Can HPV Vaccines Do More Than Prevent Cancer? Exploring Their Therapeutic Potential for Cutaneous Diseases.

🔍 Key Finding HPV vaccines show promise as a therapeutic option for various HPV-induced cutaneous diseases, including recalcitrant warts and some keratinocyte cancers, even in immunosuppressed individuals. However, larger, randomized controlled trials are needed to confirm these findings and standardize treatment protocols.

🔬 Methodology Overview

• Design: Narrative review
• Data Sources: PubMed database (January 2018 to January 2024)
• Search Terms: “HPV vaccine and dermatology”, “warts”, “condyloma”
• Selection Criteria: Original clinical studies in English involving human subjects (case series and case reports); Exclusion of papers assessing primary/secondary prophylactic efficacy, reviews, and non-English papers.
• Analysis Approach: Qualitative synthesis of findings categorized by lesion type (warts, neoplasia, lesions in immunosuppressed patients) and administration route.
• Scope: Therapeutic applications of HPV vaccines in various cutaneous lesions, focusing on complete resolution.
• Patient Population: 1437 patients (1405 warts, 7 neoplasia, 25 immunosuppression-related).

📊 Results

• Genital and Extragenital Warts:

  • qHPV vaccine: Complete wart clearance in 44% of patients with extragenital warts in one study, 46.67% in another. A larger RCT showed no statistically significant therapeutic effect.
  • 9vHPV vaccine: 62.2% overall complete response rate for recalcitrant warts, with a lower response in patients over 26 (55%) compared to those 9-26 (84%). Another study showed complete remission in two of five patients with genital warts, regression in the other three.
  • bHPV vaccine: Intralesional injection resulted in 81.8% complete wart clearance compared to 63.3% with intramuscular injection. However, another study showed intralesional bHPV took longer to achieve remission than topical podophyllin, despite fewer sessions.
  • Combined therapy (standard treatment + HPV vaccine): 85% positive clinical response vs. 40% with standard treatment alone.

• Cutaneous Neoplasia:

  • Case reports and small case series suggest potential for HPV vaccines (especially 9vHPV) in treating Bowen’s disease, high-grade penile intraepithelial neoplasia, and basaloid squamous cell carcinomas, often in combination with other therapies.

• Immunosuppressed Patients:

  • 9vHPV vaccine: Case series showed wart regression in 5 immunosuppressed patients with recalcitrant skin warts, and significant quality of life improvement. Another study with mostly immunocompromised patients showed 11% complete and 39% partial remission of palmoplantar warts after 1 year.
  • Case reports suggest potential for HPV vaccines in treating giant condyloma acuminata and acquired epidermodysplasia verruciformis in immunosuppressed individuals. Another case series showed reduction in keratinocyte carcinomas after 9vHPV vaccination.

💡 Clinical Impact HPV vaccines, originally intended for prophylaxis, show promise as a therapeutic intervention for various HPV-related cutaneous conditions, including recalcitrant warts and some precancerous/cancerous lesions, potentially expanding treatment options for these often challenging conditions. Further research, particularly larger randomized controlled trials, is needed to solidify these findings and standardize therapeutic HPV vaccine protocols.

🤔 Limitations

• Conflicting study outcomes regarding HPV vaccine efficacy for cutaneous issues.
• Limited sample sizes in many of the included studies (case reports and small case series).
• Lack of large-scale, randomized controlled trials with well-matched control groups to validate findings.
• Inconsistent efficacy of standard HPV vaccines against cutaneous HPV types, especially beta-HPVs.
• Variable treatment response based on factors like age and immune status.
• Potential for adverse reactions, including autoimmune events and localized skin reactions.
• Current vaccines offer limited cross-protection against untargeted HPV types.

✨ What It Means For You This research suggests that HPV vaccines, beyond their prophylactic role, may offer a therapeutic option for various HPV-related cutaneous conditions, including recalcitrant warts and some skin cancers, even in immunocompromised patients. Doctors should consider HPV vaccination as a potential treatment strategy for these patients, but larger, randomized controlled trials are needed to confirm efficacy and standardize treatment protocols. Further research into β-HPV targeted vaccines may significantly impact future dermatologic practice.

Reference S,andru F, Radu A-M, Petca A, Dumitras,cu MC, Petca R-C, Roman A-M. Unveiling the Therapeutic Horizon: HPV Vaccines and Their Impact on Cutaneous Diseases—A Comprehensive Review. Vaccines. 2024;12:228. https://doi.org/10.3390/vaccines12030228