title: Contact immunotherapy with squaric acid dibutylester for the treatment of recalcitrant warts.
abstract: BACKGROUND
  Contact immunotherapy has been shown to be effective for warts. Two previous studies on the use of squaric acid dibutylester (SADBE) for warts have reported widely divergent cure rates (10% and 60%).
  
  
  OBJECTIVE
  Our purpose was to determine the efficacy of SADBE in the treatment of recalcitrant warts.
  
  
  METHODS
  We treated 29 patients with SADBE for warts that were resistant to other therapies. The patient population had warts for a mean duration of 2.1 years. Patients were sensitized with 1% or 2% SADBE in acetone under occlusion, then treated with 0.5% to 5% SADBE applied to their warts every 2 to 4 weeks in the office.
  
  
  RESULTS
  Clearing of all warts was seen in 20 of 29 patients (69%), improvement in 3 patients (10%), and no change in 6 patients (21%). For the cured patients, mean duration of treatment was 4.2 months (range, 1 to 12 months) and mean number of treatments was 5.7 (range, 2 to 15). Adverse effects included acute contact dermatitis with 6 patients experiencing blisters and one experiencing hypopigmentation.
  
  
  CONCLUSIONS
  SADBE treatment is worth considering in patients with recalcitrant warts, especially in those who tolerate painful procedures poorly.
authors.affiliation: Division of Dermatology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: A N
authors.initials: AN
authors.lastname: Lee
authors.forename: S B
authors.initials: SB
authors.lastname: Mallory
mesh_terms: D000293:Adolescent; D000328:Adult; D000485:Allergens / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003503:Cyclobutanes / Q000009:adverse effects / Q000276:immunology / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D007223:Infant; D008297:Male; D012008:Recurrence; D014860:Warts / Q000628:therapy*
chemical_list: D000485:Allergens; D003503:Cyclobutanes; C020637:squaric acid dibutyl ester