Comparative study between intralesional acyclovir versus intralesional 5-flurouracil in treatment of recalcitrant...

Although different treatment modalities are available, the treatment of warts is still challenging with recalcitrant and recurrent lesions. Given that warts are viral in nature, acyclovir might be a viable treatment option. Intralesional acyclovir and 5-fluorouracil (5-FU) injections have been described for treating common warts and achieved a complete response in most of the patients.

The aim of this work was to assess the efficacy and safety of intralesional acyclovir versus intralesional 5-flurouracil in treatment of recalcitrant cutaneous warts.

This comparative study was carried out on 60 patients diagnosed with recalcitrant cutaneous warts. The patients were categorized randomly into group I (30 patients treated with intralesional acyclovir) and group II (30 patients treated with intralesional 5-FU). Treatment was repeated every two weeks to a maximum of six sessions or until complete clearance occurred. Treatment response was assessed clinically and dermoscopically. This is the first randomized clinical trial comparing intralesional acyclovir with 5-FU for recalcitrant warts.

After the end of 6 months of follow-up, complete clearance was achieved in 20 patients (66.7%) and 19 patients (63.3%) in the acyclovir and 5-FU groups, respectively. Also, complete clearance of all dermoscopic findings was observed in 66.7% of patients in the acyclovir group compared to 63.3% of patients in the 5-FU group, with no statistically significant difference between both groups (p > 0.001). Both modalities were safe and well tolerated.

Intralesional acyclovir and 5-FU are safe and effective methods in treatment of recalcitrant cutaneous warts.