Efficacy and Safety of Intralesional 5-Flurouracil in Treatment of Warts

Kaneez Fatima; Muzammal Nadeem Butt; Sidiqua Javaid; Noor-ul-Wara; Reesham Zulkiffal Bhatti; Rubab Ayesha Rasheed

doi:10.70749/ijbr.v3i3.865

Authors

Kaneez Fatima Department of Dermatology, Pakistan Emirates Military Hospital, Pakistan.
Muzammal Nadeem Butt Primary Healthcare Corporation, Qatar.
Sidiqua Javaid Department of Dermatology, Pakistan Emirates Military Hospital, Pakistan.
Noor-ul-Wara Department of Dermatology, Pakistan Emirates Military Hospital, Pakistan.
Reesham Zulkiffal Bhatti Department of Dermatology, Pakistan Emirates Military Hospital, Pakistan.
Rubab Ayesha Rasheed Department of Dermatology, Pakistan Emirates Military Hospital, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i3.865

Keywords:

Warts, Intralesional 5-FU, Genital, Human Papillomavirus

Abstract

Background: Warts are common benign skin lesions caused by human papillomavirus (HPV), with varying clinical presentations based on the type of HPV and site of infection. Treatment options aim to eliminate the infected epidermis, but pain, side effects, and cost influence treatment choice. 5-Fluorouracil (5-FU), an antimetabolite, has been explored as a potential treatment, with intralesional administration offering improved efficacy over topical application. Objective: This study aimed to evaluate the efficacy and safety of intralesional 5-FU in the treatment of warts. Methods: A cross-sectional observational study was conducted between January and June 2024, enrolling 85 patients from the Dermatology Department at Pakistan Emirates Military Hospital. Intralesional 5-FU (0.1 ml/cm², 50 mg/ml) was administered biweekly, with a maximum of six injections. Patients were monitored fortnightly for two months’ post-treatment. Clinical improvement was assessed based on predefined efficacy grades: excellent (75–100% improvement), good (50–74% improvement), satisfactory (25–49% improvement), and poor (<25% improvement). Data analysis was performed using IBM-SPSS 21.0, with statistical significance set at p ≤ 0.05. Results: Of the 85 patients, 64 (75.3%) exhibited an excellent response, primarily after the second and third injections. Eleven patients (12.9%) showed a good response, six (7.1%) had a satisfactory response, and four (4.7%) demonstrated poor improvement. The treatment was well tolerated, with minor adverse effects such as erythema and oedema, and no cases of necrosis or scarring. Conclusion: Intralesional 5-FU demonstrated significant efficacy in wart treatment, with a favourable safety profile. These findings support its use as an effective alternative for managing recalcitrant warts, warranting further research to optimize treatment protocols.

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References

Bacaj P, Burch D. Human papillomavirus infection of the skin. Archives of pathology & laboratory medicine. 2018;142(6):700-5. https://doi.org/10.5858/arpa.2017-0572-ra

Witchey DJ, Witchey NB, Roth-Kauffman MM, Kauffman MK. Plantar warts: epidemiology, pathophysiology, and clinical management. Journal of Osteopathic Medicine. 2018;118(2):92-105. https://doi.org/10.7556/jaoa.2018.024

Abduelmula A, Minhajur Rahman S, Jafferany M. Psychodermatology awareness: Representation of psychocutaneous diseases in dermatology textbooks. Journal of Cosmetic Dermatology. 2022;21(10):5266-9. https://doi.org/10.1111/jocd.14917

Zoheir MG, AL Mohsen AR, Amer MA. Efficacy of Intralesional Methotrexate versus 5-Flurouracil in treatment of Warts. Al-Azhar International Medical Journal. 2022;3(4):129-32. https://doi.org/10.21608/aimj.2022.108615.1696

Zhu P, Qi RQ, Yang Y, Huo W, Zhang Y, He L, et al. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). Journal of Evidence‐Based Medicine. 2022;15(3):284-301. https://doi.org/10.1111/jebm.12494

