Efficacy of intralesional acyclovir versus quadrivalent human papillomavirus vaccine for treatment of recalcitrant cutaneous warts: a clinical trial.

Warts are the cutaneous manifestations of human papilloma virus infection. Immunotherapy with human papillomavirus (HPV) vaccines has been tried with promising outcomes. Acyclovir is an antiviral with established efficacy against DNA viruses, could become a possible revolutionary therapeutic option for warts. This study aims to assess the efficacy and safety of intralesional acyclovir versus quadrivalent human papilloma virus vaccine in treatment of recalcitrant cutaneous warts. A total of 60 patients with recalcitrant warts were assigned into 3 groups: group I, 20 patients received Intralesional injection of acyclovir, group II, 20 patient received intralesional quadrivalent HPV vaccine, and group III, 20 patients received intralesional injection of normal saline. The patients were followed up monthly for 3 months after the last injection to detect any recurrence. Complete clearance was observed in 8 patients (40%) in group I, 16 patients (80%) in group II and no response in group III. The most common side effects were pain (100%) among all groups, hemorrhagic eschars in group I(100%), edema in group II(30%) while the least was flu like symptoms (5%) in group II. both intralesional quadrivalent HPV vaccine and intralesional acyclovir seem to be promising, well-tolerated therapeutic options for the treatment of warts, with statistically significant superiority of the quadrivalent vaccine over acyclovir.