HPV vaccination not associated with verruca Vulgaris resolution in young patients: Study

New York: The human papillomavirus (HPV) vaccination does not expedite the clearance of verruca Vulgaris (VV) in young patients, a recent study has found. The findings of which are published in the Journal of the American Academy of Dermatology.

The retrospective cohort study, the researchers say, is the first to include an unvaccinated group to control for the natural history of VV. 

Verruca Vulgaris is a common, being neoplasms of the skin caused by HPV. It is a leading indication for dermatology visits but its treatment remains challenging. HPV types 1, 2, and 4 which are not covered by HPV vaccines are the cause of VV. Recent studies have shown HPV vaccination to resolve VV, but do not consider that most people clear VV spontaneously.

Against the above background, Rachel C. Blasiak, Division of Dermatology, Jacobi Medical Center, Bronx, New York, and colleagues addressed the question of whether HPV vaccination is associated with VV resolution.

The researchers identified patients aged 9 to 21 years diagnosed with VV by a dermatologist at Montefiore Medical Center between January 1, 2014, and August 1, 2019. 

Disease outcome was defined as a decrease in VV number, defined as complete response (CR; 100%), partial response (PR; 50%-99%), or no response (NR; < 49%).

Patients were stratified by vaccination status into 1 of 3 patient groups. Unvaccinated patients were defined as having no record of HPV vaccination or whose first vaccination came after the last VV follow-up visit. Vaccinated-before-diagnosis patients had at least 1 HPV vaccination prior to VV diagnosis and no doses during VV follow-up. Vaccinated-during-follow-up patients had at least 1 HPV vaccination during VV follow-up. 

336 met the inclusion criteria of 2154 identified patients. Vaccination during follow-up was completed in 14% of patients, while 39% were vaccinated before diagnosis and 47% were unvaccinated.

Of 2154 patients identified, 336 met inclusion criteria. On average, patients were 13 years old, had 3 VV at the time of diagnosis, and were followed for 13 months. In the vaccinated-during-follow-up and vaccinated-before-diagnosis groups, 39.67% and 26.72%, respectively, received the 9-valent vaccine; 45.25% and 58.78%, respectively, received the quadrivalent vaccine; and 15.08% and 14.50%, respectively, received both. Rates of loss to follow-up differed: 45.83% in unvaccinated, 46.96% in vaccinated-before-diagnosis, and 11.11% in vaccinated-during-follow-up groups, possibly resulting in study exclusion. There were no differences in other treatment modalities between groups. 

The researchers concluded, "we did not detect increased VV clearance among vaccinated patients, which may be for several reasons. Our study's long follow-up provided time for natural resolution of VV in all groups, as VV can clear within 1 year in half of the children."

Reference:

The study titled, "Vaccination against human papillomavirus is not associated with resolution of verruca vulgaris in immunocompetent 9- to 21-year olds," is published in the Journal of the American Academy of Dermatology.

DOI: https://www.jaad.org/article/S0190-9622(21)02344-6/fulltext