Ntungo S, Malan M. Challenges in Managing Verruca Plana in a Resource Constrained Environment Complicated with Retroviral Disease: An Overview. Open Access J Biog Sci Res. 2020;5(3):1-5. https://doi.org/10.46718/jbgsr.2020.05.000121

Oren-Shabtai M, Snast I, Lapidoth M, Sherman S, Noyman Y, Mimouni D, et al. Topical and Systemic Retinoids for the Treatment of Genital Warts: A Systematic Review and Meta-Analysis. Dermatology. 2021;237(3):389-95. https://doi.org/10.1159/000511398

Sawchuk WS, Weber PJ, Lowy DR, Dzubow LM. Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. Journal of the American Academy of Dermatology. 1989;21(1):41-9. https://doi.org/10.1016/s0190-9622(89)70146-8

García‐Oreja S, Álvaro‐Afonso FJ, Tardáguila‐García A, López‐Moral M, García‐Madrid M, Lázaro‐Martínez JL. Efficacy of cryotherapy for plantar warts: A systematic review and meta‐analysis. Dermatologic therapy. 2022;35(6):e15480. https://doi.org/10.1111/dth.15480

Boroujeni NH, Handjani F, Saki N. CO2 laser treatment for plantar warts in children: A case series. Dermatologic Therapy. 2020;33(3):e13414. https://doi.org/10.1111/dth.13414

Clay PA, Thompson TD, Markowitz LE, Ekwueme DU, Saraiya M, Chesson HW. Updated estimate of the annual direct medical cost of screening and treatment for human papillomavirus associated disease in the United States. Vaccine. 2023;41(14):2376-81. https://doi.org/10.1016/j.vaccine.2023.02.049

De Oliveira BE, Amorim OH, Lima LL, Rezende RA, Mestnik NC, Bagatin E, et al. 5-Fluorouracil, innovative drug delivery systems to enhance bioavailability for topical use. Journal of Drug Delivery Science and Technology. 2021;61:102155. https://doi.org/10.1016/j.jddst.2020.102155

Jaferian S, Negahdari B, Eatemadi A. Colon cancer targeting using conjugates biomaterial 5-flurouracil. Biomedicine & Pharmacotherapy. 2016; 84:780-8. https://doi.org/10.1016/j.biopha.2016.10.004

Singh V, Brecik M, Mukherjee R, Evans JC, Svetlíková Z, Blaško J, et al. The complex mechanism of antimycobacterial action of 5-fluorouracil. Chemistry & biology. 2015;22(1):63-75. https://doi.org/10.1016/j.chembiol.2014.11.006

Wu Y, Su Q, Wang C, Du Y, Wang F. Needle-free injection of 5-fluorouracil suggests efficacy and tolerability in the treatment of palmoplantar warts: A randomized clinical trial. Journal of the American Academy of Dermatology. 2023;88(5):1152-4. https://doi.org/10.1016/j.jaad.2022.11.042

Kamal T, Ahmad F, Iftikhar U. Efficacy and safety of intralesional 5-fluorouracil in treatment of warts. Journal of Pakistan Association of Dermatologists. 2018 Dec 13;28(3):337-9.

Iscimen, A. et al. (2004). Use of intralesional 5-FU in the treatment of common plantar warts. Journal of Dermatological Treatment, 15(3), 176-180.

Swinehart, J. M. et al. (1983). Intralesional 5-fluorouracil for the treatment of condylomata acuminata. Archives of Dermatology, 119(1), 21-25.

Yazdanfar, A. et al. (2019). Efficacy of intralesional 5-FU in the treatment of warts: A clinical study. Dermatologic Therapy, 32(4), e13085.

Srivastava, A. et al. (2020). Efficacy and safety of intralesional 5-fluorouracil in the treatment of palmoplantar warts. Indian Journal of Dermatology, 65(2), 112-118.