Majid Imran, Imran Saher
Departments of Dermatology and Venereology, Government Medical College, Srinagar, India.
Indian J Dermatol. 2013 Sep;58(5):360-5. doi: 10.4103/0019-5154.117301.
Warts are sometimes resistant or they tend to recur after every possible destructive therapy. Immunotherapy with skin-test antigens has been used as a viable therapeutic option in such recalcitrant cases.
The aim of the study was to evaluate the response of resistant or recurrent warts to intralesional Candida albicans antigen immunotherapy.
A total of 40 patients with resistant or recurrent warts who showed a positive test reaction to C. albicans antigen were given intralesional injections of purified C. albicans antigen solution in a single wart at 3-weekly intervals for a total of three doses. The patients were monitored for resolution of the injected wart as well as other untreated warts. The patients who responded positively were then followed up for any relapses over the next 6 months. Adverse events, if any, were also documented.
Of the 40 patients enrolled in the study, 34 completed the total treatment protocol of three injections and 6 months of follow-up. In these 34 patients, 19 (56%) showed a complete resolution of warts at all places on the body. In addition, two patients (6%) showed a partial or complete resolution of the treated wart, but there was no effect on the untreated warts. Thirteenpatients (38%) failed to show any response to the treatment regimen. In all patients showing resolution of all the warts, there were no relapses at any site over the next 6 months of follow-up. The most common adverse effect seen was pain during the intralesional injection.
Intralesional Candida immunotherapy seems to be an effective treatment option in more than half of the patients who fail to show a positive response to destructive modes of treatment or in whom there are multiple recurrences.
The small sample size and lack of control group are the main limitations of the study.
疣有时具有抗药性，或者在每一种可能的破坏性治疗后都容易复发。在这种顽固病例中，使用皮肤试验抗原进行免疫治疗已成为一种可行的治疗选择。
本研究的目的是评估抗药性或复发性疣对皮损内注射白色念珠菌抗原免疫治疗的反应。
共有40例对白色念珠菌抗原试验反应呈阳性的抗药性或复发性疣患者，每隔3周在单个疣体皮损内注射纯化的白色念珠菌抗原溶液，共注射三剂。对患者注射的疣体以及其他未治疗的疣体的消退情况进行监测。对反应呈阳性的患者在接下来的6个月内进行复发情况随访。如有不良事件也进行记录。
在参与研究的40例患者中，34例完成了三次注射的全部治疗方案和6个月的随访。在这34例患者中，19例（56%）全身所有部位的疣完全消退。此外，2例患者（6%）治疗的疣体部分或完全消退，但未治疗的疣体无变化。13例患者（38%）对治疗方案无任何反应。在所有疣体均消退的患者中，随访的接下来6个月内任何部位均未复发。最常见的不良反应是皮损内注射时的疼痛。
皮损内注射白色念珠菌免疫治疗似乎是超过半数对破坏性治疗方式无阳性反应或多次复发患者的有效治疗选择。
样本量小和缺乏对照组是本研究的主要局限性。
