Intralesional HPV vaccine may clear recalcitrant warts

Key takeaways:

• A quadrivalent HPV vaccine injected into lesions cleared recalcitrant warts in 90% of patients.
• Bivalent vaccines were also efficacious, but at a significantly lower rate.

While both bivalent and quadrivalent HPV vaccines are promising treatments for recalcitrant warts, the quadrivalent option shows a significant statistic superiority, according to a research letter.

“Management of verrucae poses a persistent challenge despite the existence of numerous destructive and immunotherapeutic modalities,” Ahmad Nofal, MD, of the department of dermatology at Zagazig University in Zagazig, Egypt, and colleagues wrote. “Traditional destructive maneuvers are limited to the targeted lesions without distant therapeutic effect, might be uncomfortable for patients and can be associated with significant adverse effects. HPV vaccines, either in the intramuscular or the intralesional routes, have recently shown promise in the treatment of common warts.”

In a randomized controlled trial, 50 patients with multiple recalcitrant warts were assigned to receive intralesional 0.1 mg doses of either quadrivalent HPV vaccine, bivalent vaccine or saline control into their largest wart every 2 weeks until complete clearance or five sessions.

Of the 20 patients in the quadrivalent vaccine group, complete clearance was seen in 18 (90%), whereas six of the 20 patients (30%) in the bivalent group achieved this goal. None of the patients in the saline control group experienced complete clearance.

The researchers called adverse events mild and tolerable, in addition to being comparable to adverse events found in typical intramuscular HPV vaccination programs.

“Mechanisms underlying the therapeutic role of HPV vaccines in warts are not fully understood. These include induction of long-term neutralizing humoral immune response against their targeted HPV types and to a lesser extent a cellular immune one, enhancement of virus recognition by cell-mediated immunity and production of cross-reactive antibodies,” the authors wrote.