الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Warts are benign proliferations of skin caused by the HumanPapillomavirus (HPV). Currently, more than 100 types of HPV have been identified. Certain HPV types tend to occur at particular anatomic sites; however they may occur at any site. Warts occur at any age, but are unusual in infancy and early childhood. The incidence increases during the school years to reach a peak in adolescence and early adulthood. Warts spread by direct contact or autoinoculation. This means if a wart is scratched, the viral particles may spread to another area of skin.
There are various types of viral warts including common warts, plantar warts, plane or flat warts, filiform warts, periungual warts, epidermodysplasia verruciformis (EV), oral warts and genital warts.
There are many therapeutic modalities available for the treatment of warts including chemical treatment using salicylic acid or similar compounds, cryotherapy with liquid nitrogen, electrosurgery (curettage and cauttery), laser vaporization and photodynamic therapy but none of them offers a guarantee of cure and recurrence is common. All these previous destructive modalities are variably effective, frequently painful and usually cause scarring. More over these modalities require individual treatment of each wart and do not prevent recurrence.
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 rather than humoral immunity plays an important role in control of HPV infection as the incidence of warts increases in subjects with cell mediated immune defects. Various methods have been used to stimulate the immunological response as oral levamisole, cimetidine, zinc sulfate, cidofovir, intralesional interferons, imiquimod, intralesional immunotherapy with mumps, candida and trichophyton antigens and intradermal BCG vaccine.
In this work, we studied the efficacy of tuberculin antigen as immunotherapy modalities in treatment of warts.
Thirty patients suffering from different types of warts at different sites, of both sexes and of different age groups were included in this study. They were divided into 2 groups, Group 1 included 20 patients who were subjected to intralesional tuberculin injection. Group 2 include 10 patients who were subjected to intralesional saline injection as a control group.
The result showed that 60% of patients had complete resolution, 25% of patients had incomplete resolution, and 15%of patients showed no response which was significantly high when compared with the response of 10 patients who received intralesional saline.20% of patients showed incomplete resolution and 80% of patients showed no response. No statistically significant difference in response according to type, number of warts and the size of warts.
The cure rate was better in patients with a shorter duration of the disease, the difference was statistically significant. In addition, there was a significant directly proportional correlation between wart resolution and size of tuberculin reaction.
No serious side effects occurred in any of the patients included in this study. Only local reaction at the site of injection in the form of redness, tenderness, oedema and blistering. All these reactions subsided 4 days later after injection without any medications.
Intralesional immunotherapy by PPD is a promising treatment modality for common warts, particularly the multiple ones. It seems to be inexpensive, effective and safe option that has the potential advantages of widespread and sustained effects against HPV. It is especially promising in countries where vaccination against tuberculosis is performed routinely.