DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20202661

Role of autoinoculation in the management of cutaneous warts: a comparison study with 100% tricholoroacetic acid application

Karla N. Faleiro, Pankaj Shukla

Abstract


Background: Persistent and recurrent warts pose a challenge to physicians despite the availability of multiple treatment options. Autoinoculation exposes HPV antigens to the dermis and vasculature thereby activating a delayed hypersensitivity response, facilitating clearance of both local and distant warts. The aim of this study was to assess the efficacy of autoinoculation and compare it with chemical cautery using 100% trichloroacetic acid.

Methods: A non-blinded interventional study was conducted at Goa Medical College, a tertiary care centre. Non-immunocompromised patients with 5 or more non-genital warts were included. Group 1: a wart was removed by punch biopsy, minced and implanted in the dermis. The procedure was repeated at 4 and 8 weeks. Group 2: weekly trichloroacetic acid (100%) application. Response was assessed at 4, 8 and 12 weeks in terms of percentage reduction in the number of warts. Statistical correlation with respect to age, sex, duration, number and type of warts was assessed using Welch ANOVA.

Results: In group 1, 63 patients and in group 2, 54 patients completed the study. Post autoinoculation, complete clearance was seen in 46.0% and 3.2% had partial clearance. With TCA application, 33.3% patients had complete and 13% had partial clearance. Response differed with the type of warts. Palmoplantar, periungual warts and verruca vulgaris showed better response to autoinoculation. Filiform and plane warts showed better response to TCA.

Conclusions: Autoinoculation is an efficacious treatment modality which can be performed routinely especially for palmoplantar and periungual warts which are particularly challenging to treat with other modalities.


Keywords


Autoinoculation, Cutaneous wart, Tricholoroacetic acid

Full Text:

PDF

References


Sterling JC, Jones HS, Hudson PM. Guidelines for management of cutaneous warts. Br J Dermatol. 2001;144:4-11.

Lal NR, Sil A, Gayen T, Bandyopadhyay D, Das NK. Safety and effectiveness of autoinoculation therapy in cutaneous warts: a double blind, randomized placebo-controlled study. Indian J Dermatol Venereol Leprol. 2014;80:515-20.

Shivakumar V, Okade R, Rajkumar V. Auto implantation therapy for multiple warts. Indian J Dermatol Venerol Leprol. 2009;75:593.

Nischal KC, Sowmya CS, Swaroop MR, Agrawal DP, Basavaraj HB, Sathyanarayana BD. A novel modification of the auto implantation therapy for the treatment of multiple, recurrent and palmoplantar warts. J Cutan Aesthet Surg. 2012;5(1):26-9.

Srivastava PK, Bajaj AK. Auto wart injection therapy for recalcitrant warts. Indian J Dermatol. 2010;55:367-9.

Das P, Sood A, Bhatnagar A, Verma R, Baveja S, Vashisht D. Clinical outcomes and recurrences after homologous auto implantation therapy for warts: a prospective study. J Mar Med Soc. 2017;19:103-7.

Das S. Auto wart inoculation: an easy and effective treatment of multiple, recalcitrant and genital warts. J Pakistan Association Dermatologists. 2016;26(3):229-34.

Gugle AS, Jadhav VM, Kote RP, Deshmukh MD, Vankawala D. Study of homologous auto implantation therapy for treatment of multiple warts in patients attending the dermatology outpatient department. MVP J Med Sci. 2015;2:110-7.

Biberstein H. Immunization therapy of warts. Arch Dermatol. 1944;30:338-41.

Cormia FE. Auto lysate therapy for verruca vulgaris. Arch Dermatol. 1934;30:44-8.

Ghosh LM, Maplestone PA. Warts and their treatment. Indian Med Gazette. 1935:441-4.

Shirodaria PV, Matthews RS. An immuno fluorescence study of warts. Clin Exp Immunol. 1975;21(2):329-38.

Malison MD, Morris R, Jones LW. Autogenous vaccine therapy for condyloma acuminata: a double-blind controlled study. Br J Vener Dis. 1982;58:62-5.

Avgerinou G, Georgala S, Theodoridis A, Vareltzdis A, Stratigos J. Reduction of cell mediated immunity in patients with genital warts of long duration. Genitourin Med.1986;62:396-8.

Gulanikar AD, Bhide DS, Pethe SA. Auto implantation therapy for recalcitrant viral warts. Clin Dermatol Rev. 2018;2:74-7.

Khatu SS, More YE, Vankawala D, Pawar SS, Gokhale NR, Chavan DC. Treating multiple and recalcitrant wart with auto implantation technique. J NTR Univ Health Sci. 2017;6:247-50.