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Intralesional Antigen Immunotherapy for the Treatment of Warts: Current Concepts and Future Prospects

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Abstract

Many destructive and immunotherapeutic modalities have been used for the management of warts; however, an optimal treatment with high efficacy and absent or low recurrence has not been explored to date. Recently, the use of intralesional immunotherapy with different antigens has shown promising efficacy in the treatment of warts. We review the different aspects of this new modality, including candidates, types of warts treated, dosage, number and interval between treatment sessions, mode of action, efficacy, adverse effects, recurrence rate, advantages, disadvantages, current place and future prospects. A literature review revealed that healthy immune subjects are the best candidates, and a pre-sensitization test is usually done before the start of therapy. The dosage, the number and interval between sessions, and the success rates varied among the different studies. The mode of action is still uncertain, but is essentially mediated through stimulation of T helper-1 cell cytokine response. Adverse effects are mild and generally insignificant, and the recurrence rate is absent or low. Intralesional antigen immunotherapy seems to be a promising, effective and safe treatment modality for viral warts. Future well-designed and controlled studies would help to more clearly define its place in the challenging field of wart therapy.

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References

  1. Jabbar IA, Fernando GJ, Saunders N, et al. Immune responses induced by BCG recombinant for human papillomavirus L1 and E7 proteins. Vaccine. 2000;18:2444–53.

    Article  CAS  PubMed  Google Scholar 

  2. Rivera A, Tyring SK. Therapy of cutaneous human papillomavirus infections. Dermatol Ther. 2004;17:441–8.

    Article  PubMed  Google Scholar 

  3. Lipke MM. An armamentarium of wart treatments. Clin Med Res. 2006;4:273–93.

    Article  CAS  PubMed  Google Scholar 

  4. Dasher DA, Burkhart CN, Morrell DS. Immunotherapy for childhood warts. Pediatr Ann. 2009;38:373–9.

    Article  PubMed  Google Scholar 

  5. Goihman-Yahr M, Goldblum OM. Immunotherapy and warts: a point of view. Clin Dermatol. 2008;26:223–5.

    Article  PubMed  Google Scholar 

  6. Bacelieri R, Johnson SM. Cutaneous warts: an evidence-based approach to therapy. Am Fam Physician. 2005;72:647–52.

    PubMed  Google Scholar 

  7. Mulhem E, Pinelis S. Treatment of nongenital cutaneous warts. Am Fam Physician. 2011;84:288–93.

    PubMed  Google Scholar 

  8. Silverberg NB, Lim JK, Paller AS, Mancini AJ. Squaric acid immunotherapy for warts in children. J Am Acad Dermatol. 2000;42:803–8.

    Article  CAS  PubMed  Google Scholar 

  9. Goncalves MA, Donadi EA. Immune cellular response to HPV: current concepts. Braz J Infect Dis. 2004;8:1–9.

    Article  CAS  PubMed  Google Scholar 

  10. Adler A, Safai B. Immunity in wart resolution. J Am Acad Dermatol. 1979;1:305–9.

    Article  CAS  PubMed  Google Scholar 

  11. D’Alessandria RM, Khakoo RA. Granulomatous hepatitis in a healthy adult following BCG injection into a plantar wart. Am J Gastroenterol. 1977;68:392–5.

    PubMed  Google Scholar 

  12. Malison MD, Salkin D. Attempted BCG immunotherapy for condylomata acuminata. Br J Vener Dis. 1981;57:148.

    CAS  PubMed  Google Scholar 

  13. Brunk D. Injection of Candida antigen works on warts. Skin Allergy News. 1999;30:5.

    Google Scholar 

  14. Phillips RC, Ruhl TS, Pfenniger JL, Garber MR. Treatment of warts with Candida antigen injection. Arch Dermatol. 2000;136:1274–5.

    Article  CAS  PubMed  Google Scholar 

  15. Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or Candida skin test antigens: a novel immunotherapy for warts. Arch Dermatol. 2001;137:451–5.

    CAS  PubMed  Google Scholar 

  16. Signore RJ. Candida albicans intralesional injection immunotherapy of warts. Cutis. 2002;70:185–92.

    PubMed  Google Scholar 

  17. Clifton MM, Johnson SM, Roberson PK, et al. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatr Dermatol. 2003;20:268–71.

    Article  PubMed  Google Scholar 

  18. Johnson SM, Horn TD. Intralesional immunotherapy for warts using a combination of skin test antigens: a safe and effective therapy. J Drugs Dermatol. 2004;3:263–5.

    PubMed  Google Scholar 

  19. King M, Johnson SM, Horn TD. Intralesional immunotherapy for genital warts. Arch Dermatol. 2005;141:1606–7.

    Article  PubMed  Google Scholar 

  20. Kus S, Ergun T, Gun D, Akin O. Intralesional tuberculin for treatment of refractory warts. J Eur Acad Dermatol Venereol. 2005;19:515–6.

    Article  CAS  PubMed  Google Scholar 

  21. Horn TD, Johnson SM, Helm RM, Roberson PK. Intralesional immunotherapy of warts with mumps, Candida and trichophyton skin test antigens: a single-blinded, randomized and controlled trial. Arch Dermatol. 2005;141:589–94.

    Article  PubMed  Google Scholar 

  22. Gupta S, Malhotra AK, Verma KK, Sharma VK. Intralesional immunotherapy with killed Mycobacterium w vaccine for the treatment of ano-genital warts: an open label pilot study. J Eur Acad Dermatol Venereol. 2008;22:1089–93.

    Article  CAS  PubMed  Google Scholar 

  23. Maronn M, Salm C, Lyon V, Galbraith S. One-year experience with candida antigen immunotherapy for warts and molluscum. Pediatr Dermatol. 2008;25:189–92.

