Bivalent human papillomavirus (HPV) vaccine in combination with Candida antigen can effectively treat multiple recalcitrant warts, according to research published in the Journal of Cosmetic Dermatology.

Researchers conducted a prospective comparative study of 40 participants (24 men and 16 women; mean age 32.5±24.7 years) with different types of multiple recalcitrant warts to examine the therapeutic role of combining a bivalent HPV vaccine and Candida antigen vs Candida antigen alone.

Group A received intralesional Candida antigen injection (0.2 mL of 1/1000 solution) into the largest wart at 2-week intervals until cured or for up to 5 sessions. Group B received a combination therapy of the bivalent HPV vaccine plus the Candida antigen; 0.5 mL of bivalent HPV vaccine was injected intramuscularly at 0, 1, and 6 months and Candida antigen was administered on the same schedule as group A.

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At baseline, the number of lesions ranged from 5 to 26 warts with a duration since onset of 2 to 8 years. The most common wart subtypes included genital and plantar, and cryotherapy was the most commonly used therapeutic modality prior to study-treatment initiation.

In the group receiving Candida antigen, 40% of patients showed a complete resolution of warts, 25% demonstrated a partial response, while 35% of patients had no response. In the group that received combination therapy, 70% of patients demonstrated complete resolution, whereas 20% had only a partial response and 10% showed no response to treatment. The researchers noted a statistically significant difference in favor of combination therapy for treatment of recalcitrant warts.

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Adverse effects of the Candida antigen injection included tolerable pain during injection, edema or induration, erythema, and flu-like symptoms in both groups. With the exception of mild pain at injection site, no patients in the group receiving combination therapy experienced adverse effects associated with the bivalent HPV vaccine injection.

Recurrence of warts was not detected in either group at 6-month follow-up.

“HPV vaccines have been used since 2006 to prevent HPV-associated precancerous and cancerous conditions,” the researchers noted. “A statistically significant regression of both genital and extra-genital warts was observed after the combined use of [bivalent HPV vaccine] and Candida antigen as compared [with] Candida antigen alone. The synergistic effect of both agents may have caused robust cell-mediated immunity against HPV.”

The researchers of the study concluded, “The results of this combination therapy are promising and can overcome the failure rate of intralesional immunotherapeutic agents when injected alone.… Although this study was limited to a small number of patients, the preliminary outcomes strongly suggest that HPV vaccines have an evident potential in the treatment of warts.”

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Marei A, Nofal A, Alakad R, Abdel-Hady A. Combined bivalent human papillomavirus vaccine and Candida antigen versus Candida antigen alone in the treatment of recalcitrant warts [published online July 22, 2019]. J Cosmet Dermatol. doi: 10.1111/jocd.13077