Intralesional immunotherapy with Bacille Calmette- Guerin (BCG) vaccine for the treatment of cutaneous warts

Abstract

Myriad of therapeutic modalities for warts are available but none promises complete response. Despite adequate treatment, the virus may persist in the surrounding tissues leading to recurrence. Immunotherapy is considered better than destructive options where there are multiple lesions, extensive involvement and is best suitable for paediatric patients. The aim of the study was to evaluate the efficacy and safety of intralesional BCG vaccine in the management of cutaneous warts (common warts, plantar and periungual warts). Patients of age 12 years and above clinically diagnosed with cutaneous warts and presenting consecutively in the outdoor clinic of Dermatology, Venereology & Leprosy Department of Dr. R.P. Govt. Medical College, Kangra at Tanda, Himachal Pradesh between June 2021 to May 2022 were enrolled. BCG vaccine was administered into the largest wart intralesionally and the injection was repeated every 3 weeks for a maximum of four injections or till the complete clearance of warts, whichever was earlier. The efficacy was assessed every 3 weeks and patients were followed up at 3 and 6 months. Majority of patients were in the age group of 14-53 years. The study showed therapeutic response in 35.08% (20/57) patients and partial response in 63.15% (36/57) patients while there was no response in 1.75% (1/57) patients at the end of 12 weeks with a very low recurrence rate (5.2%). Plantar warts have responded excellently showing complete clearance in 91.5% and partial response in 9.5% of the patients followed by palmar warts achieving complete response in 60% and partial response in 40% of the patients. The reconstituted BCG immunotherapy is a cheap, effective and easily available therapeutic option which can easily be practised routinely. However, due its considerable adverse effects as compared to other immunotherapeutic agents, we do not recommend it to be the first line agent.