Effectiveness of autoinoculation in viral warts: A single arm, open-label, and clinical trial

Viral warts are well-defined, hyperkeratotic mucocutaneous lesions caused by human papilloma virus infection, that can occur anywhere on the body. Various medical and surgical modalities are required for treatment of warts as spontaneous regression is rarely seen. Despite the availability of multiple treatment options, warts are often recurrent and resistant to treatment. The effectiveness of autoinoculation in the treatment of multiple or recurrent verruca was evaluated. Consecutive cases with at least five warts or recurrent warts were included. A treatment-free washout period of 1 month was ensured. Patients with verruca vulgaris (n = 13), palmoplantar (n = 4), periungual (n = 5) were included in the study. The warty tissue was excised, minced and homogenous tissue implanted in a small dermal pocket in the left forearm. Patients were evaluated every 4 weeks. The procedure was repeated at 4th and 8th week. Response was assessed at each visit and at 12th week. Fifteen cases were recruited. Majority of the patients were diagnosed with verruca vulgaris (87%, n = 13) followed by periungual warts (33%, n = 5) and palmoplantar warts (27%, n = 4). Recurrent warts were present in 73% (n = 11) patients. Average improvement at the end of 12 weeks was seen in 65% cases. Ten (67%) patients showed complete resolution of warts. In two patients, warts increased in number while on treatment. Local site infection was seen in two patients. The study is limited by its small sample size. Autoinoculation is an effective modality of treatment for multiple and recurrent warts. Furthermore, it is an effective treatment modality for periungual and plantar warts, which are usually resistant to other modalities.