title: Squaric acid immunotherapy for warts in children.
abstract: BACKGROUND
  Warts are a common pediatric skin infection caused by human papillomavirus (HPV). Spontaneous clearance of warts involves anti-HPV immunity, which may be enhanced by contact sensitizers. Squaric acid dibutylester (SADBE) is a nonmutagenic sensitizing agent useful for immunotherapy of alopecia areata.
  
  
  OBJECTIVE
  We hypothesized that SADBE home application might be effective therapy for warts.
  
  
  METHODS
  An open-label, retrospective study of 61 children with warts was performed. Sensitization with 2% SADBE on the forearm was followed with home application of 0.2% SADBE to warts 3 to 7 nights per week for at least 3 months.
  
  
  RESULTS
  Complete clearing occurred in 34 patients (58%), with a mean duration of therapy of 7 weeks. Partial clearing occurred in 11 (18%), and no response in 14 (24%). Clearance correlated with plantar distribution, wart duration under 2 years (P <.05), and first-line therapy with SADBE. Mild side effects occurred in one third of patients, were limited most commonly to mild erythema at the site of sensitization, and necessitated discontinuation of therapy in only 2 patients.
  
  
  CONCLUSIONS
  SADBE topical immunotherapy is a safe, effective option for home therapy of warts in children.
authors.affiliation: Department of Pediatrics and Dermatology, Northwestern University Medical School, Children's Memorial Hospital, Chicago, IL 60614, USA.
authors.forename: N B
authors.initials: NB
authors.lastname: Silverberg
authors.forename: J K
authors.initials: JK
authors.lastname: Lim
authors.forename: A S
authors.initials: AS
authors.lastname: Paller
authors.forename: A J
authors.initials: AJ
authors.lastname: Mancini
mesh_terms: D000276:Adjuvants, Immunologic / Q000009:adverse effects / Q000627:therapeutic use*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003503:Cyclobutanes / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008297:Male; D027383:Papillomaviridae / Q000276:immunology; D030361:Papillomavirus Infections / Q000276:immunology / Q000628:therapy; D012189:Retrospective Studies; D014412:Tumor Virus Infections / Q000276:immunology / Q000628:therapy; D014860:Warts / Q000628:therapy*
chemical_list: D000276:Adjuvants, Immunologic; D003503:Cyclobutanes; C020637:squaric acid dibutyl ester