Intralesional immunotherapy using tuberculin PPD in the treatment of palmoplantar and periungual warts

ABSTRACT

Background: Cutaneous warts are self-limited but can persist and increase in size and number. Palmoplantar and periungual warts are difficult to treat. Many local treatments are used for warts including immunotherapy using mumps, candida, and trichophyton skin test antigen. Objective: To determine the effect of immunotherapy with tuberculin PPD for palmoplantar and periungual warts. Methods: Intralesional tuberculin PPD was injected into the same lesion every two weeks until the lesion disappeared. Results: We studied 42 patients, 21 patients under 15 years old. The number of warts was from one to more than 20; 23 patients had more than one lesion. Forty patients (93%) were in remission. The lesion disappeared in 14%, 38%, 64%, 71%, 81%, and 93% after 1, 2, 3, 4, 5, and 6 treatments, respectively. In patients with multiple warts, lesions that were not treated also disappeared in 20 out of 23 patients (87%). Three patients had edema and erythema on the injected sites. Other three patients had painful purpura at the site of injection. During at least six months follow-up, one patient had new lesions, which were again effectively treated with tuberculin PPD. Conclusion: Intralesional tuberculin PPD was effective in treatment of cutaneous palmoplantar and periungual warts. It is a simple procedure, not very painful, and may be used as an alternative treatment for cutaneous palmoplantar warts, especially in multiple warts.