Human Papillomavirus Vaccine in Patients With Palmoplantar Warts

The quadrivalent or nonavalent human papillomavirus (HPV) vaccine in patients with palmoplantar warts may be efficient. The vaccine is well tolerated although there is a high failure rate in the management of palmoplantar warts after salicylic acid or liquid nitrogen have been used. These are among the study findings published in the Journal of the European Academy of Dermatology and Venereology.

Researchers sought to evaluate the therapeutic response to the quadrivalent or nonavalent HPV vaccine in patients with palmoplantar warts. The primary outcome was complete remission (CR), the absence of a visible lesion at 12 months (M12) following the first injection. Partial remission (PR) defined as at least 50% regression of lesions at M12, adverse reactions, rate of recurrence or delayed cure and average time to onset, and time to response were secondary outcomes.

Researchers conducted a multicentric retrospective study through the French Society of Dermatology that included 18 patients (median age 39.5 years, range 18-64 years; 8 women) who should have received at least 1 dose of vaccine between January 2009 and July 2020. Among these 18 patients, 14 were immunocompromised. The investigators defined 13 of the patients thusly: 3 HIV+ with CD4 between 100 and 200/mm³, 1 organ transplant, 4 common variable immune deficiency, 3 multiple sclerosis on fingolimod, 1 GATA2 deficiency, 1 idiopathic lymphopenia), and 14 presented another associated HPV infection, respectively, according to the researchers. Most of these patients’ warts were described as “difficult-to-treat” having evolved for a median of 10 years (range 6-20 years). Of these 18 patients, 4 received 2 doses of vaccine and 8 received the usual vaccination schedule of baseline, M2, and M6, respectively. It was not noted what, if any, vaccine the remaining 6 patients received.

Researchers found there were 2 patients (11%) in CR at M12 and 7 patients (39%) in PR with mean time to response of 3.5 months (range 1-12 months). They mentioned this CR rate was lower than found in the literature (31%-47%). They noted no significant factors associated with a response treatment among sex, age, smoking, immunocompromised status, association with other HPV infections, location of warts, number of previous treatments, duration of evolution, and type of vaccine or number of doses received.

They observed the responder patients’ recurrence rate was 44% (mean time 19 months), and that later healing — that was complete or partial — among PR or nonresponder patients also occurred in 44% of patients (mean time, 22 months). They noted no adverse reactions.

Study limitations include the underpowered sample size, the retrospective design, the unknown complete vaccination schedule of all patients, the lack of an unvaccinated control group, and association with other treatment.

Researchers concluded that the HPV quadrivalent or nonavalent vaccine could be efficient although possibly less efficient in some subpopulations. They stated “there is a high rate of failure in the management of palmoplantar warts once [salicylic acid or liquid nitrogen] have been used,” and they reiterated the vaccine is well tolerated.

Reference

Merio L, Chanal J, Jachiet M, et al.; with the support of the GrIDIST. Human papilloma virus vaccine for palmoplantar warts: a retrospective study of 18 patients. J Eur Acad Dermatol Venereol. Published online August 16, 2022. doi:10.1111/jdv.18523