COMPARISON OF EFFICACY OF INTRALESIONAL PURIFIED PROTEIN DERIVATIVE (PPD) WITH CRYOTHERAPY IN THE TREATMENT OF CUTANEOUS WARTS

Abstract

Objective: To compare the efficacy of intralesional purified protein derivative (PPD) with conventional cryotherapy in the treatment of cutaneous warts.

Study Design: Quasi experimental study.

Place and Duration of Study: Dermatology Department, Pak Emirates Military Hospital (PEMH) Rawalpindi, from Jul 2017 to Jan 2018.

Methodology: Total number of 60 patients were included in the study through Out Patient Department OPD. All patients were randomly divided in 2 groups by lottery method. Group A patients were given intra-lesional PPD (0.1ml in a single wart or targeting the largest wart in case of multiple warts, procedure was repeated fortnightly) while Group B patients were given cryotherapy with liquid nitrogen (2 freeze thaw cycles 20 sec duration each fortnightly). All patients were followed up after the end of treatment (maximum 6 sessions i.e. 3 months or complete clearance of wart whichever is earlier) and assessment of treatment efficacy was based on the response which was noted after 3 months of treatment. The response was categorized as excellent (no visible lesion), good (50-99% improvement), intermediate (<50% improvement) and poor (no response) depending upon the decrease in lesion numbers and size as measured by calibrated scale. The treatment was considered efficacious if there was good to excellent response.

Results: A total of 21 (70%) cases in PPD and 9 (30%) cases in cryotherapy were treated successfully. Efficacy of treatment was significantly higher in PPD group compared to cryotherapy group, p-value <0.05.

Conclusion: Intralesional purified protein derivative (PPD) was more effective in the treatment of cutaneous warts as compared to conventional cryotherapy. PPD may be adopted for treatment of viral warts to gain more satisfactory results and efficacy.