A comparative study evaluating the efficacy of multipuncture technique with topical bleomycin vs topical ppd in treatment of cutaneous warts

Abstract

I N T R O D U C T I O N newline1 newlineINTRODUCTION newlineWarts are mucocutaneous exo /endophytic growths caused by newlinehuman papilloma virus (HPV) which is a double stranded DNA virus newlineand has more than hundred strains. Various treatment options for newlinewarts include keratolytics, cytotoxic agents, caustic agents, newlineimmunomodulators, antiviral drugs, surgical therapies, cryotherapy, newlinepsychotherapy, photodynamic therapy and immunotherapy. Warts newlinespontaneously regress in few patients whereas in some there may be newlinepersistence and progression leading to physical and emotional stress. newlineMost of the therapeutic modalities ablate the growth without newlinegeneration of a specific immunity against the warts. This often leads newlineto irritation, pain, recurrence, scarring and prolonged morbidity. newlineStimulation of immune system by exposing the virus to immune newlinemediators forms the ideal modality of treatment leading to newlinespontaneous regression of wart with long lasting immunity. newlineQuadrivalent HPV vaccine has shown it s efficacy in wart regression. newlineHowever serotypes other than those in the vaccin e also can cause newlinewarts and hence this modality may not be always effective. newlineAutoinoculation is a novel auto-graft technique which treats warts by newlinestimulating an immune response against the same serotype of HPV newlinecausing warts unlike the HPV vaccine. Multipun cture technique is a newlinemodified autoinoculation procedure where the immune system is newlinestimulated when multiple punctures on the wart tissue causes the newlineentry of virus into the dermis. newlineI N T R O D U C T I O N newline2 newlineBleomycin is an anti mitotic drug derived from streptomyces newlineverticillus having anti tumor, anti bacterial and anti viral activity. It newlinebinds to DNA causing strand scission, elimination of purine and newlinepyrimidine bases. It inhibits cell cycle at G2 phase. Bleomycin newlinehydrolase enzyme normally found in all body tissues is present in newlinevery small amounts in the skin. newlinePurified protein derivative (PPD), an extract of Mycobacterium newlinetuberculosis, contains live attenuated mycobacterium bovis.