Warts are papillomatous benign skin outgrowths arising from the epidermis as a result of an infection by human papilloma virus .1 Clinical manifestatations could range from asymptomatic papules, plaques with verrucous surface, pruritis , painful plaques involving any part of skin, mucocutaneous or mucosal tissue leading to cosmetic disfigurement and morbidity with atendency to spread contiguously and distally.2 Depending on the number and site of warts a wide plethora of treatment options are available including topical keratolytics like salicyclic acid, topical podophyllin, imiquimod application, topical sensitizers like dinitrochlorobenzene(DNCB), squaric acid dibutyl ester( SADBE), radiofrequency monopolar ablation, cryotherapy, ablative CO2 laser, intalesional MMR, intralesional bleomycin. 1 Treatment with the above modalities poses a challenge when warts are multiple in number, refractory to treatment and recurs following treatment, painful wounds following electrosurgical or destructive procedures especially when multiple or is located at a site difficult to treat such as over eyelids, peri or subungual area. 1 There is a need for a treatment procedure that involves minimal sittings and is practically simple to perform with minimal wounds, this lead to the development of autoinoculation as a procedure to treat multiple and recurrent warts. Since the procedure involves a surgical procedure that is being increasingly utilized one is bound to encounter adverse effects both minor and major and a study of the side effects encountered is warranted to examine its potential as an effective treatment modality for viral warts. • Patients diagnosed with viral
warts between December 2025 to November 2026 attending the Dermatology OPD will
be recruited in this study with a minimum sample size of 29 patients. •
Characteristics such as
age, sex and duration of warts, any previous administered treatment, history of
recurrence is noted, presenting features such as history of itching, pain are
noted. • Examination findings such as clinical morphology and site of warts
is noted. Number of warts and percentage decline is noted at the end of 1st
and 3rd month. • Autoinoculation procedure is performed as follows: • After obtaining informed written consent and obtaining photographs
of warts at baseline, routine investigations are done such as complete blood
count, random blood sugar, tests for HBsAg, HIV, HCV and other investigations
as indicated. Those unvaccinated were administered the tetanus toxoid vaccine
prior to procedure. Test dose for 2% lignocaine is administered. • The older onset warts are preferred for donor site. • Procedure followed is as per description by Lal NR et al3 with
minor modifications.
Under
sterile aseptic precautions the selected donor wart after administering 2%
lignocaine is shave excised using number 15 surgical scalpel blade. The donor
site hemostasis is ensured with the coagulation mode of a radiofrequency
monopolar • probe.
• The wart tissue excised is cut into small bits using the scalpel
blade, the ventral surface is examined for a white surface which is indicative
of wart material and placed in a sterile bowl with normal saline.
• Recipient area is chosen over the ventromedial aspect of the non-dominant
arm, palpated to ensure no underlying pulsation and a nick 3 mm long after
ensuring asepsis is made using a fresh sterile number 15 surgical blade. Tissue
to the medial aspect of this incision is dissected using blunt curved artery
forceps to create a subdermal pocket where the wart material obtained is placed
and the skin is sutured using 3-0 non absorbable suture material. Hemostasis is
ensured and the donor and recipient sites are dressed with topical mupirocin. The
patient is given 5 days of oral amoxcillin and clavulanic acid and
anti-inflammatory agent in case of pain. Patients were instructed to keep the
dressing till 3 days following which it can be changed at a local hospital once
in 2 days and to review after 10 days for suture removal.
• Patients were then asked to follow up after 1 month and 3 months and
examined for number of warts and percentage reduction and quantified as
<25%, 26-50%, 51 -75% and >75 % improvement if any, worsening or no
improvement was also noted. Patients were asked for immediate side effects such
as pain, bleeding after 10 days , delayed changes such as secondary infection,
contact dermatitis, hyperpigmentation and
new wart at autoinoculation site, side effects at the donor site
included hypopigmentation and scarring if any at the end of 1st and
3rd month. • probe.
• The wart tissue excised is cut into small bits using the scalpel
blade, the ventral surface is examined for a white surface which is indicative
of wart material and placed in a sterile bowl with normal saline.
• Recipient area is chosen over the ventromedial aspect of the non-dominant
arm, palpated to ensure no underlying pulsation and a nick 3 mm long after
ensuring asepsis is made using a fresh sterile number 15 surgical blade. Tissue
to the medial aspect of this incision is dissected using blunt curved artery
forceps to create a subdermal pocket where the wart material obtained is placed
and the skin is sutured using 3-0 non absorbable suture material. Hemostasis is
ensured and the donor and recipient sites are dressed with topical mupirocin. The
patient is given 5 days of oral amoxcillin and clavulanic acid and
anti-inflammatory agent in case of pain. Patients were instructed to keep the
dressing till 3 days following which it can be changed at a local hospital once
in 2 days and to review after 10 days for suture removal.
• Patients were then asked to follow up after 1 month and 3 months and
examined for number of warts and percentage reduction and quantified as
<25%, 26-50%, 51 -75% and >75 % improvement if any, worsening or no
improvement was also noted. Patients were asked for immediate side effects such
as pain, bleeding after 10 days , delayed changes such as secondary infection,
contact dermatitis, hyperpigmentation and
new wart at autoinoculation site, side effects at the donor site
included hypopigmentation and scarring if any at the end of 1st and
3rd month. |