Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
Therapy Letters
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Therapy Letter
87 (
); 285-287

Immunotherapy using topical measles, mumps and rubella vaccine for treatment of verruca plana

Department of Dermatology, Venereology and Leprosy, Government Medical College, Kota, Rajasthan, India
Corresponding author: Dr. Suresh Kumar Jain, Department of Dermatology, Venereology and Leprosy, Government Medical College, Kota - 324 005, Rajasthan, India.
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Mohta A, Kushwaha RK, Gautam U, Jain SK. Immunothesrapy using topical measles, mumps and rubella vaccine for treatment of verruca plana. Indian J Dermatol Venereol Leprol 2021;87:285-7.


Verruca plana or plane warts are flat or slightly raised papular lesions, caused by human papillomavirus (HPV), seen commonly over sites prone to trauma such as face, neck and extremities. Recently, immunotherapy has emerged as an effective modality for warts by enhancing the patient’s delayed hypersensitivity immune reaction. Intralesional measles, mumps and rubella (MMR) vaccine has established itself to be reliable immunotherapy for warts.1,2 Here we report 2 cases of verruca plana, treated with topical MMR vaccine at the department of dermatology, Government Medical College, Kota, Rajasthan.

The first case was of an 18-year-old male patient who presented with multiple hyperpigmented flat-topped papules on the right cheek, temple, bilateral eyelids and forehead for 9 months. He had already been diagnosed to have verruca plana with koebnerization, six months back, for which he was prescribed oral zinc-sulfate and topical tretinoin for two months, with no relief, followed by chemical cauterization using topical trichloroacetic acid (TCA) three months back, before recurrence. The patient had stopped all treatment for the last three months. His immunocompetent status was ensured by carrying out hemogram, renal and liver function test, serology for HIV, hepatitis B and C and VDRL test. The patient was advised not to take any concurrent treatment during this time. The lesional skin was wiped with normal saline and allowed to dry. Standardized lyophilized MMR vaccine (live) I.P. (freeze-dried) TRESIVAC® was reconstituted with 0.5 mL of distilled water and the entire volume was applied over warts for two hours under plastic occlusive dressing. After once a week application for six consecutive weeks, all verruca plana simultaneously disappeared only, leaving behind residual hyperpigmentation [Figures 1 and 2].

Figure 1:: Multiple verruca plana on right side of face before treatment
Figure 2:: Complete clearance with residual hyperpigmentation on right side of face after 6 applications

Another patient, a 21-year-old immunocompetent man, presented with multiple clustered flesh-colored smooth papules over the bilateral mandibular and mental region, first noticed by him within three weeks of getting his beard shaved at a new local barbershop. As he continued to shave, he observed a gradual increase in the number of lesions over the last six months. Similar discreet lesions were also present over the temple and forehead. A clinical diagnosis of verruca plana was made, confirmed by histopathological examination revealing hyperkeratosis, mild papillomatosis, and koilocytes in suprabasal layers. The patient was treated similarly with weekly topical MMR application under a plastic occlusive dressing for the next five weeks, which resulted in the complete disappearance of all verruca plana [Figures 3 and 4].

Figure 3:: Multiple verruca plana on right side of face before treatment
Figure 4:: Complete clearance on right side of face after 5 applications of topical measles, mumps and rubella vaccine

Both patients were explained beforehand about the experimental nature of the therapy. A monthly follow-up was done in both the patients for the next three months, with no recurrence. Various conventional modalities used to treat warts include destruction with salicylic acid, trichloroacetic acid, surgical excision, cryotherapy, and lasers; antiviral (cidofovir), and antiproliferative agents like podophyllin, etc.3 Most of these procedures are either cumbersome or painful with high recurrence rates. Recently immunotherapy has emerged as an alternative treatment option. It is indicated for recalcitrant, recurrent, extensive, and difficult to treat (periungual, palmoplantar) warts.3 Various immunotherapies include autoimplantation, vitamin D3, mumps antigen, candida antigen, Trichophyton skin test antigen, purified protein derivative tuberculin, and e BCG, MMR, and Mycobacterium w vaccine.2 They are most commonly given intralesionally. The only topical immunotherapies tried in the past are topical BCG, sinecatechins, and imiquimod.3,4 MMR vaccine clears the virus and infected keratinocytes by stimulating humoral and cell-mediated immunity. The use of three antigens together helps to incite a stronger immune response against HPV with the production of IL-1, IL-2, IL-4, IL-5 and TNF-α. IL-1 and TNF-α have been shown to have antiviral effects on HPV, through the down-regulation of its gene transcription. Various placebo-controlled studies assessing MMR have reported complete clearance in 67-79% cases along with side effects like pain, itching, erythema and flu-like symptoms.1

The use of topical immunotherapy could overcome these adverse events. Neither of our patients reported any signs of immediate/delayed hypersensitivity or side effects like erythema, burning, itching or urticaria (ruling our hypersensitivity cross-reaction to any growth media or preservative used in MMR vaccine). However, a subclinical reaction cannot be ruled out.

Although literature mentions that the rate of spontaneous clearance in warts is high in children, in adults the rates are much lower and may take up to 24 months.5 It was doubtful that such spontaneous clearance could have occurred during the short period of our patients’ observation and follow-up. Additionally, we only chose patients with no other treatment history, to ensure that the effect of topical MMR vaccine was not influenced by other therapies. We were unable to find any previous studies, reporting the effect of topical MMR vaccine as an immunogen. Though we found topical MMR vaccine to be effective while treating verruca plana with no recurrence or side-effects, our observations are meant merely for generating a hypothesis about its mechanism of action and further controlled studies are needed to reproduce these results.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


  1. , , . Intralesional measles-mumps-rubella is associated with a higher complete response in cutaneous warts: A systematic review and meta-analysis of randomized controlled trial including GRADE qualification. J Dermatolog Treat [published online ahead of print, 2020 Jan 27]
    [Google Scholar]
  2. , , , , . The efficacy and safety of intralesional immunotherapy with measles, mumps, rubella virus vaccine for the treatment of common warts in adults. Indian Dermatol Online J. 2019;10:19-26.
    [Google Scholar]
  3. , . Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J. 2016;7:364-70.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , , , et al. Immunotherapy in viral warts with intradermal Bacillus Calmette-Guerin vaccine versus intradermal tuberculin purified protein derivative: A double-blind, randomized controlled trial comparing effectiveness and safety in a tertiary care center in Eastern India. Indian J Dermatol Venereol Leprol. 2017;83:411.
    [CrossRef] [PubMed] [Google Scholar]
  5. . An armamentarium of wart treatments. Clin Med Res. 2006;4:273-93.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views

PDF downloads
View/Download PDF
Download Citations
Show Sections