Other related work

"Warts are the most common skin problem managed by family physicians", she told listeners. Approximately 7 to 10% of patients have them. Conventional methods of wart treatment achieve a 60 to 70% cure rate, but with these forms of therapy repeated treatments are often necessary even when patients are cured. "This can be very time consuming for the busy practitioner", she observed.

Previous studies using a 1:1000 dose of Candida antigen yielded a 71% cure rate, with no significant side effects and complete resolution of the wart with one injection. Thus, the present study was undertaken to determine if a 1 cc intradermal injection of a stronger solution (1:100 dose) would be an improvement. Ms. Ricker and her colleague Ruth Bolton, MD, found that the stronger dose was not more effective than the 1:1000 dose of Candida antigen, and in fact there was evidence that the higher antigenic dose caused too rapid tissue sloughing and "may prevent a systemic reaction from occurring, thereby decreasing the chances of elimination of all the warts on the body, as was dramatically seen with the 1:1000 dosing", she told listeners.

Sixty patients were entered in the study of the stronger dose, all of them volunteers, referred by six family physicians. These patients had warts as their chief healthy. Exclusion criteria included pregnancy and treatment with medications. All patients were seen at 48 hours following intradermal injection under the "mother" wart and every two weeks until eight weeks elapsed or the wart was cured. "We got patients who were willing to undergo this treatment and follow-up because nothing else worked", she noted.

Previous studies have suggested that resolved warts are related to an immune component. DCNB, a form of topical immunotherapy that has to be administered topically several times, is used by dermatologists to treat warts. However, Candida is a much more common antigen than DCNB, explained Ms. Ricker.

Twenty-nine patients received the Candida antigen and 31 patients received a control medication. Of the 29 patients, 17 were cured (58.6%). Twenty-five of the control group elected to have the Candida treatment after the code was broken, and 15 of these patients (60%) achieved a cure, said Ms. Ricker.

"My hope was that this treatment would make a person immune to warts over a lifetime. Remarkably, 50% of patients had complete resolution of warts all over their body, regardless of the side involved. This is proof that a systemic resolution is primarily responsible for wart resolution", she said.

Duration of warts was found to be a significant factor, since warts present for less than 12 months were more readily cured by the Candida antigen than those of longer duration. Size of wart was not related to resolution. In fact, Ms. Ricker showed a slide of a wart that was 704 square millimeters that resolved with the study treatment.

Two of the study patients requested a second dose of the antigen after it was evident that their "mother" warts were smaller but not fully resolved. A second injection led to full resolution of their warts, prompting Ms. Ricker to recommend that multiple doses should be utilized at various intervals to attempt to increase the cure rate.

"These results have several implications for future therapy of warts. The 1:1000 dose is particularly effective for patients with multiple warts at remote sites. To date, this therapy has been proven safe and is associated with minimal discomfort to the patient. This study opens the door for new avenues of antiviral therapy. It is possible that the Candida antigen will be effective in treating venereal warts, and studies should be undertaken in the future", she told listeners.

In another presentation, Dr. Bolton (co-author of the study presented by Ms. Ricker) pointed out that venereal warts are of particular concern because of their oncogenic potential. "The literature on this subject suggests that the perception of these warts is rapidly changing. Currently, 15 to 25% of the American population is exposed to venereal warts, which has implications for public health practices".

Dr. Bolton agreed that immunotherapy is the wave of the future in treating all warts. She too is hopeful that treatment with the Candida antigen will prove to be a viable, effective therapy for venereal warts.

"Immunotherapy tends to be less scarring than conventional wart therapies and also has the potential advantage of treating more than one wart at a time. Immunotherapy holds the most promise for future treatment of warts", concluded Dr. Bolton.

Both Dr. Bolton and Ms. Ricker are affiliated with the Department of Family Practice at the University of Minnesota.

"Intralesional Immunotherapy of Warts with Mumps, Candida and Tripchophtyon Skin Test Antigens, Arch Dermatol 2005;141:589-594.  Abstract

They noted better results with immunotherapy than saline, with no improvement with the addition of interferon.  They noted proliferation of peripheral blood mononuclear cells to HPV antigens, suggesting a cell-mediated response plays a role in local and distant resolution of warts.