الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cutaneous warts are benign papillomas of the skin of which common warts and plantar warts are the most common types. Cutaneous warts cause significant physical and psychological inconvenience. Therefore, patients with warts frequently consult physicians, mostly in primary care.
Despite rigorous investigation, a definitive treatment for viral warts remains elusive. Treatment options may involve application of topical preparations or surgical approaches.
Immunotherapy has many advantages, including the ability to treat many lesions simultaneously, and the reduction in frequency and size of relapsing warts. Because wart proliferation is controlled by the immune system. Various methods have been used to stimulate the immunological response as cimetidine, zinc sulfate, cidofovir, intralesional interferons, imiquimod, intralesional immunotherapy using candida and trichophyton antigens, PPD, MMR vaccine.
The aim of this work to was to evaluate the safety and effectiveness of intralesional injection of tuberculin antigen versus MMR vaccine for the treatment of multiple common warts.
Forty patients suffering from multiple common warts at different sites, of both sexes and of different age groups were included in this study. They were divided into 2 groups: Group 1 included 20 patients who were subjected to intralesional MMR vaccine injection and Group 2 included 20 patients who were subjected to intralesional tuberculin injection to compare clinical efficacy and safety in both modalities.
There was no statistically significant difference between the two groups regarding the age, sex, duration, sites affected by warts and previous therapy of the patients.
In the present study comparison between the two treated groups according to response to treatment in the target wart showed that excellent response was found in 50% of patients in the MMR group compared to 45% in the tuberculin group while Good and poor responses in the MMR group were found in 5% of patients and 15% respectively compared to 15% and 15% in the tuberculin group respectively and lastly non responders were 30% in MMR group compared to 25% in the tuberculin group. There was no statistically significant difference in response to treatment in the target warts between the two studied groups.
There was a statistically significant positive relation between response in target warts and response in distant ones which could be explained by the immune stimulating effects of both PPD and MMR vaccine in patients suffering from warts especially multiple ones.
According to the present study, patients with shorter durations responded better to MMR vaccine while those with longer durations in the tuberculin group responded better. Also patients with smaller number of warts responded better in the MMR group in contrast to tuberculin group where patients with larger number of warts responded better.
No serious side effects occurred in any of the patients included in this study. Only local reactions at the site of injection in the form of erythema, pain and oedema. All these reactions subsided three to five days following injection without any medications.
Intralesional immunotherapy by MMR vaccine and tuberculin is a promising treatment modality for verruca vulgaris, particularly the multiple recalcitrant ones. It seems to be inexpensive, effective and safe option that has the potential advantages of widespread and sustained effects against HPV. It is especially promising in countries where vaccination against measles, mumps and rubella viruses and tuberculosis is performed routinely.