For patients with recalcitrant warts, combination therapy with acitretin and intralesional Candida antigen is superior to either acitretin or Candida antigen alone, according to a study published in the Journal of Cosmetic Dermatology.

Researchers compared the safety, efficacy, and immunological effects of Candida antigen alone or acitretin alone with acitretin-Candida antigen combination therapy for patients with intractable warts (N=60). Participants were divided into 3 groups to test each therapy, and interferon-gamma (IFN-γ) and interleukin 10 (IL-10) serum cytokine levels were measured at baseline and after therapy in all groups.

Eight participants in the acitretin alone group achieved total wart resolution (40%) compared with 9 participants in the Candida antigen alone group (45%), vs 15 participants in the combination therapy group (75%). 

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Overall therapeutic response was statistically higher for patients in the combination therapy group vs either single agent group. Nonsignificant adverse effects were observed in all 3 groups, and no statistically significant posttherapy differences in IFN-γ or IL-10 serum cytokine levels were observed between responders and non-responders.

Study investigators concluded that “combination therapy (acitretin + Candida antigen) is superior to monotherapy (acitretin alone and Candida antigen alone) in the treatment of recalcitrant warts. Although it has been postulated that wart regression is controlled by the immune system, serum cytokine levels of IFN‐γ and IL‐10 were not associated with clearance or persistence of warts in any of the studied groups.”

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Nofal A, Elkot R, Nofal E, Mazen M. Combination therapy versus monotherapy in the treatment of recalcitrant warts: A clinical and immunological study [published online December 30, 2018]. J Cosmet Dermatol. doi: 10.1111/jocd.12848