Introduction: The human papillomavirus (HPV) vaccine has been reported to lead to
clinical clearance of lesions when used as an off-label treatment for recalcitrant extragenital
warts. The aim of the study is to evaluate the therapeutic and adverse effects of HPV vaccine
as an adjunctive therapy for treatment-resistant acral warts.
Methods: Patients with persistent warts despite first and second line therapies, and
subsequently receiving the quadrivalent HPV vaccine between July 2013 and June
2016 as an adjunctive treatment for recalcitrant warts at the National Skin Centre,
were included.
Results: Twenty-six patients with a median age of 34 years (range 8 to 77 years) were treated
with the HPV vaccine. Nineteen (73.1%) patients completed 3 doses of the vaccine, of whom
5 (26%) achieved complete clearance, 8 (42%) had partial clearance and 6 (32%) did not
respond to the vaccine. Among the 4 patients who received 2 doses of the vaccine, 3 (75%)
had complete clearance whereas 1 (25%) had partial improvement of their warts. None of the
patients reported adverse reactions.
Conclusion: Our study suggests a potential adjunctive role of the HPV vaccine in the
treatment of acral warts recalcitrant to conventional therapy.
Keywords: Acral warts, HPV vaccine, quadrivalent vaccine, recalcitrant warts