Objective: The aim of this work is to make a comparative study between the efficacy of intralesional BCG vaccine and intralesional combination of 5-fluorouracil (5-FU), lidocaine (L) and epinephrine (E) for the treatment of warts.
Patients & Methods: Sixty patients were included in the study with age range from 18 – 65 years. Patients with different types of warts ( common, planter, genital, periungual warts) were selected from the outpatient clinic of Dermatology & Andrology Department of Benha University Hospital. The selected patients were randomized into two treatment groups where group (A) received intralesional 5-FU+ LE (4mL of 50 mg/mL 5-fluorouracil and 1 mL of a mixture of 20 mg/mL[2%] lidocaine and 0.0125 mg/mL epinephrine) at biweekly intervals till complete clearance of the warts. In group (B) a single wart in each patient was injected intralesionally with 0.1 ml BCG. This therapy is repeated every 3 weeks till complete clearance of the warts or for a maximum of four treatments without response.
Results: The number of sessions required to achieve response varied between both drugs, ranging from 1-4 sessions for BCG, and more than 6 sessions for 5-FU with time interval between sessions 2 weeks for 5-FU and 3 weeks for BCG. The study found that there was no response in 3.3% for 5-FU versus 20% for BCG. Partial response was observed in 33.3% of patients treated with 5-FU versus 40% for BCG, and 63.9% had complete response with 5-FU versus 40% for BCG. The response was better in patients who received 5-FU treatment than those who received BCG treatment regarding to the number of warts. It is also notable that the larger the number of warts the better the response. Results were higher for 5-FU in all wart types with maximum response in genital warts, while the least response was observed equally in both planter and palmer sites. It was also notable that the longer the duration of warts, the better the response to either drugs.
Conclusion: 5-FU was better in treating large number of warts, although BCG was easier in administration. 5-FU achieved best response in genital warts; unfortunately we were unable to compare with BCG. The second best response was in periungual warts followed by common warts. The least response was observed in plantar and palmar warts. It was also noted that larger and older warts responded better to either drugs.
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