A multitude of therapeutic strategies for treatment of warts exist, with no one therapy universally preferred. Location, size, type and number of warts merit consideration of therapy, while choosing a therapeutic modality along with patient pain tolerance, patient preference and physician preference.

The immune response of the host to HPV is important for resistance to and resolution of infection, with or without treatment. Cutaneous warts often resolve spontaneously in immunocompetent patients, So why do we treat warts?.^2,3  Spontaneous resolution may take months to years, in the interim  warts can grow and spread, cause pain and emotional distress due to their appearance.

Table: Treatments for cutaneous warts^1-5

*It is proposed that ablative therapies and even therapies such as duct tape might expose the immune system to HPV antigen, causing a host immune reaction.

A 24 yr old male presented with extensive tiny warts in beard area with 3 month history of the same. It was so extensive that cryotherapy or co2 laser would have left a lot of appreciable scarring in the beard area leading to cosmetic disfigurement. Only keratolytics as topical therapy would have lead to more chances of recurrences.

0.025 ml of Mw vaccine was initially injected intradermally in the deltoid region on both the sides, followed 2 weeks later by intralesional injection into the larger beard warts by drop and prick method using insulin syringe, total of no more than 0.1ml per sitting. The  intralesional injections were to be repeated 2 wkly. but patient came for second intralesional therapy after a month from the previous intralesional. he was advised to take tab ascazine thrice a day for at least 1 month. but the patient could take the medication just for 15 days. There was significant reduction of warts post first injection into the deltoid region and complete resolution of all the warts  after 2 sittings of intralesional injection. No recurrence was seen till 5 months of followup.

Immunotherapy is a safe, cost effective and efficient method of dealing with disseminated warts. Warts away from the injected warts also respond well due to generation of systemic immunity. Immunotherapy is worth considering in extensive or difficult to treat warts.

References 

1  Lynch MD, et al. Management of cutaneous viral warts. BMJ. 2014; 348: g3339 doi : 10.1136/bmj.g3339

2.       Kwok CS, et al. Topical treatments for cutaneous warts. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD001781. DOI: 10.1002/14651858.CD001781.pub3.

3.       Boull C, Groth D. Update: treatment of cutaneous viral warts in children. Pediatr Dermatol. 2011; 28: 217-29.

4.       Leung L. Recalcitrant nongenital warts. Aust Fam Phys. 2011; 40: 40-2.

5.       Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2006; 4: 273-93.