Background: BCG vaccine as an antigen has proved its effectiveness as an immunotherapy\nfor viral warts. Tuberculin is an antigenic extract of M. tuberculosis capable\nof eliciting an immunological skin reaction. Objective: To assess the efficacy of tuberculin\nintralesional injection in the treatment of viral warts. Patients and Methods:\nThis single ,blind, placebo controlled study was conducted at the Department\nof Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2010 to July\n2011.Forty-one patients with different types of viral warts were enrolled in this study;\ntuberculin test was done to patients prior to instillation of intralesional treatment.\nThen the patients treated by intralesional tuberculin in each lesion located on the\nright side of the body, and intralesional distilled water in each lesion located on the\nleft side of to a maximum of 3 injections, at 2 weeks interval or until full resolution of\nthese lesions. Patients were evaluated every 2 weeks to assess the regression of their\nlesions and to record any local and systemic adverse effects. The response to treatment\nwas evaluated by decrease in size and reduction in number of warts. Scoring of\nresponse to treatment was as follow: 1) Responders: including patients who showed\ncomplete cure or those with good response (>50% reduction). 2) Non responders:\nincluding patients who showed minimal response (<50% reduction), or those with\nno improvement (stable disease and disease progression). The follow up period\nlasted up to 2 months after the last dose. Results: Thirty out of 41 patients had completed\nthe study, of them 14 (46.66%) patients showed response of their lesions on\nthe right side of the body that were treated with tuberculin; 15 patients showed no\nresponse, 1 patient showed minimal response, 7 patients showed good response and\n7 patients showed complete cure (23.33%). Regarding the lesions treated with intra-lesional distilled water, 25 patients showed no response, 3 patients showed minimal\nresponse, 2(6.66) patients showed good response and no patient showed complete\ncure of their warts. Of the 14 responder patients to intralesional tuberculin, 10 patients\nwere tuberculin tested positive, and 4 patients were tested negative, and of the\n16 non responder patients to intralesional tuberculin, 3 patients were tuberculin\ntested positive, and 13 patients were tuberculin tested negative which was statistically\nsignificant difference. No side effects reported from tuberculin therapy apart from\nmild pain at site of injection. Conclusion: Intralesional injection of tuberculin is an\neffective therapy for viral warts when compared with control, possibly through its\nlocal immunological action and had no systemic immunological response. Patients\nwith previous BCG vaccine showed better response to tuberculin injection.
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