Intralesional injection of purified protein derivatives versus zinc sulfate 2% in recalcitrant palmar and/or plantar warts

Background The immune system plays an essential role in the clearance of warts, and thus recently there is a trend to use immunotherapy in wart treatment. Tuberculin-purified protein derivatives (PPDs) and zinc sulfate 2% were not previously compared regarding their efficacy in the treatment of warts. Objective The aim of this study was to determine the efficacy and safety of intralesional (IL) immunotherapy with tuberculin PPD versus zinc sulfate 2% in multiple recalcitrant palmar and/or plantar warts. Patients and methods Forty-five patients who presented with resistant palmar and/or plantar warts were divided randomly into two groups: the first group included 23 patients treated with IL tuberculin PPD, and the second group included 22 patients treated with IL zinc sulfate 2%. Results The target wart in the tuberculin-PPD-treated group showed a statistically nonsignificant higher rate of complete clearance compared with the zinc sulfate 2%- treated group (87 vs. 72.7%, respectively). Partial response was seen in 13 versus 13.6% and no response was seen in 0 versus 13.6%. In untreated distant warts, the tuberculin-PPD-treated group showed statistically significant higher rates of complete response compared with the zinc sulfate 2%-treated group (73.9 vs. 40.9%, respectively); the partial response was 13 versus 36.4% and no response was 13 versus 22.7%, respectively. Conclusion IL immunotherapy with tuberculin PPD was more effective than zinc sulfate 2% in the treatment of cutaneous warts. It is a simple, effective, safe procedure, with tolerable pain, and it may represent an alternative treatment for multiple resistant palmar and/or plantar warts.