Use of Squaric Acid Dibutylester (SADBE) for Cutaneous Warts in Children

Abstract

We evaluated the efficacy of squaric acid dibutylester (SADBE) contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satisfied at least two of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or parent refusal to undergo destructive or surgical treatment. Excluded from the study were children with single warts or with flat warts located exclusively on the face and children less than 2 years of age. Treatment consisted of twice weekly applications of serial dilutions of SADBE (0.03-3%) for no more than 10 weeks. Of the 148 children who completed the study, 124 (84%) showed complete clinical resolution with no significant side effects. Of those with total clinical resolution, 101 completed a 24-month follow-up with no relapses. Twenty-four (16%) children were nonrespondent. No apparent correlation between treatment response and age, gender, anatomic site, lesion type, or atopy was found. Contact immunotherapy with SADBE is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children.

Update: Treatment of Cutaneous Viral Warts in Children

“…Two series of 29 and 188 mostly pediatric patients sensitized and then treated with SADBE applications demonstrated 69% and 84% clearance rates, respectively (46,47).…”

British Association of Dermatologists' guidelines for the management of cutaneous warts 2014

“…All plantar warts responded, but statistical analyses to identify whether the wart site was a significant variable was not undertaken. 136 A retrospective review has suggested that topical trichloroacetic acid 50% in combination with SADBE immunotherapy can enhance clearance rates. 137 Side-effects of SADBE and DPC include erythema, desquamation, oedema, pruritus and mild burning.…”

“…Combination treatments can be undertaken 10,17,20,21 Other treatments: dithranol, 87 5-FU, 93 formaldehyde, 78 glutaraldehyde, 35 hyperthermia, 55 laser, 58,65 PDT, 68,73 podophyllotoxin, 90 topical immunotherapy 133,136 Plane warts On the backs of the hands or face, plane warts are mainly a cosmetic problem and spontaneous clearance can often be awaited. Destructive and caustic agents are more likely to produce scarring at these sites and should be used with care Salicylic acid cream/ointment 2-10% or cautious use of salicylic acid paint, 12-17%, used without occlusion Cryotherapy, milder freeze Topical retinoid 110,111 Others treatments: acupuncture, 171 cantharidin, 41 for the most part, weak.…”

Development and validation of a liquid chromatographic method for the analysis of squaric acid dibutyl ester and its impurities

“…Since destructive and surgical treatment of warts is painful, especially for children, topical immunotherapy with contact sensitizers is encouraged [1][2]. However, some of these sensitizing compounds such as 2,4-dinitrochlorobenzene are considered as mutagenic [3][4].…”