09/22/2022    Leonard A. Levy, DPM, MPH

Treatment of Warts with Needle-Free Injection of Fluorouracil

Warts, a very common infectious skin disease caused
by human papillomavirus has been treated with
several pharmacological agents (e.g., salicylic
acid, cryosurgery, fluorouracil (FU), and
bleomycin). However, the treatment of warts remains
a challenge because of unsatisfying results and
sometimes painful processes. An article by B.M. Yu
Wu and Fei Wang Fei Wang, MD, Department of
Dermatology, Zhongda Hospital, Southeast
University, No. 87, Dingjiaqiao, Gulou District,
Nanjing 210000, China describes two patients with
warts who were successfully treated with needle-
free injection of FU, a method for warts not
previously reported.

One of the patients was a 25-year-old man with an 8
mm in diameter wart of 2 months’ duration on the
big toe of his right foot. The patient was treated
with an intralesional injection of FU with a
needle-free injector (Injex; Aijex Pharma) which
works on a spring mechanism that is drawn back and
then released by hitting a trigger, pushing a
specific dose of drug from the ampoule into the
skin The warts are first wiped with alcohol and
then superficially pared with a scalpel to remove
the associated callus without reaching the bleeding
point; 0.05 mL of a mixture of FU (10 mL, 0.25 g)
and lidocaine (5 mL, 0.1 g) was then injected
vertically into each wart. The patient's pain score
was 2 of 10.

Two weeks later, round black scabs formed at the
injection site, 1 of which had fallen off with no
residue underneath. After 2 treatments, the warts
on the big toe were healed completely without
scarring or hyperpigmentation. No recurrence
occurred during a 6-month follow-up. Although 93%
of patients could experience complete resolution
with treatment with a conventional needle injection
of FU, many, especially children, have difficulty
tolerating the pain of needle injections. The
volume and depth of the injections are also
difficult to control. In addition, needle-free
injection uses high-speed liquid flow to deliver
drugs into skin tissue without causing much pain,
which allows for a more even and controllable
distribution of the drug.

While needle-free injections of bleomycin for
recalcitrant plantar warts have been reported to
have an 89.9% cure rate, FU is cheaper and has
fewer adverse effects. Therefore, it is potentially
promising to apply needle-free injection of FU in
warts. The warts in the patient described were
completely cleared after treatment with the needle-
free injections of FU, and the pain caused by the
treatment was kept to a very low level. A larger
randomized clinical trial is currently underway to
determine the efficacy and safety of this novel
therapy. (September 14, 2022.
doi:10.1001/jamadermatol.2022.3318)

Leonard A. Levy, DPM, MPH, Ft. Lauderdale, FL

There are no more messages in this thread.