    Article  PubMed  Google Scholar 

  24. Fayed ST, Amer M, Ammar E, Salam MA. Local BCG injection administered to patients with flat condyloma of the cervix. Int J Gynaecol Obstet. 2009;107:253–4.

    Article  PubMed  Google Scholar 

  25. Nofal A, Nofal E. Intralesional immunotherapy of common warts: successful treatment with mumps, measles and rubella vaccine. J Eur Acad Dermatol Venereol. 2010;63:1166–70.

    Article  Google Scholar 

  26. Kim KH, Horn TD, Pharis J, et al. Phase 1 clinical trial of intralesional injection of Candida antigen for the treatment of warts. Arch Dermatol. 2010;146:1431–3.

    Article  PubMed  Google Scholar 

  27. Choi H, Kim HR, Na CH, et al. Intralesional immunotherapy of warts with mumps, measles and rubella vaccine. J Dermatol Suppl. 2012;39:63–4.

    Article  Google Scholar 

  28. Chandrashekar L. Intralesional immunotherapy for the management of warts. Indian J Dermatol Venereol Leprol. 2011;77:261–3.

    Article  PubMed  Google Scholar 

  29. Bacelieri R, Johnson SM. Cutaneous warts: an evidence-based approach to therapy. Am Fam Physician. 2005;72:647–52.

    PubMed  Google Scholar 

  30. Bohle A, Doehn C, Kausch I, Jocham D. Treatment of recurrent penile condylomata acuminata with external application of bacillus Calmette-Guerin. J Urol. 1998;160:394–6.

    Article  CAS  PubMed  Google Scholar 

  31. Bohle A, Buttner H, Jocham D. Primary treatment of condylomata acuminata with viable bacillus Calmette-Guerin. J Urol. 2001;165:834–6.

    Article  CAS  PubMed  Google Scholar 

  32. Metawea B, El-Nashar AR, Kamel I, et al. Application of viable bacille Calmette-Guérin topically as a potential therapeutic modality in condylomata acuminata: a placebo-controlled study. Urology. 2005;65:247–50.

    Article  PubMed  Google Scholar 

  33. Sharquie KE, Al-Rawi JR, Al-Nuaimy AA, Radhy SH. Bacille Calmette-Guerin immunotherapy of viral warts. Saudi Med J. 2008;29:589–93.

    PubMed  Google Scholar 

  34. Eassa BI, Abou-Bakr AA, El-Khalawany MA. Intradermal injection of PPD as a novel approach of immunotherapy in anogenital warts in pregnant women. Dermatol Ther. 2011;24:137–43.

    Article  PubMed  Google Scholar 

  35. Salem A, Nofal A, Hosny D. Treatment of common and plane warts in children with topical viable bacillus Calmette-Guerin. Pediatr Dermatol. 2012. doi:10.1111/j.1525-1470.2012.01848.x.

  36. Lahti A, Hannuksela M. Topical immunotherapy with tuberculin jelly for common warts. Arch Dermatol Res. 1982;273:153–4.

    Article  CAS  PubMed  Google Scholar 

  37. Freed DL, Eyres KE. Persistent warts protected from immune attack by a blocking factor. Br J Dermatol. 1979;100:731–3.

    Article  CAS  PubMed  Google Scholar 

  38. Luo Y, Henning J, O’Donnell MA. Th1 cytokine-secreting recombinant Mycobacterium bovis bacillus Calmette-Guérin and prospective use in immunotherapy of bladder cancer. Clin Dev Immunol. 2011;2011:728930.

    Article  PubMed  Google Scholar 

  39. Leung L. Recalcitrant nongenital warts. Aust Fam Physician. 2011;40:40–2.

    PubMed  Google Scholar 

  40. Perman M, Sterling JB, Gaspari A. The painful purple digit: an alarming complication of Candida albicans antigen treatment of recalcitrant warts. Dermatitis. 2005;16:38–40.

    Article  PubMed  Google Scholar 

  41. Miller L, Reynolds J. Autism and vaccination—the current evidence. J Spec Pediatr Nurs. 2009;14:166–72.

    Article  PubMed  Google Scholar 

  42. Baker GE, Tyring SK. Therapeutic approaches to papillomavirus infections. Dermatol Clin. 1997;15:331–40.

    Article  CAS  PubMed  Google Scholar 

  43. Choi MH, Seo SH, Kim IH, Son SW. Comparative study on the sustained efficacy of diphencyprone immunotherapy versus cryotherapy in viral warts. Pediatr Dermatol. 2008;25:398–9.

    Article  PubMed  Google Scholar 

  44. Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ. 2002;325:461.

    Article  PubMed  Google Scholar 

  45. Brodell RT, Johnson SM. Warts: diagnosis and management: an evidence based approach. New York: Martin Dunitz; 2003.

    Google Scholar 

  46. Dall’oglio F, D’Amico V, Nasca MR, Micali G. Treatment of cutaneous warts: an evidence-based review. Am J Clin Dermatol. 2012;13:73–96.

    Article  PubMed  Google Scholar 

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No funding was received for the preparation of this manuscript. The authors have no conflicts of interest to declare.

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Authors and Affiliations

  1. Dermatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt

    Ahmad Nofal, Eman Salah, Eman Nofal & Ayman Yosef

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  1. Ahmad Nofal
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  2. Eman Salah
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  3. Eman Nofal
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  4. Ayman Yosef
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Correspondence to Ahmad Nofal.

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Nofal, A., Salah, E., Nofal, E. et al. Intralesional Antigen Immunotherapy for the Treatment of Warts: Current Concepts and Future Prospects. Am J Clin Dermatol 14, 253–260 (2013). https://doi.org/10.1007/s40257-013-0018-8

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