Intralesional injection of mumps or Candida skin test antigens - A novel immunotherapy for warts

Background: Warts are common and induce physical and emotional discomfort. Numerous therapies exist, yet none is optimal. Despite theoretical advantag es, immunotherapeutic modalities are often neglected as first-line wart the rapies. Objective: To compare treatment with intralesional skin test antigen inject ion of 1 wart vs cryotherapy of all warts. Design: Pilot study. Setting: University dermatology outpatient clinic. Patients: A total of 115 consecutive patients with at least 1 nongenital wa rt. Interventions: Patients with warts were tested for immunity to mumps and Ca ndida using commercial antigens. Nonresponders received cryotherapy and imm une individuals received cryotherapy or intralesional injection of 1 antise rum. Results: Thirty-four (30%) of the 115 patients did not respond to the test injections and 81 (70%) had detectable immunity. Of the immune group, 26 (3 2%) received cryotherapy. 45 (56%) received intralesional mumps antiserum, and 10 (12%) received intralesional Candida antiserum. Of the anergic patie nts. 28 (82%) were treated with cryotherapy; 6 (18%) refused cryotherapy. O f the 39 patients who were treated with immunotherapy and completed the pro tocol, 29 (74%) had complete clearing of the treated wart. Fourteen (78%) o f 18 patients with complete resolution of their immunotherapy-treated wart also had resolution of untreated, distant warts. Conclusions: Intralesional injection of mumps or Candida antigens into wart s of immune individuals represents effective treatment. Observation of clea ring of anatomically distinct and distant warts suggests acquisition of hum an papillomavirus-directed immunity in some patients. We conclude that this novel approach to immunotherapy may serve as first-line treatment in immun e individuals with multiple or large warts and as second-line treatment in immune patients for whom cryotherapy fails.