Intralesional immunotherapy of warts with mumps, Candida, and Trichophyton skin test antigens: a single-blinded, randomized, and controlled trial.
BACKGROUND
Warts occur commonly in humans. Destructive modalities are generally the first physician-administered therapy. Other treatment options include immunotherapy. Intralesional immunotherapy using mumps, Candida, or Trichophyton skin test antigens has proved efficacy in the treatment of warts.


OBJECTIVE
To determine rates of wart resolution in response to injection of antigen alone, antigen plus interferon alfa-2b, interferon alfa-2b alone, and normal saline; and to compare response according to viral type, major histocompatibility complex antigens, and peripheral blood mononuclear cell proliferation to autologous human papillomavirus antigen before and after injection.


METHODS
Randomized, single-blinded, placebo-controlled, clinical trial.


METHODS
Medical school-based dermatology department.


METHODS
Two hundred thirty-three patients clinically diagnosed as having 1 or more warts. Main Outcome Measure Clinical resolution of warts in response to intralesional immunotherapy.


RESULTS
Responders were observed in all treatment arms, but were significantly more likely to have received antigen (P<.001). Resolution of distant untreated warts was observed, and was significantly more likely in subjects receiving antigen (P<.001). Interferon did not significantly enhance the response rate (P = .20) and did not differ from normal saline (P = .65). No viral type or major histocompatibility complex antigen correlated with response or lack of response (P>.99 and P = .86, respectively). A positive peripheral blood mononuclear cell proliferation assay result (2 times pretreatment levels) was significantly more likely among responders (P = .002). While there was no significant difference in response based on sex (P = .56), older subjects (>40 years) were less likely to respond (P = .01).


CONCLUSIONS
Intralesional immunotherapy using injection of Candida, mumps, or Trichophyton skin test antigens is an effective treatment for warts, as indicated by significantly higher response rates and distant response rates in subjects receiving antigen. Viral type and major histocompatibility complex antigens did not seem to influence treatment response. Response is accompanied by proliferation of peripheral blood mononuclear cells to human papillomavirus antigens, suggesting that a human papillomavirus-directed cell-mediated immune response plays a role in wart resolution.
Horn
Thomas D
TD
Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. hornthomasd@uams.edu
Johnson
Sandra M
SM
Helm
Ricki M
RM
Roberson
Paula K
PK
D000328:Adult; D000946:Antigens, Fungal / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000956:Antigens, Viral / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D002175:Candida / Q000276:immunology*; D002455:Cell Division / Q000187:drug effects; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006649:Histocompatibility Antigens / Q000097:blood; D006801:Humans; D007167:Immunotherapy / Q000009:adverse effects / Q000379:methods*; D015552:Injections, Intralesional; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009000:Monocytes / Q000473:pathology; D009109:Mumps virus / Q000276:immunology*; D027383:Papillomaviridae / Q000276:immunology; D011994:Recombinant Proteins; D016896:Treatment Outcome; D014249:Trichophyton / Q000276:immunology*; D014860:Warts / Q000188:drug therapy / Q000628:therapy*
D000946:Antigens, Fungal; D000956:Antigens, Viral; D000998:Antiviral Agents; D006649:Histocompatibility Antigens; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor