Modified intralesional acyclovir therapy in the management of recalcitrant palmoplantar and ungual warts: a case series of 14 patients.

This study evaluated the efficacy and safety of Intralesional Acyclovir in the treatment of recalcitrant palmoplantar and ungual warts in 14 patients(7 male and 7 female) of mean age 24.5 +- 8.19 years. The warts were infiltrated with modified acyclovir(50mg/ml) prepared by mixing 4 ml of distilled water and 1 ml of 2% lignocaine in 250mg of lyophilised powder of acyclovir. 0.1ml of solution was injected in each wart or till blanching occurred. The treatment was repeated after paring off the eschar every 2 weeks till a complete cure for a maximum of five sessions. A total of 55(82%) of the 67 warts showed complete response and 12(17.9%) showed partial response by the end of five sessions. Out of 55 warts, complete clearance was seen in 20 warts (29.8%) at 2 weeks, 37 warts (55.2%) by 4 weeks, 50 warts (74.6%) by 6 weeks and 55 warts (82%) by 8th as well as 10th week. Adverse effects reported were lesional tenderness for 2-3 days following injection in 3(23%) patients. Blistering and nail plate damage were seen in one patient respectively. Modification of acyclovir therapy with the addition of lignocaine resulted in an unaltered concentration while maintaining efficacy. The efficacy and safety were comparable to previous studies with higher patient acceptability.