Efficacy of intralesional injection of mumps-measles-rubella vaccine in patients with wart

Zamanian, Abbas; Mobasher, Pezhman; Ahmadi Jazi, Ghazaleh

Efficacy of intralesional injection of mumps-measles-rubella vaccine in patients with wart

Authors

¹ Skin and Stem Cell Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran; Department of Dermatology, Rasoul-e Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

² Skin Diseases and Leishmaniasis Research Center, Department of Dermatology, Isfahan University of Medical Sciences, Isfahan; Skin and Stem Cell Research Center, Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran

³ Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Background: In the previous studies, it has been shown that mumps-measles-rubella (MMR) vaccine resulted in regression of warts via immunomodulatory effect and induction of immune system. Due to the high prevalence of warts in various populations, we evaluated the efficacy of MMR vaccine injection in the treatment of cutaneous warts.
Materials and Methods: This double-blind randomized controlled clinical trial was conducted in Hazrat-e-Rasoul Hospital in Tehran in 2011-2012 on 24 patients with warts who were allocated to two groups including MMR group and normal saline group. MMR vaccine was injected intralesionally in the MMR group, whereas normal saline was injected into the lesions in the second group. These injections were repeated every 2 weeks intervals for maximum 3 injections. All patients were followed up every 15-day interval up to 45 days and then up to 6 months regarding relapses and finally, side effects, probable relapse, and therapeutic outcomes were evaluated and compared.
Results: At the end of follow-up period, therapeutic outcomes in the MMR group included no cure in 2 cases, relative cure in 4 cases, and complete cure in 18 cases. In normal saline group, these rates included no cure in seven cases, relative cure in nine cases, and complete cure in six cases (P < 0.001). No significant complication occurred in the two groups.
Conclusion: MMR vaccine may result in desirable therapeutic response. The hypothesis that is considered here is that MMR vaccine, via induction of cellular and humoral immune system, accelerates the destruction of virus and infected host cells.

Keywords

References

1.	Kilkenny M, Marks R. The descriptive epidemiology of warts in the community. Australas J Dermatol 1996;37:80-6.
2.	Laimins LA. The biology of human papillomavirus: From warts to cancer. Infect Agents Dis 1993;2:74-86.
3.	Myers G, Lu H, Calef C, Leitner T. Heterogeneity of papillomaviruses. Semin Cancer Biol 1996;7:349-58.
4.	zur Hausen H. Papillomaviruses causing cancer: Evasion from host-cell control in early events in carcinogenesis. J Natl Cancer Inst 2000;92:690-8.
5.	Lowy DR, Warts EJ. In: Fitzpatrick′s Dermatology in General Medicine. 6 ^th ed. Freedberg IM, Arthur Eisen, Goldsmith LA, Katz S, Austen KF, Wolff K, editors. New York: McGraw- Hill; 2004. p. 2119-30.
6.	Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med 1997;102:3-8.
7.	Sellors JW, Mahony JB, Kaczorowski J, Lytwyn A, Bangura H, Chong S, et al. Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada. Survey of HPV in Ontario Women (SHOW) Group. CMAJ 2000;163:503-8.
8.	Syrjänen S, Puranen M. Human papillomavirus infections in children: The potential role of maternal transmission. Crit Rev Oral Biol Med 2000;11:259-74.
9.	Lipke MM. An armamentarium of wart treatments. Clin Med Res 2006;4:273-93.
10.	Bacelieri R, Johnson SM. Cutaneous warts: An evidence-based approach to therapy. Am Fam Physician 2005;72:647-52.
11.	Loureiro WR, Cação FM, Belda W Jr, Fagundes LJ, Romiti R. Treatment of genital warts in men with potassium hydroxide. Br J Dermatol 2006;158:180-1.
12.	Bolton RA. Nongenital warts: Classification and treatment options. Am Fam Physician 1991;43:2049-56.
13.	Sterling JC, Handfield-Jones S, Hudson PM. British Association of Dermatologists. Guidelines for the management of cutaneous warts. Br J Dermatol 2001;144:4-11.
14.	Sterling JC. Virus infections. In: Burns T, Breathnach S, Cox N, Griffiths C, editors. Rook′s Textbook of Dermatology. 7 ^th ed. Oxford: Blackwell Science; 2004. p. 25.15-25.37.
15.	Nofal A, Nofal E. Intralesional immunotherapy of common warts: Successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol 2010;24:1166-70.
16.	Gamil H, Elgharib I, Nofal A, Abd-Elaziz T. Intralesional immunotherapy of plantar warts: Report of a new antigen combination. J Am Acad Dermatol 2010;63:40-3.
17.	Center of Disease Control and Prevention. Sexually transmilted diseases treatment guidelines 2002. MMWR Morb Mortal Wkly Rep 2002;51:1-78.
18.	Shepherd PS, Hebert A. T-cell responses to HPV in cervical dysplasia. Papillomavir Rep 1999;10:53-78.
19.	Coleman N, Birley HD, Renton AM, Hanna NF, Ryait BK, Byrne M, et al. Immunological events in regressing genital warts. Am J Clin Pathol 1994;102:768-74.
20.	Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or candida skin test antigens: A novel immunotherapy for warts. Arch Dermatol 2001;137:451-5.
21.	Stulberg DL, Hutchinson AG. Molluscum contagiosum and warts. Am Fam Physician 2003;67:1233-40.
22.	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;141:589-94.

Advanced Biomedical Research