Urticaria as a side-effect of diphencyprone therapy for resistant viral warts

A large case series on the use of diphencyprone immunotherapy in the clearance of palmoplantar warts

BACKGROUND

Palmoplantar viral warts are common, often affecting the quality of life of patients and present a major therapeutic challenge. Immunotherapy using diphencyprone (DCP) can be beneficial especially if first-line treatments fail.

AIM

To determine the effectiveness of DCP in clearing viral warts, and to provide detail on the number of treatments required and any adverse effects (AEs).

METHODS

This was a retrospective case series of 124 patients who had received DCP treatment in a UK private practice setting from 1991 to 2008, carried out by a dermatologist experienced in the procedure. All patients had been referred by other clinicians after failure of standard treatments. The study data were extracted from clinical records, with follow-up until wart clearance or treatment discontinuation.

RESULTS

There was an equal distribution in sexes (63 females, 61 males), with 37% of patients having warts present for greater than 5 years. The majority (93%) of patients had already tried cryotherapy, which was unsuccessful in clearing warts completely in all cases. Following DCP treatment, 77% of patients achieved full eradication of their warts, including three patients who were immunosuppressed. The mean number of DCP treatments required to achieve full clearance was 4·7, and the mean concentration of DCP required was 4%. Only 12% of patients experienced AEs, which were mild, and included urticaria and blistering.

CONCLUSION

We suggest that DCP immunotherapy is a safe and effective treatment for eradicating viral warts, especially in recalcitrant cases.

Use of Contact Immunotherapy in the Treatment of Skin Diseases Other than Alopecia Areata

For decades, contact immunotherapy with dinitrochlorobenzene, diphencyprone, and squaric acid dibutylester has played an important role in both clinical practice and scientific research. It is listed as the first-line treatment for extensive alopecia areata and was more recently approved for melanoma treatment as an orphan drug in the USA. Moreover, owing to the relative low cost and safety, topical immunotherapy has also been used in many infectious, neoplastic, and inflammatory dermatological diseases. It is especially valuable in vulnerable groups, for cosmetic/pain sensitive areas, or for multiple lesions. In this review, we summarize the current evidence supporting the use of contact immunotherapy for treatment of skin diseases, from articles collected from PubMed database. Owing to space limitation and already numerous studies focusing on alopecia areata, we include only skin diseases other than alopecia areata. In addition to diseases that have been reported to be treated by contact immunotherapy, the hypothesized mechanism, prognosis prediction, efficacy, and safety of these topical agents are discussed.

Treatment of Warts in Children: An Update

Warts are among the most common skin infections in children. Although numerous treatment options are available, none are completely effective in a single session. Treatment is particularly complicated in children, not only because certain treatments are poorly tolerated, but also because parents frequently have unrealistic expectations. In this article, we offer an update on the treatments available for warts, focusing specifically on pediatric patients. We do not discuss treatments for oral and anogenital warts.

Treatment of palmoplantar warts with a diphencyprone and salicylic acid ointment

We report on 50 consecutive suitable patients with one or more palmoplantar warts who were treated with a patient-applied ointment comprising 0.1% diphencyprone and 15% salicylic acid in white soft paraffin. All patients sensitized to diphencyprone were followed up clinically and assessed by patient questionnaire. The intention to treat success rate in this series was 88%. The time to wart clearance ranged from less than 4 weeks to 4 months. In our patient group, 90% rated their treatment as 'excellent' or 'good', whereas 10% stated that the reaction induced by diphencyprone was 'too severe'. Our results are compared with those previously published using diphencyprone in the treatment of palmoplantar warts.