Dear Editor,

We thank Dr. Al-Mendalawi for his valuable comments.1 We agree that there are multiple therapies available for the treatment of warts. Regarding the Bacillus Calmette-Guérin (BCG) vaccine, recent studies showed that the measles-mumps-rubella (MMR) vaccine has superior or comparative results to BCG.2,3 Moreover, BCG needs a prior Mantoux test and is considered unsafe in a tuberculosis-endemic area, making the choice of using MMR superior to BCG.4 Measurement of Th1 and Th2 cytokines during various intralesional immunotherapies is non-practical and unnecessary. Besides, it needs specialized labs which are not available in most settings. There is no definite follow-up period for patients with warts, but a period of three to six months is considered appropriate. In fact, both patients were followed further after publishing the cases and there is no recurrence to date.

references

1. Al-Mendalawi MD. Can We justify intralesional immunotherapy with measles-mumps-rubella vaccine for recalcitrant facial warts? Oman Med J 2022 Nov;37(6):e
2. 1. Eldahshan RM, Ashry WM, Elsaie ML. Comparative study between intralesional injection of MMR, BCG, and candida albicans antigen in treatment of multiple recalcitrant warts. J Cosmet Dermatol 2022 Mar;21(3):1120-1126.
3. 2. Munnangi P, Kishore JC, Nivedita DV. Comparative study between intralesional MMR and intralesional BCG in treatment of verruca vulgaris. IOSR J Dent Med Sci 2018;17(2):44-50.
4. 3. Daulatabad D, Pandhi D, Singal A. BCG vaccine for immunotherapy in warts: is it really safe in a tuberculosis endemic area? Dermatol Ther 2016 May;29(3):168-172.