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Immunotherapy for warts


Wart treatment options have grown to include immunotherapy, in addition to destructive modalities. But there is no magic bullet, and more research is needed to find better, more effective treatments.

Key Points

Little Rock, Ark. - Gold standard destructive methods for treating warts are giving way to modern approaches that focus on recruiting the body's immune system to fight the lesions.

"Destructive treatments address the wart from the outside in," says Sandy Johnson, M.D., F.A.A.D., assistant clinical professor, department of dermatology, University of Arkansas, Little Rock, Ark.

"With immunotherapy," she tells Dermatology Times, "the body recognizes the virus as abnormal, so the body can then fight off ... the virus, regardless of where it is."

Dr. Johnson, coauthor of "Warts Diagnosis and Management: An Evidence-based Approach" (Martin Dunitz 2003), says she recommends that patients who want to treat their warts at home suffocate the virus with either clear nail polish or duct tape. This is as an option to, or in addition to, using salicylic acid.

The Fort Smith, Ark., dermatologist says liquid nitrogen treatments, like salicylic acid, destroy the skin that contains the virus.

Enter immunotherapy

The problem with destructive therapies, according to Dr. Johnson, is that even though dermatologists can destroy the skin surrounding the wart, the reality is that the virus continues to grow and spread until the person's immune system recognizes it as abnormal.

"That is why after freezing some warts, patients will get a scar in the middle and a doughnut shaped wart around the treated area. That occurs because the virus is still pretty active on the skin," she says. "But if the body is able to recognize the virus as abnormal, the body would be able to get rid of the virus without - potentially - any scarring."

Warts not immune to immunotherapy

Dr. Johnson has a patented immunotherapy treatment for warts: candida skin test antigen.

She injects 0.03 ml directly into one wart on the body. She says that, while dermatologists have to treat all the warts on a patient's body with liquid nitrogen to rid the patient of warts, she needs to only treat one wart with immunotherapy.

The injection results in the body's fighting the warts from the inside out. Not only do most of the warts then disappear, but they tend to recur less with the candida skin test antigen than with traditional destructive therapies, she says.

Dr. Johnson has shown in studies that immunotherapy's success rate is even higher on difficult-to-treat warts. And, overall, immunotherapy eliminates the risk of scarring.

Among her findings in studies reported in the literature:

In patients who were treated with immunotherapy in one wart, 78 percent of those patients also cleared their distant warts. Seventy-four percent treated with immunotherapy cleared their warts as opposed to 55 percent with liquid nitrogen (Arch Dermatol. 2001;137:451-455).

Phillips RC et al reported in 2000 in the Archives of Dermatology that 86 percent of people were satisfied with immunotherapy treatment results and would repeat it for their warts.

"We have not had side effects from using immunotherapy," Dr. Johnson says. "With liquid nitrogen, we expect it to form a blister, which is an expected effect."

Combined approach

Dr. Johnson, who says coding for wart treatments has changed from 17000, 17003 and 17004 in 2006 to 17110 and 17111 in 2007, combines destructive and immunotherapy treatments for many patients with warts.

Reimbursement for treating warts has diminished, she says, and she does not typically get reimbursed for the immunotherapy procedure, so she bills for the destructive therapy and often does the immunotherapy for free.

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