الفهرس 
Human Papilloma Virus
Oral florid papillomatosisOnly 14 pages are availabe for public view
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Abstract
Warts are caused by Human Papilloma Virus (HPV), a double stranded DNA virus. Warts have a variety of clinical manifestations depending on the viral type and site and are usually treated by a wide variety of methods including cryotherapy, surgical excision, podophyllin, bleomycin and various lasers. Each mode of therapy has its own complications and failure rates.
The treatment of patients with multiple, recalcitrant or recurrent verrucae continues to be a formidable task for both primary care physicians and dermatologists. Previous mentioned methods are not always successful and may be associated with adverse events. Even when existing warts are successfully eradicated, patients may develop new warts in other areas.
There are new trends towards the use of immunotherapy in treatment of warts, as the immune system seems to play an important role in the control of warts infection. Although the exact mechanisms are unclear but most evidences suggest that cell mediated immunity plays an important role in control of HPV infection as the incidence of warts increases in subjects with cell mediated immune defects e.g (HIV infection patients, malignant diseases. etc….).
Various methods have been used to stimulate the immunological response as oral levamisole, cimetidine, zinc sulfate, cidovir, intralesional interferons, topical DNCB, SADBE, imiquimod, intralesional immunotherapy with mumps, candida and trichophyton antigens, intradermal BCG vaccine, and intralesional MW vaccine.
We aimed in this work to assess safety and effectiveness of intralesional injection of tuberculin antigen injection versus MMR (mumps, measles, rubella) for the treatment of multiple warts as well as to investigate their effect on serum levels of IL 4 and IL12 being members of T helper 2 and T helper 1 cytokines.
We performed our study on 30 patients with multiple warts. The patients were divided into 3 groups, the first group included 10 patients injected with tuberculin antigen. The second group included 10 patients injected with MMR vaccine. The third group was injected with saline as a control group. Only the mother wart was injected. A 5ml venous blood sample was taken from all patients and controls before and 3 weeks after the previous modes of therapy for measuring serum levels of interleukin 4 and interleukin 12, serum TLC and PMN count.
As regard the response of the target wart, each of the PPD- and MMR- treated groups showed better results compared with the control group, both showing higher rates of complete response (60% and 80% versus 0% respectively), but as regard minimal response it was 30% and 10% versus 40% respectively and as regard no response it was 10% and 10% versus 60 % respectively. As regard the response of the distant wart each of the PPD-and MMR-treated groups showed also better results compared with the control group showing higher rates of complete response (60% and 40% versus 0% respectively), partial response (0 % and 20% versus 0% respectively), minimal response (30% and 40% versus 0% respectively), no response (10% and 0% versus 100% respectively).
No serious side effects were reported in patients included in this study with both PPD and MMR treatments. Only reported were local reactions in the form of pain, swelling and erthyma.
We found no statistically significant difference in response according to type or number of warts. The cure rate was better in patients with a shorter duration of the disease, the difference was statistically significant.
We found in this work that serum interleukin levels after treatment with PPD and MMR were significantly higher than in the control group. With regard to both types of immunotherapy, they seem to have a comparable effect on all laboratory parameters investigated except for IL-12 which showed a significantly higher level after treatment with MMR despite the absence of a reflection of this increase in IL-12 on a significantly higher clinical response. IL-4 levels and TLC after treatment, in the MMR –treated group only, showed a significant positive correlation with the clinical response. Serum TLC and PMN cell count do not seem to have an important modulatory effect on the immune mechanism of these types of treatment.
We found that treatment of multiple warts by PPD and MMR vaccine is safe and effective, with good cure rates and excellent safety profile. We found also that Interleukins-4 and 12 appear to increase following tissue destruction or inflammation or antigen injection, however, high serum levels are not usually associated with wart clearance.