Alternating intralesional purified protein derivative and Candida antigen versus either agent alone in the treatment of multiple common warts

Nofal, Ahmad; Yehia, Esraa; Khater, Elsayed; Bessar, Hagar

doi:10.1016/j.jaad.2020.01.054

Cited by 9 publications

(12 citation statements)

References 4 publications

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“…Combined immunotherapy, in an alternating manner, was also tried by Nofal et al. [ 10 ], who compared an alternating therapy of PPD and Candida antigen versus therapy of each individual antigen. A statistically significant difference in the therapeutic response was found between the alternating therapy group (complete clearance in 70.6%) and the individual antigen groups (61.1% of the PPD group and 36.8% of the Candida antigen group).…”

Section: Discussionmentioning

confidence: 99%

“…[ 7 ] Combined bivalent HPV vaccine and Candida antigen Mean of 29 years 13 males and 7 females 0.2 ml of Candida antigen; up to five sessions 0.5 ml of IM HPV vaccine at 0, 1, 6 months 70 Not mentioned Edema, erythema, and flu-like in few patients No recurrence Nofal et al. [ 10 ] Alternating therapy of PPD and Candida antigen Mean of 22.4 years 14 males and 20 females 0.1 ml of each antigen in an alternating manner Up to six sessions 70.% Not mentioned Insignificant No recurrence Current study Triple immunotherapy of PPD, Candida antigen, and MMR versus monoantigen Mean of 28.6 years 15 males and 25 females 0.3 ml Up to 5 sessions 77.5 65% Erythema in 17.5%, edema in 22.5%, and flu-like symptoms in 10% 6.45% …”

Section: Discussionmentioning

confidence: 99%

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Triple Intralesional Antigen Immunotherapy versus Monoantigen in the Treatment of Multiple Recalcitrant Warts

Nofal

Elkholy

Abd-Elmonsef

et al. 2022

Dermatol Ther (Heidelb)

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Introduction Warts can be resistant to treatment or recur despite the use of various destructive and immunotherapeutic modalities. Combination immunotherapy might contribute to better response rates. The aim of this study was to assess the effectiveness and safety of a triple intralesional immunotherapy combination composed of purified protein derivative (PPD), Candida antigen, and measles–mumps–rubella vaccine (MMR), versus each agent alone, in the management of multiple recalcitrant warts. Methods In total, 160 patients with numerous resistant extragenital warts were included in the research. They were randomly assigned to one of four groups (each with 40 patients): PPD, Candida antigen, and MMR, or combination of the three antigens. Injections into the biggest wart were repeated every 2 weeks until clearance or for a total of five sessions. Results Complete wart clearance was reported in 31 patients (77.5%) who received triple-antigen immunotherapy, 23 patients (57.5%) who received intralesional PPD, 29 patients (72.5%) injected with Candida antigen, and 25 patients (62.5%) who received MMR. The combined therapy was found to be superior to the other therapies and had the lowest recurrence rate, but the difference was not statistically significant. Conclusions Triple intralesional antigen immunotherapy is as safe as, and more effective than, monoantigen immunotherapy, and can be added to the armamentarium against recalcitrant human papilloma virus (HPV) infections.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Triple Intralesional Antigen Immunotherapy versus Monoantigen in the Treatment of Multiple Recalcitrant Warts

Nofal

Elkholy

Abd-Elmonsef

et al. 2022

Dermatol Ther (Heidelb)

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“…Previous comparative studies between different types of injectable antigens, for example, Candida antigen, PPD, BCG, MMR, and Mycobacterium W, are demonstrated in Table 4. [11][12][13][14][15][16][17] In our clinical trial, we evaluated, for the first time, the comparative efficacy and safety of intralesional MMR and intralesional Candida antigen in the treatment of multiple common and plantar warts. The results revealed complete clearance of warts in 73.5% of patients treated with Candida antigen versus 67.5% of those treated with intralesional MMR vaccine.…”

Section: Discussionmentioning

confidence: 99%

“…Previous comparative studies between different types of injectable antigens, for example, Candida antigen, PPD, BCG, MMR, and Mycobacterium W, are demonstrated in Table 4. 11 -17…”

Section: Discussionmentioning

confidence: 99%

Intralesional Measles, Mumps, and Rubella Vaccine Versus Intralesional Candida Antigen in the Treatment of Common and Plantar Warts

et al. 2021

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Background Intralesional immunotherapy has been effectively used in the treatment of warts; however, comparative studies between different antigens are limited. Objective To evaluate the efficacy and safety of intralesional measles, mumps, and rubella (MMR) vaccine compared with intralesional Candida antigen for the treatment of multiple common and plantar warts. Methods Sixty-eight adult patients with multiple common and plantar warts were randomly assigned into two groups, each containing 34 patients. The first group received intralesional MMR vaccine, while the second group received intralesional Candida antigen. Each treatment was injected into the largest wart at 2-week intervals until complete clearance or for a maximum of 5 sessions. Results The overall therapeutic response was higher in the Candida antigen group (73.5%) compared with the MMR group (67.7%); however, the difference was not statistically significant. Complete clearance of common warts was higher in the Candida antigen group, while that of plantar warts was higher in the MMR group. Adverse effects were transient and well tolerated in both groups. No recurrence was detected during the 6-month follow-up period. Conclusion Intralesional MMR and intralesional Candida antigen showed comparable efficacy and safety in the treatment of common and plantar warts.

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“…4 Notably, high-response rates with PPD are not expected in countries not using BCG in their immunization programs (BCG is a part of the National Childhood Immunization Program in Egypt). 26 Therefore, we propose that the use of Candida antigen might be more suitable for use in different countries.…”

Section: Respectively)mentioning

confidence: 99%

Intralesional immunotherapy for multiple recalcitrant plantar warts: Candida antigen is superior to intralesional purified protein derivative

Nofal

Adel

Fawzy

et al. 2022

Dermatologic Therapy

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Treatment of recalcitrant plantar warts represent a highly challenging issue for both patients and physicians. Candida antigen and purified protein derivative (PPD) have shown promising efficacy in the treatment of warts, however no previous studies have compared both antigens for recalcitrant plantar warts. To assess the efficacy and safety of intralesional Candida antigen versus intralesional PPD in the management of recalcitrant plantar warts. The study included 120 adult patients with multiple recalcitrant plantar warts. They were randomly assigned to one of three groups; Candida antigen, PPD, or normal saline. Injections into the largest wart were repeated every 2 weeks until clearance or for a maximum of five sessions. Complete wart clearance was reported in 33 patients (82.5%) of the Candida antigen group, in 22 patients (55.6%) of the PPD group, and in one patient (5%) of the control saline group. A statistically significant difference was found between the studied groups in favor of Candida antigen. Adverse effects were mild and insignificant in the three groups. Intralesional antigen immunotherapy by Candida antigen or PPD is a promising, safe, and cost-effective therapeutic option for multiple recalcitrant plantar warts, with statistically significant superiority of Candida antigen.

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Alternating intralesional purified protein derivative and Candida antigen versus either agent alone in the treatment of multiple common warts

Cited by 9 publications

References 4 publications

Triple Intralesional Antigen Immunotherapy versus Monoantigen in the Treatment of Multiple Recalcitrant Warts

Triple Intralesional Antigen Immunotherapy versus Monoantigen in the Treatment of Multiple Recalcitrant Warts

Intralesional Measles, Mumps, and Rubella Vaccine Versus Intralesional Candida Antigen in the Treatment of Common and Plantar Warts

Intralesional immunotherapy for multiple recalcitrant plantar warts: Candida antigen is superior to intralesional purified protein derivative

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