Varicella zoster vaccine versus bleomycin intralesional injection in treatment of warts

Background Warts are viral cutaneous infections induced by human papillomavirus, characterized by verrucous proliferations on the skin surface. Intralesional bleomycin is a well-known modality in the treatment of warts; however, the varicella zoster vaccine (VZV) is a novel approach to intralesional immunotherapy and may serve as a viable treatment for warts. Objective To evaluate the effectiveness and adverse effects of the VZV vaccine versus bleomycin injection in wart treatment. Patients and methods This study was a randomized controlled clinical trial that was conducted on 50 patients with warts of varying sizes and clinical kinds. The participants were randomly allocated into two equal groups: group A was treated with intralesional bleomycin (1 mg/ml solution), whereas group B was administered intralesional VZV. Both groups had four sessions, one every 2 weeks. Results Regarding treatment response following the last session, 80% of patients administered bleomycin achieved complete clearance, compared to 72% of patients receiving the VZV vaccination, with no statistically significant difference observed between the two groups ( P =0.74). Regarding side effects, 52% of patients administered the VZV vaccine experienced edema and induration, whereas 24% of patients treated with bleomycin exhibited similar effects, with statistically significant differences between the two groups ( P =0.04). No substantial difference was seen between the two groups concerning the recurrence rate of warts ( P =1.00). Conclusion Intralesional injection of VZV vaccine is as effective as intralesional injection of bleomycin, especially in patients with multiple warts with more edema and induration compared to bleomycin.