Tuberculin purified protein derivative (RT 23) 100 tuberculin units/ml solution for injection 1.5ml vials

BACKGROUND: Cutaneous warts are exophytic, benign proliferative lesions caused by human papillomavirus infection of basal keratinocytes. Many intralesional immunomodulatory agents are used by dermatologists these days including Bacillus Calmette-Guerin vaccine, measles-mumps-rubella vaccine, purified protein derivative (PPD), Candida extract, vitamin D3, interferon alpha, zinc sulphate, and hepatitis B vaccine. Intralesional acyclovir is considered a novel intralesional therapy for warts as it directly destroys the viral cells. The objectives of this study are to provide the latest comparison among different intralesional therapies and to specifically compare acyclovir with PPD. METHODS: A comprehensive search strategy was implemented to identify relevant randomized controlled trials, and those with single-arm studies were excluded. After this, 5 studies were finally included in the review. Statistical analysis was done using a frequentist random-effects model. Dichotomous outcomes were analyzed using odds ratio and 95% confidence interval with statistical significance set as P-value < .05. All analyses were performed using R version 4.4.1.The study involved a total of 295 patients with sample size ranging from 30 being the least number of participants and 97 being the highest number of participants in a single study. RESULTS: Use of saline had the highest probability of being the best treatment for achieving a complete response (probability to be the best 96%, P-score = .96) and partial response (98% probability, P-score = .98) when compared with other modalities. The forest plot shows no statistically significant differences among the treatment arms except for saline (P < .01) for no response as compared with PPD. Blister formation was found to be higher on the use of cryotherapy (P = .03) and Mycobacterium w vaccine (P = .02). CONCLUSION: This network's meta-analysis concludes the superiority of intralesional saline in achieving response to treatment when compared with other modalities such as cryotherapy and vaccines. A higher risk of adverse events was noted on use of vaccines. Future research is needed to strengthen these findings.

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Background Evidence on the accuracy and safety of the ESAT-6/CFP-10–based Diaskintest ® in BCG-vaccinated populations outside Eastern Europe remains limited. In Brazil, recurrent shortages of purified protein derivative (PPD) have challenged the implementation of tuberculin skin testing, underscoring the need to evaluate alternative tools for tuberculosis infection (TBI) screening. This trial compared the diagnostic performance and safety of Diaskintest ® with the tuberculin skin test (TST) using PPD Rt-23 in Brazilian adults, a predominantly BCG-vaccinated population. Method A double-blind randomized clinical trial was conducted at eight centers in Brazil between July 2023 and September 2024. Participants were allocated to the TB group (microbiologically confirmed pulmonary TB), in whom sensitivity was estimated, and the control group (healthy, unexposed adults), in whom specificity was estimated using the QuantiFERON-TB Plus ® (QFT-Plus) as the reference standard. All participants first underwent QFT-Plus testing, followed by intradermal application of Diaskintest ® and TST in opposite arms, with randomized right–left allocation. Induration was measured at 48–96 h using a prespecified 5 mm cutoff. Secondary outcomes included safety, assessed through active monitoring of adverse events (AEs), included injection site reactions. Results A total of 337 controls and 136 TB participants were enrolled. TST showed higher sensitivity than both Diaskintest and QFT-plus (0.84 [95% CI 0.76–0.90] vs. 0.68 [95% CI 0.59–0.76], and 0.63 [95% CI 0.54–0.72], respectively). Diaskintest ® demonstrated higher specificity than TST (0.93 [95% CI 0.90–0.96] vs. 0.75 [95% CI 0.70–0.80]). Injection-site reactions occurred less frequently with Diaskintest ® than with TST (1.7% vs. 4.9%. RR = 0.35 [0.15–0.79]). The most common reactions were phlyctenular reactions and itching. No serious AEs were observed. Conclusion TST had greater sensitivity than Diaskintest ® , whereas Diaskintest ® demonstrated higher specificity and fewer local adverse reactions. In this study, specificity was estimated using QFT-Plus as a surrogate reference standard, acknowledging the absence of a true gold standard for tuberculosis infection. These complementary performance profiles highlight a trade-off between false-positive reduction and case detection, suggesting that the choice of test should consider programmatic priorities and local epidemiological context. Clinical trial registration https://ensaiosclinicos.gov.br/ , identifier RBR-7tn2ysw.

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Molluscum contagiosum (MC) is a skin and mucous membrane infection caused by the molluscum virus (MCV). To evaluate safety and efficacy of intralesional injection of tuberculin purified protein derivative (PPD) antigen injection versus MMR (mumps, measles, rubella) antigen for the treatment of molluscum contagiosum (MC). A total of thirty clinically confirmed patients of molluscum were recruited for this trial. Patients who were divided into three groups (A, B and C). Each group consisted of (30) patients. Group (A) subjects received intralesional MMR injections, group (B) subjects received intralesional PPD injection and group (C) received intralesional saline injection. The results of the present study revealed complete clearance of the injected lesions in 12 patients (80%), partial response in 3 patients (20%) of group (A). In group (B), complete clearance of the treated warts was observed in 11 patients (73.3%) and partial response in 4 (26.7%) of patients. In group (C), the majority of patients 8 (53.3%) demonstrated no response while 7 (46.7%) patients showed only partial clearance. We established a good safety and efficacy profile for tuberculin PPD and MMR antigens in treatment of molluscum contagiosum.

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