007;19:372-375