Intralesional measles, mumps, and rubella vaccine for cutaneous warts: A systematic review and meta-analysis

BACKGROUND: Warts, caused by the human papilloma virus (HPV), are mucocutaneous proliferations controlled by cell-mediated immunity. Intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine, is postulated to induce a higher immune response for clearance of lesions.OBJECTIVE: To assess the efficacy, safety and effect on recurrence of intralesional MMR vaccine for the treatment of warts.METHODS: We searched online databases for randomized controlled trials on intralesional MMR vaccine for warts. Effects measured were the complete clearance of target and distant warts, adverse events noted and recurrence after treatment duration.RESULTS: Four RCTs comparing intralesional MMR vaccine and placebo were assessed. Meta-analysis showed a risk ratio of 0.24 [95% CI: 0.18, 0.34] favoring intralesional MMR vaccine and a highly significant difference in completely clearing target warts (P-value CONCLUSIONS: Intralesional MMR vaccine significantly reduces and clears target and distant warts as compared to placebo. It is a generally safe intervention with lasting effect assessed up to 6 months follow-up.

Five percent potassium hydroxide for the treatment of anogenital warts: A systematic review and meta-analysis

@#<p><strong>BACKGROUND AND OBJECTIVES:</strong> Potassium hydroxide (KOH) is effective and safe as treatment of viral dermatoses. No systematic review has been done reporting its efficacy as a treatment for anogenital warts.</p><p><strong>METHODS:</strong> A systematic literature search for controlled clinical trials using KOH, any drug or ablative procedure measuring the clearance rate was conducted. Analysis was done using RevMan v5.3 software.</p><p><strong>RESULTS:</strong> Four low quality trials, composed of 197 patients were included but only two qualified for meta-analysis. Two studies compared KOH to cryotherapy while the two other trials compared KOH to intralesional 5-fluorouracil (FU) + salicylic acid (SA) and carbon dioxide (CO2) laser vaporization. The KOH group showed a higher clearance rate compared to cryotherapy (RR= 1.40, P> 0.05, I2=39 %) and no recurrence was noted (RR= 0.17, P> 0.05, I2=0) but the difference is not statistically significant. Isik et al., 2014 and Asadi et al., demonstrated that there was no significant difference among groups receiving KOH, 5-FU+SA and CO2 laser vaporization in the mean lesion count and size at follow up visits. (P > 0.05).</p><p><strong>CONCLUSIONS:</strong> Potassium hydroxide has comparable efficacy to the present treatment modalities but well-structured RCTs are needed to further support its use.</p>

Intralesional measles, mumps, and rubella vaccine for cutaneous warts: A systematic review and meta-analysis

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>Warts, caused by the human papilloma virus (HPV), are mucocutaneous proliferations controlled by cell-mediated immunity. Intralesional immunotherapy with measles, mumps, and rubella (MMR) vaccine, is postulated to induce a higher immune response for clearance of lesions.<br /><strong>OBJECTIVE: </strong>To assess the efficacy, safety and effect on recurrence of intralesional MMR vaccine for the treatment of warts.<br /><strong>METHODS: </strong>We searched online databases for randomized controlled trials on intralesional MMR vaccine for warts. Effects measured were the complete clearance of target and distant warts, adverse events noted and recurrence after treatment duration.<br /><strong>RESULTS: </strong>Four RCTs comparing intralesional MMR vaccine and placebo were assessed. Meta-analysis showed a risk ratio of 0.24 [95% CI: 0.18, 0.34] favoring intralesional MMR vaccine and a highly significant difference in completely clearing target warts (P-value <0.00001) versus placebo. Three of the 4 trials assessed response of distant warts showing a risk ratio of 0.28 [95% CI: 0.08, 0.96] and a significant difference (P=0.04) versus placebo. Pain and flu-like symptoms were the most common side effects with no recurrence seen after 3-6 months.<br /><strong>CONCLUSIONS: </strong>Intralesional MMR vaccine significantly reduces and clears target and distant warts as compared to placebo. It is a generally safe intervention with lasting effect assessed up to 6 months follow-up.</p>