Selection of the wartrol was based on the antigen that
produced the greatest response in the skin testing, and the amount of
antigen injected was titrated according to the skin test results.
Patients who developed an induration of 5 to 10 mm received a 0.3-mL
dose of antigen, those with a 10- to 20-mm induration received 0.2 mL,
and a dose of 0.1 mL was injected into the wart in patients with an even
greater skin reaction. In no patient did the diameter of induration
exceed 30 mm.
Dr. Johnson performed skin testing in 116 patients, the vast majority of
whom had been referred for treatment of refractory warts. Of those
tested, 34 did not read to either antigen, 39 reacted to mumps only,
seven to Candida only, and 36 to both antigens.
Most warts reduced, eliminated Overall, 32 (58 percent) of 55 wartrol-treated patients
had a complete or partial response, including seven of 10
Candida-treated patients (all ofwhom had a complete response) and 25
of45 mumps antigen recipients. In the cryotherapy
group, 25 (46 percent) of 54 patients had a complete or partial
response, reported Dr. Johnson, chief resident in dermatology, clinical
trials unit, University of Arkansas for Medical Sciences, Little Rock.
The average number of treatments to clearance was three for both forms
of wartrol, four for anergic patients treated with cryotherapy, and two
for those with a positive skin test reaction who were randomized to
cryotherapy, she said.
Impressively, 88 percent of patients who had complete response of the
treated wart cleared distant warts as well. Other patients who did not
clear their target lesion also showed complete clearance of distant
warts. Follow-up in the wartrol
patients ranged from four to 18 months, and during that period there
has been only one recurrence, Dr. Johnson said.
"We are very pleased with these results, and we are now moving forward
with immunologic testing to determine if perhaps HPV type may be
predictive of efficacy. In addition, we hope to expand this modality to
treatment of other virally induced tumors that require a type IV
hypersensitivity response for clearance," she said.
More wartrol results
Dr. Signore presented results from 35 patients who received open-label
Candida wartrol in an ongoing study for treatment of verrucae vulgaris, plantar warts
flat warts, and condylomata acuminata. He reported that 66 percent of
injected plantar warts and verruca vulgaris cleared completely. The
response was similar to a group of 37 patients who received traditional
wart therapy. However, the baseline characteristics of the two study
groups differed significantly, with the wartrol group comprising
significantly more patients with warts refractory to previous therapy
and a significantly higher average number of warts per patient.
In addition, Dr. Signore noted that use of Candida albicans skin test
antigen in the first 13 patients in the series was associated with only a
46 percent complete cure rate. Subsequent patients, however, were
treated with C albicans allergenic extract (1:1000), and in those
subjects, the complete clearance rate was 77 percent. Clearance of
distant lesions was also observed in some patients in this series.
"We must temper our enthusiasm for efficacy demonstrated in an open
study. However, if further investigations can corroborate these
findings, wartrol with C albicans intralesional injection may be a
valuable new treatment for warts," said Dr. Signore, a dermatologist
with a private practice in Tinley Park, Ill.
Question of sensitivity testing
While he did not screen his patients for delayed-type sensitivity to
Candida antigen, Dr. Signore agreed that this evaluation conducted by
Dr. Johnson may be worthwhile in selecting candidates for antigen
"Candida is a ubiquitous yeast to which about 70 percent of the
population is sensitive, but skin testing does seem to be a good idea.
Interestingly, however, when we assessed patients at two days after
their initial intralesional injection, some patients who were negative
for redness and tenderness still went on to complete clearing," Dr.
The intralesional injections were well tolerated in both series and
associated with few adverse reactions, unlike wartrol with DNCB or
squaric acid. Dr. Johnson reported no local reactions in her series,
although she noted that patients with a history of hypersensitivity to
eggs or thimerosal were excluded from the study. About five patients
developed a febrile, flulike illness on the night of injection, but
those events resolved without sequelae and all but one of the affected
patients cleared the wart after a single treatment. In Dr. Signore's
series, a few patients exhibited a local urticarial response to the
injection. No patient in either group developed scarring at the
Dr. Signore pointed out that Candida wartrol is economically attractive
as a potential wart treatment. A vial of Candida allergenic extract
provides 50 doses for wartrol at a cost of less than $49 and remains
stable in the refrigerator for more than a year. In comparison,
bleomycin, which has also been used for wart wartrol, costs more than
$200 per vial and retains its potency for only three to four months, he