Quadrivalent human papillomavirus vaccination: a promising treatment for recalcitrant cutaneous warts in children.

Cutaneous human papillomavirus (HPV)-induced warts are common in the general population, especially among children. Prevalence rates among primary schoolchildren are between 22% and 33% (1). In childhood, in particular, the spontaneous resolution rate of HPV-induced warts is high. Half of primary schoolchildren will be free of warts within one year (2) and approximately two-thirds of warts clear without treatment within 2 years (3). However, dermatologists still see a high number of children with extragenital warts that do not resolve spontaneously for years and cause psychological (particularly if located on the hands and fingers) and physical (pain and irritation if located sub-or peri-ungually) problems. At present a large number of different approaches to treat these problematic warts are used in clinical practice, but there is no universally effective treatment (4). During the last few years a number of publications have reported high clearance rates after repeated intralesional injections of immune-stimulating mumps or Candida antisera (5), or commercially available mumps, measles and rubella vaccine (6–8). A report of successful treatment of recal-citrant plantar warts in a 59-year-old healthy woman by administering quadrivalent HPV vaccine in the patient's arm in 3 doses at 0, 2 and 6 months (9), formed the basis for our current case study, using the vaccine in children aged 9–11 years who had had therapy-resistant extrage-nital warts for years. MATERIAL AND METHODS All 6 children had had painful and/or embarrassing recalcitrant extragenital warts for more than 2 years (Table I) and a number of therapeutic approaches had failed. In all children topical sa-licylic acid, duct tape occlusion therapy and cryotherapy, alone or in combination, had been performed. In addition, imiquimod (n = 3), laser treatment (n = 2), cimetidine (n = 1), topical 5-flu-orouracil (5-FU) (n = 5) and glutaraldehyde (n = 5) had failed. Administration of the vaccine was therefore started. The vaccine was administered in 3 separate intramuscular injections in the deltoid region of the upper arm. Permission was obtained from parents and referring paediatricians. The vaccine is licensed for use at 9 years of age and over in Germany. No other vaccination regime was performed 4 weeks prior to this treatment, during the active vaccination process and 4 weeks afterwards. RESULTS The vaccine was well-tolerated, with local swelling, lasting only for a short time, in some children. In 4 children healing of warts was documented between the 2 nd and 3 rd vaccination, 1 girl was …