A comparative analysis of efficacy of intralesional mumps measles rubella vaccine versus 5-fluorouracil in the treatment of palmoplantar warts – a randomised control trial.

Abstract

INTRODUCTON: Viral warts are cutaneous and sometimes mucosal lesions caused by various strains of Human Papilloma Viruses which may occur as cutaneous as well as mucosal lesions.1 Palmoplantar warts are quite resistant to treatment because of their endophytic growth pattern, increased viral load and very thick cornified layer.2 Treating multiple palmoplantar warts is a challenge as the results of the current ablative treatment modalities leads to pain, temporary immobility, secondary infections and scarring.3 It has been found that cell-mediated immunity (CMI) plays a major role in wart resolution which highlights the need for immune protection against Human Papilloma Virus (HPV) infection and has directed attention towards stimulation of the patient’s immune system, particularly CMI to eradicate viruses. So, treatment modalities using immunotherapeutic methods are being increasingly used to overcome drawbacks in treatment of warts.4 5-floururacil (5FU) is an antimetabolite drug that inhibits DNA and RNA synthesis and may also function as an immunomodulatory drug. 5FU suppresses cell division and cause cell cycle arrest.2 This mechanism of action allows intralesional 5FU to be utilized in the treatment of viral warts caused by Human Papilloma Virus (HPV).2 Intralesional injection of 5FU permits higher drug concentrations throughout the lesion2. Intralesional Mumps Measles Rubella (MMR) vaccine immunotherapy employs the ability of the immune system to recognize viral antigens that induces a delayed type hypersensitivity reaction not only to the antigen, but also against the Human Papilloma virus, thereby increasing the ability of the immune system to recognize and clear HPV. Consequent to this, the stimulated immune response clears all the lesions on other body sites along with locally treated lesions. Immunotherapy using intralesional MMR vaccine has been found useful in treating common warts especially in children.5 AIMS AND OBJECTIVES: To evaluate the efficacy of intralesional Mumps Measles Rubella (MMR) Vaccine versus 5-Flourouracil(5-FU) in the treatment of palmoplantar warts.