Treating Warts with Immunotherapy

There is a considerable body of scientific opinion that considers a strong immune system has the ability to eradicate warts. These benign skin growths are caused by the human papillomavirus (HPV), a highly infectious double-stranded DNA virus. And just as a vaccine encourages an individual’s immune system to fight infectious agents such as the flu virus, so the same principle applies to intralesional wart immunotherapy. A molecule, typically Candida antigen is injected into the wart to encourage the patient’s body to fight back.

What is Immunotherapy?

In general, immunotherapy is any form of treatment that stimulates your immune system to respond. This is also known by some as biological response modifier therapy. It is commonly known to treat serious forms of sicknesses like various types of cancer, rheumatoid arthritis, psoriasis, etc.

Antigen stands for antibody generating and the Candida antigen causes the immune system to generate antibodies that recognize and target the HPV virus. These white blood cells then move toward the site of infection ready for the kill, and HPV is no more. 

Immunotherapy Vaccines

There are more than 100 different types of human papillomavirus that infect humans, and some vaccines, particularly Gardasil are effective against genital warts by preventing infection in the first place. Other vaccines may well be developed that could target warts that affect other parts of the body.

The kind of treatment used on warts varies. It’s either through the traditional way of treating warts (cryotherapy, surgery, laser treatment) or through immunotherapy. Immunotherapy may be administered through injection or through body surface application.

In most cases, it is hard to choose which immunotherapy treatment will be used because of the many options one can choose and the most important thing that needs to be considered is the strength of a patient’s immune system. You would also consider some factors like medical history, the type of warts, the gender, and the age.

Topical Immunotherapy

• Diphencyprone (DCP) – The initial use of the treatment was for alopecia areata or patches of hair loss, but it was found advantageous in treating plantar warts later on. The possible side effect for using this treatment is blistering around the affected area. DCP is mainly effective with periungual, palmar, and plantar warts. DCP is not recommended for pregnant women and should never be used for self-treating. Consult with your doctor before opting this form of treatment. Regular follow-up check-ups are necessary when this treatment is used. This is also not recommended for treating genital and filiform warts.
• Diphenylcyclopropenone (DPCP) – Similar to Diphencyprone (DCP), this form of treatment is used in warts found on the fingers, palms, toes, soles, and heels with a specific percentage of concentration depending on the area. Treatment of warts may be repeated in between 1 to 4 weeks of intervals and will be stopped when a wart is no longer clinically visible. Pigmentation may commonly occur after the use of the treatment and blistering occurs on the area treated and the sensitized area.
• Dinitrochlorobenzene (DNCB) – The way how Diphencyprone (DCP) is applied is similar to DNCB. However, DCP is a more effective sensitizer and is more secure to use than DCNB.
• Squaric Acid Dibutyl Ester (SADBE) – The use of SADBE is known to be really effective in treating multiple common and plantar warts. This may also be used to genital warts but with some limitations as the treatment can cause skin irritation on treated areas and that can be very unpleasant to the patient. Other than this side effects, there are no other serious side effects. This is somehow considered as an effective way to treat common and plantar warts because side effects are not as serious as another form of topical immunotherapy treatments and it is somewhat painless. This can be an alternative way to treat warts instead of the aggressive traditional method.
• Imiquimod – It is one of the commonly known treatments used in warts and works well in treating genital and non-genital warts. For treating genital warts, imiquimod must be applied on the wart every other day before sleeping. Wash off the applied imiquimod with soap and water after 6 to 10 hours. Application of imiquimod may reach up to 16 weeks at most. Erythema, redness of the skin, may occur in between treatments and the treatment is known to work more impressively in women than men. For treating non-genital warts, apply imiquimod on warts once a day for 4 weeks. It is known to have promising results and have low chances of recurring.

 Intralesional Immunotherapy

• Bleomycin – This form of treatment is administered only by doctors and is not for self-treatment. Bleomycin has been used to treat warts for a long time now and is known to work effectively, specifically, warts in the palmoplantar and periungual areas. Even though it’s known as one of the effective ways to treat warts, US FDA has not approved this form of wart treatment. The treatment also has its restrictions and is not recommended for children and pregnant women.
• Candida albicans antigen – An antigen called candida albicans is injected directly to the wart. Normally, warts on the palmoplantar and periungual areas are treated with this form of immunotherapy treatment. 1 to days after the initial treatment, warts can become sore or itchy. Each session has an interval of 4 to 8 weeks and warts should be gone after 3 sessions. If not, you may choose a different form of treatment. Skin reactions like itching, soreness, and pain may occur. The use of this antigen may not always be effective, but a lot have shown promising improvements even if they failed other traditional treatments. Candida albicans antigen is not advisable for patients who are pregnant and breastfeeding. It is also not recommended to those who have a fever, a current asthma attack, maintaining immunosuppressant or beta-blocker medications, or if you had an organ transplant.
• Measles, mumps, and rubella (MMR) vaccine – Usage of MMR vaccine to treating warts is somehow advantageous as it doesn’t leave any form of scars on the skin and there is a low chance for warts to recur. However, its effectiveness has not been scientifically proven yet.

 Immunotherapy Success Rates

One study demonstrated complete clearance of warts in 47% of participants and a 75 to 99% clearance rate in 13% of test subjects. Intriguingly, in 34% of people enrolled in the study, there was complete wart removal from parts of the body that were distant from the injection site. In 22% of study members, clearance rates of 75 to 99% were observed at distant sites. (Clifton MM, et al. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatr Dermatol 2003; 20: 268-71). It should be noted that mumps antigen is no longer used.

Another study compared the efficacy of Candida antigens, mumps and cryotherapy. The Candida antigen came out on top with a wart clearance rate of 70% compared to the 42% clearance rate observed for cryotherapy (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).

Disadvantages and Side Effects of Immunotherapy

Some side effects have been observed in patients who have been injected with Candida antigen and these have included an influenza-like illness that has lasted for less than 24 hours and itching at the injection site.

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