Intralesional Antigen Immunotherapy for the Treatment of Warts

NewsBot · Jul 3, 2013

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Intralesional Antigen Immunotherapy for the Treatment of Warts: Current Concepts and Future Prospects
Ahmad Nofal, Eman Salah, Eman Nofal, Ayman Yosef
American Journal of Clinical Dermatology June 2013

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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Admin2 · Jun 19, 2014

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NewsBot · Jun 19, 2014

Two-year experience of using the measles, mumps and rubella vaccine as intralesional immunotherapy for warts
C. H. Na, H. Choi, S. H. Song, M. S. Kim and B. S. Shin
Clinical and Experimental Dermatology; Volume 39, Issue 5, pages 583–589, July 2014

Background
The currently available treatments for warts, including cryosurgery, laser surgery, electrosurgery, and topical keratolytic applications, are often very painful and can induce disfiguring scars. Recently, intralesional immunotherapy with skin test antigens and vaccines has been shown to be effective in the management of warts.
Aims
To evaluate the efficacy of a new intralesional immunotherapy for warts, using the measles, mumps and rubella (MMR) vaccine.
Methods
A retrospective study was performed, and we enrolled 136 patients with various types of warts into the study, which was for a duration of 2 years. Patients were treated for a total of six times at 2-week intervals. The treatment response was classified as one of three levels, based on reduction in the size and number of warts, and patients with complete response (CR) were checked for recurrence. Clinical evaluations were carried out using photographs and medical records.
Results
Over half (51.5%) of patients experienced > 50% reduction in the size and number of warts, and 46.7% who had distant warts (in different locations) showed good response. Common warts showed significantly higher treatment response than other types of warts (P < 0.05). However, other clinical variables did not have any effect on efficacy. Almost all the patients reported mild pain during the injection, but other side effects were rarely observed. Only 5.6% of patients who experienced CR had recurrence of warts after 6 months.
Conclusions
We suggest that intralesional immunotherapy with MMR vaccine is a tolerable and effective method for patients who are sensitive to pain, concerned about side effects, or have common warts. Treatment response is improved by increasing the number of injections.
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NewsBot · Mar 22, 2016

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature
Adam Souhail Aldahan, Stephanie Mlacker, Vidhi V. Shah, Preetha Kamath, Mohammed Alsaidan, Sahal Samarkandy and Keyvan Nouri
Dermatologic Therapy; Early View

Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Many of these options are destructive and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Systemic approaches such as immunotherapy have demonstrated success in treating multiple lesions by combining a targeted approach with upregulation of the host immune system. An extensive literature review was performed to evaluate the various vaccine antigens that have been used intralesionally to treat cutaneous and anogenital warts. The specific intralesional immunotherapies that have been studied include: Candida albicans; measles, mumps, and rubella; Trichophyton; and tuberculin antigens such as purified protein derivative, Mycobacterium w vaccine, and Bacillus Calmette-Guerin. Intralesional vaccine injection represents a safe, effective, and tolerable treatment for warts, including recalcitrant and anogenital warts. This approach has been somewhat overlooked in the past despite substantial evidence of high response rates with a low side effect profile. Large comparative trials are necessary to determine the most effective immunotherapy treatment option as well as the most appropriate dosing parameters.
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NewsBot · Sep 9, 2017

Wart Immunotherapies: A Short Review
Ryan S. Sefcik and Craig G. Burkhart
The Open Dermatology Journal, 2017, 11, 30-34

Objective:
To review the efficacy and costs of various contact immunotherapies, contact allergens, intralesional immunotherapies, and
intralesional cytotoxic agents for the treatment of recalcitrant warts.
Background:
Cutaneous warts are common viral skin lesions caused by human papillomavirus that can be challenging to treat and frustrating for
physicians and patients. Although several treatment options exist, there is no single treatment that can ensure a complete response
with lack of lesion recurrence. Immunotherapies for recalcitrant warts present as a cost-effective, efficient therapy option for patients.
Intralesional approaches have the added benefit of affecting warts at locations distant to the target location by inducing a systemic Tcell
mediated response in the body.
Results:
Various contact immunotherapies, contact allergens, intralesional immunotherapies, and intralesional cytotoxic agents have shown to
be effective in treating warts. The costs of each treatment varies drastically from around $10 US to over $1000 US to achieve a
complete response. Several antigens were found to be both efficacious and cost effective.
Conclusion:
Although efficacy of several antigens has been confirmed by randomized studies, more randomized comparative studies will need to
be performed in order to determine the best antigen and correct standardized doses for the treatment of warts in individual patients. It
is important to note that individual response to antigen type and dose may vary among patients. Therefore, further studies may play an
important role in the use of immunotherapies in a clinical setting
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NewsBot · Apr 10, 2020

Intralesional vitamin D3 versus Candida antigen immunotherapy in the treatment of multiple recalcitrant plantar warts: A comparative case-control study.
Fathy G et al
Dermatol Ther. 2019 Sep;32(5)

Intralesional immunotherapy is one of the therapeutic tools of warts. Intralesional Candida antigen was reported as successful treatment of warts. Topical and intralesional vitamin D have been used recently for wart treatment. We aim to evaluate the efficacy and safety of intralesional injection of vitamin D3 in treatment of multiple recalcitrant plantar warts in comparison with intralesional Candida antigen. Sixty patients were divided into three groups: Group I received intralesional vitamin D3, Group II intralesional Candida antigen, and Group III intralesional saline (control group). Injection was done every 3 weeks until clearance of warts or a maximum of three treatments. There was a statistically significant more reduction of warts numbers after treatment in Group I than in the other groups (p < .05). Group I showed better clinical response than Group II (p = .021). In both Groups I and II, clinical response was less favorable in patients with longer disease duration (p = .026). There was also limitation as it is a small study population. Intralesional vitamin D3 injection in multiple recalcitrant plantar warts is a simple, safe, cost effective treatment modality with minimal side effects, and superior results compared with intralesional injection of Candida antigen.
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