Intralesional injection of Candida albicans antigen versus measles, mumps, and rubella vaccine for treatment of plantar warts

Abstract

Introduction: Many therapeutic modalities have been used for management of plantar warts; however, no optimal treatment with high efficacy and no or low recurrence has been explored to date. Intralesional immunotherapy has shown promising results in the treatment of different types of warts. Here we compare the efficacy of Candida albicans-specific antigen versus measles, mumps, and rubella (MMR) vaccine for treatment of plantar warts by intralesional injection. Methods: Sixty patients with refractory or recurrent plantar warts were randomly divided into two equal groups. Group A was treated with C. albicans antigen and Group B with MMR vaccine. Both groups were injected intralesionally in a single wart every 3 weeks until complete clearance of the wart or for a maximum of five sessions. The patients were followed up for an additional 2 months. Results: C. albicans antigen yielded a statistically significant higher cure rate (80.0%) than MMR vaccine (26.7%) in the treatment of plantar warts through a mean of 3.98 sessions versus 4.24 sessions, respectively (p = 0.002), and both modalities were well tolerated, with no remarkable side effects and no recurrence in cured patients during follow-up. Conclusions: Intralesional C. albicans antigen injection is an easy and effective treatment tool for plantar warts, even resistant and recalcitrant ones, with no post-procedural downtime and only transient occasional side effects. MMR vaccine is thought to be less effective.

Systematic Review of Intralesional Therapies for Cutaneous Warts

“…Wart types most commonly included verruca vulgaris, followed by verruca plantaris and verruca palmaris, and least commonly included verruca plana and periungual warts. Only 4 therapies were trialed in greater than 10 RCTs: these 4 most common therapies were MMR (n = 24), PPD (n = 19), vitamin D (n = 15), and Candida (n = 14) ( Table 3 ) ( Abd-Elazeim et al, 2014 ; Abd El-Magiud et al, 2020 ; Agrawal et al, 2018 ; Ahmed et al, 2020 ; Amin et al, 2021 ; Amirnia et al, 2016 ; Awad et al, 2023 ; Awal and Kaur, 2018 ; Baaniya et al, 2021 ; Bhalala et al, 2021 ; Eldahshan et al, 2022 ; ElGhareeb, 2019 ; El Sayed et al, 2020 ; Elsayed Ghaly et al, 2021 ; Fathy et al, 2019 ; Fawzy et al, 2020 ; Hodeib et al, 2021 ; Ibrahim et al, 2022 , 2020 ; Jain and Marfatia, 2021 ; Jartarkar et al, 2021 ; Kareem et al, 2019 ; Kaur et al, 2021 ; Khozeimeh et al, 2017 ; Khurshid and Pal, 2009 ; Mehta et al, 2021 ; Milante et al, 2019 ; Mohammed et al, 2021 ; Mohta et al, 2022 , 2021 ; Nassar et al, 2022 ; Nofal et al, 2022a , 2022b , 2022c , 2021a , 2021b , 2020b ; Nofal and Nofal, 2010 ; Rageh et al, 2021 ; Rajegowda et al, 2020 ; Rezai et al, 2019 ; Rutnin et al, 2023 ; Shaldoum et al, 2020 ; Wan Ahmad Kammal et al, 2021 ; Zamanian et al, 2014 ; Zainab et al, 2021 ). The most common therapy, MMR, was reported in 807 patients across studies.…”

“…Other therapies with greater than 80% response rate include bleomycin in 4 different studies ( Adalatkhah et al, 2007 ; Dhar et al, 2009 ; Hodeib et al, 2021 ; Soni et al, 2011 ), bleomycin with cryotherapy ( Muhammad et al, 2019 ), Candida in 2 additional studies ( Nofal et al, 2021a ; Rageh et al, 2021 ), PPD with cryotherapy ( Ibrahim et al, 2022 ), HPV vaccine ( Nofal et al, 2020a ), IFN alfa-2b with pulsed dye laser ( Choi et al, 2002 ), Mycobacterium indicus pranii (MIP) vaccine ( Kaur et al, 2021 ), MMR in 6 additional studies ( Baaniya et al, 2021 ; Mohammed et al, 2021 ; Mohta et al, 2021 ; Nofal and Nofal, 2010 ; Shaldoum et al, 2020 ), PPD in 1 additional study ( Rutnin et al, 2023 ), and vitamin D3 in 3 additional studies ( Amin et al, 2021 ; Ibrahim et al, 2020 ; Nofal et al, 2021a ).…”

Treatment of warts by intralesional immunotherapy

“…3 ml was intralesionally injected into the biggest wart at 3week intervals. Regarding side effects, there was a statistically significant higher incidence of pain, redness, swelling, and flu-like symptoms [18] .…”

Intralesional full‐concentration (25 mg/ml) methotrexate in the treatment of plantar warts: A pilot study

“…Many therapeutic modalities are available for the treatment of plantar warts. However, plantar warts continue to represent a therapeutic challenge due to treatment resistance, inconvenience of most modalities, and high rates of recurrence 5 …”

“…However, plantar warts continue to represent a therapeutic challenge due to treatment resistance, inconvenience of most modalities, and high rates of recurrence. 5 Methotrexate is a cytotoxic chemotherapeutic agent, widely used in dermatologic practice. Intralesional methotrexate has been used for many dermatological indications such as tumors (e.g., keratoacanthoma, squamous cell carcinomas, and lymphoma) and inflammatory conditions (e.g., plaque and nail psoriasis, pyoderma gangrenosum, cutaneous Crohn's disease, and amyloidosis).…”