Intralesional MMR versus intralesional bleomycin in the treatment of digital warts: A randomized comparative study and review of the literature

Abstract

Introduction: Warts are benign hyperkeratotic viral infections poorly responsive to most treatment modalities. Commonly used destructive methods can cause the scarring of the digits. Intralesional agents are preferred in digital warts. Individual efficacy has been assessed, but previously intralesional bleomycin and immunomodulator measles, mumps, and rubella (MMR) vaccine have not been compared. Objectives: To assess the effectiveness and safety of intralesional bleomycin versus intralesional MMR vaccine in the treatment of digital warts. Materials and Methods: All consenting adults with ≤5 digital warts were randomly divided into two groups by chit method: group A got intralesional MMR vaccine and group B got intralesional bleomycin monthly for 3 months with follow-up at the fourth month. Clearance and reduction in wart sizes and side effects were noted. Results: Totally 45 patients completed the study, and with single injection, clearance in group B was significantly higher than in group A (P = 0.001, Chi-square test). Necrosis, eschar formation, and residual pain were seen in group B. Overall, there was no significant difference in clearance rates at three injections (P = 0.198, chi-square test). Conclusion: Intralesional MMR vaccine and intralesional bleomycin are both effective in treating digital verrucae. Faster clearance is seen with intralesional bleomycin, with more side effects such as necrosis, eschar, and pain, controlled with oral analgesics.