|
|
Vignette
See it on the Archives of Dermatology web site. used by permission Treatment of Warts with Candida Antigen Injection Immunotherapy holds promise as a simple method of treating common warts1-4. Injection with one sensitizing agent, candida antigen, has been adopted by some physicians without the support of any published studies. Our goals were to evaluate (1) the safety of candida antigen injections for the treatment of common warts, (2) patient satisfaction with the treatment, and (3) response rates. Review of Cases. We performed a retrospective chart review of 149 consecutive adult and pediatric patients at a referral, procedures practice who were treated with intralesional and intradermal injection of a 1:1 mixture of candida antigen (Candin®, Allermed Laboratories, San Diego, Ca) solution and 1% lidocaine. Most had long-standing warts that had not responded to home treatment or treatment by other physicians. The mixture (0.1cc) of was injected into each of multiple warts (genital and facial warts excluded) up to 1.0cc total. Injections were repeated every 4 weeks for a total of three injection visits or until there was no evidence of warts, whichever came first. One hundred four patients (or parents) could be reached by phone at least a year after the injection(s): 54 patients (52%) had mild, local reactions (pain, burning, blister, and peeling), usually associated with effective treatment. Only 3 (3%) had "moderate" or "severe" pain. There were no severe reactions. Transient body aches occured in one patient and fever in 1 other. Seventy-nine patients (76%) were "very happy", 10 (10%) "happy", 13 (12%) "unhappy" and 2 (2%) "very unhappy". Unhappy patients cited discomfort and lack of efficacy. Eighty five patients (82%) would repeat the treatment if needed. Seventy-five patients (72%) were completely cured within 8 weeks of the last injection, without subsequent recurrence. Many others experienced a decrease in the size and number of warts, even those warts that were not injected. Five percent continued to have warts despite finishing three treatments, and 17% did not complete the protocol. Discussion: Candida antigen injection for the treatment of common warts was demonstrated as safe and well accepted by patients in this limited case series. This has been confirmed by extensive use (>1,000 injections) since the study period was completed, without any serious complications. Potential advantages to this method include no scarring, minimal pain, and no disability while being treated. It is simple and uses materials available in many offices. Based on these results we suggest a randomized controlled trial to evaluate more rigorously the efficacy of this simple treatment. Complete report of the study: www.altoonahosp.org/afp/wartstudyRebecca Copp Phillips, MD Midland, Michigan References1. Naylor MF, Nelder KH, Yarbrough GD, Rosio TJ, Iriondo M, Yeary J. Contact immunotherapy of resistant warts. Journal of the American Academy of Dermatology. 1988;19:679-683. 2. McConahy JG. Common warts: immunity as a result of therapy. Cutis. 1976;17:301-304. 3. Epstein E. Immunotherapy of warts with masoprocol cream. Cutis. 1997;59:287-289. 4. Munn SE, Higgins E, Marshall M, Clement M. A new method of intralesional bleomycin therapy in the treatment of recalcitrant warts. British Journal of Dermatology. 1996;135:969-971. Acknowledgments:Special thanks to Ling Shih, MD, Thomas Zuber, MD and Patricia Wolfgram, MLS for their assistance. Table I. Patients reporting "side effects" of candida antigen injection (N=104)No side effects 50 (48%) *Some patients reported more than one side effect. Table II. Cure rates after each injection of candida antigen1st injection (N=104) 36 (35%) Overall (N=104) 75 (72%) Note: This is copyrighted material by the AMA. Used by permission.
|