Comparative study of intralesional BCG and PPD in the treatment of multiple cutaneous warts

Introduction: Multiple cutaneous warts are often asymptomatic, cosmetically disfiguring and difficult to treat with conventional modalities, hence immunotherapeutic modalities can be used in such cases. There are no comparitive studies with immunotherapeutic modalities for the treatment of multiple and extensive warts. This study aims to compare the efficacy and safety of intralesional BCG and PPD in the treatment of multiple cutaneous warts. Materials and Methods: It is a double blinded randomized clinical trial involving thirty patients having more than ten cutaneous warts with a positive mantoux reaction. The patients were randomly allocated into two treatment groups, group A – PPD and group B - BCG. Intralesional injections were given at two weekly intervals till complete clearance of all the warts or for a maximum of four sessions in both the groups. Response in injected warts and distant warts was assessed at each visit and sequential clinical photographic records were maintained. Results: Thirty patients with positive mantoux reaction were enrolled for the trial, 17 patients in group A (PPD) and 13 patients in group B (BCG). Complete resolution of lesions was noted in 35.3% in PPD group and 30.8% in BCG group and partial resolution was noted in 47.0% and 38.4 % in PPD and BCG group respectively. Conclusion: Intralesional PPD showed marginally better results than intralesional BCG in the treatment of multiple cutaneous warts. Majority of the patients treated with BCG had tender nodule at injection site.