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Whittling away at warts


The options in wart treatment 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.


Little Rock, Ark. - Gold standard destructive methods for treating warts are giving way to modern approaches that recruit 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.

"With immunotherapy, the body recognizes the virus as abnormal, so the body can then fight off and rid the body of the virus, regardless of where it is," Dr. Johnson says.

Dr. Johnson, co-author 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, such as salicylic acid, destroy the skin that contains the virus with the hope that the virus won't remain.

"It is not a very specific therapy," she tells Dermatology Times. "But it is the treatment that has been studied the most and is the gold standard in office treatment for warts."

Enter immunotherapy

The problem with destructive therapies 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 it without - potentially - any scarring."

Warts not immune to immunotherapy

Dr. Johnson's patented immunotherapy treatment for warts, Candida skin test antigen, has been available to dermatologists for nearly eight years.

She injects the 0.03 ml Candida skin test antigen 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 than with traditional destructive therapies.

The dermatologist has shown in studies that the success rate with immunotherapy is even higher on difficult-to-treat warts. And overall, immunotherapy eliminates the risk of scarring.

"I see a lot of kids who have 30 or 40 warts, and to freeze all of them is pretty difficult. This is a much more efficient and more comfortable approach for the patient," Dr. Johnson says.

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 of people 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 the results and would repeat immunotherapy treatment 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."

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