Intralesional Measles Mumps Rubella Vaccine versus Cryotherapy in Multiple Extragenital Warts: A Prospective Interventional Study

Introduction: Verruca, commonly known as warts, is a common cutaneous infection caused by Human papillomavirus (HPV), often challenging to treat effectively. Traditional therapies like cryotherapy have limitations, prompting interest in immunotherapeutic alternatives, including intralesional Measles Mumps Rubella (MMR) vaccine. Aim: To evaluate the clinical outcomes of cryotherapy vs intralesional MMR vaccine in patients with multiple extragenital warts. Materials and Methods: The present prospective interventional study was conducted in the dermatology Outpatient Department (OPD) of Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India over a period of 18 months. A total of 50 patients diagnosed with multiple extragenital warts were enrolled, with 25 patients in each treatment group: Cryotherapy (CT) (Group CT) and intralesional Measles Mumps Rubella vaccine (Group MMR). The treatment outcomes were measured using a Visual Analogue Scale (VAS), percentage of clearance of the largest lesion and Likert’s patient satisfaction scores. For continuous variables, comparisons between the two treatment groups were made using the independent t-test. For categorical variables, Chi-square test was used. Results: Both groups had comparable wart characteristics, with verruca vulgaris being the most common type, with 10(40%) of patients in the MMR group and 11 (44%) of patients in CT group. Clinical improvement assessed using the VAS score showed better and faster clearance, predominantly in the early weeks of treatment (week 2 and week 4) in the MMR group. The assessment based on the size of the largest wart and patient satisfaction using the Likert score also demonstrated better clearance in Group MMR at two, four and six weeks. Blisters 10 (40%) and hypopigmentation 5 (20%) were exclusively observed in the CT group. Conclusion: While response to both therapies were good and comparable, intralesional MMR can be considered as a superior alternative to cryotherapy because administration of MMR into a single large lesion showed significant clinical improvement of not just the lesion injected, but clearance of warts at distant sites as well which was in contrast to cryotherapy where each and every wart was to be treated.