The Use of Bacillus Calmette-Guerin (BCG), Mycobacterium Indicus Pranii (Mw Vaccine), and Purified Protein Derivative (PPD) for the Treatment of Recalcitrant Warts: Challenges and Trends

Recalcitrant warts can accurately be defined as warts that persist after six months of conventional
therapy. Traditional treatment options for warts include topical salicylic acid, cryotherapy, and
electrocautery; however, patients with recalcitrant warts remain a major therapeutic challenge. There
is evidence that immunotherapy can clear recalcitrant warts if traditional treatment fails. Given this,
clinical studies published in PubMed and Google Scholar that used Bacillus Calmette-Guerin (BCG),
Mycobacterium Indicus Pranii (Mw vaccine), and purified protein derivative (PPD) as immunotherapy
for wart, were reviewed in this study. Neither of these treatments has been subjected to a randomized
controlled trial, thus to date, there are no standardized protocols to use them. Our review highlights
the scientific facts in the clinical applications of the previous options to treat recalcitrant warts and
investigate the differences among them, concerning efficacy, adverse effects, dosage, and route of
administration.Mw vaccine consists of heat-killed bacilli in a buffer solution, and its use neither needs
a prior tuberculin test nor has a specific age group. Further randomized controlled studies are
required to obtain more information to construct a therapeutic protocol.