Download Regression of Nevi After Candida Injection for the Treatment of

Regression of Nevi After Candida Injection for the Treatment of Verruca Vulgaris
Emily Kollmann DO, David Cleaver DO, Lloyd Cleaver DO
Northeast Regional Medical Center, ATSU-KCOM
Abstract
Discussion
Importance: Many treatments exist for verruca vulgaris.
The most common treatment methods are destructive
methods that are often painful and treat individual verruca.
Thus immune modulators including, Candida
immunotherapy, are used to treat persistent recalcitrant
and multiple verruca simultaneously.
Observation: Very few serious side effects are reported
with Candida immunotherapy including vitiligo and now
halo nevi.
Conclusions and Relevance: Physicians need to be aware
and discuss side effects with patients receiving Candida
immunotherapy.
Candida antigen is a commonly used immune
modulator used to treat recurrent, recalcitrant or
multiple verruca. However, the same
immunomodulating technique has been
conducted using paramxyovirus and
trichophyton. Other immune modulators include
imiquimod and contact sensitizers such as
diphencyprone and squaric acid dibutyl ester.
There are accounts of Candida immunotherapy
inducing vitiligo (2). The induction of vitiligo
may occur secondary to immune modulators that
may induce cytotoxic effects on melanocytes or
by revealing occult disease through
koebnerization (3, 4, 5). It has also been
proposed through a murine model that vitiligo is
induced secondary to a local inflammatory
response secondary to the trauma of the injection
(6). Similarly, the regression of nevi in our
patient could be secondary to the induction of
cytotoxic effects on the nevus cells as distant
nevi began to regress. Thus physicians should
educate patients and their parents that regression
of nevi and the onset of vitiligo are possible side
effects from Candida immunomodulating
therapy.
Figure 2 – Regression of nevi at third visit
Introduction
Case Report
Verruca vulgaris is a viral induced disease
frequently seen in children. Treatment is often
difficult for both the patient and the physician.
Destructive methods such as cryotherapy,
cantharidin, laser ablation and excision are used
most commonly to treat verruca. Destructive
methods are often painful and treat only
individual lesions. Methods such as Candida
immunotherapy were developed to treat
numerous verruca simultaneously with less pain.
Candida immunotherapy presumably enhances
recognition of the virus by the immune system
allowing for distant recognition and clearing (1).
It is possible that alerting the immune system to
the human papillomavirus could alert the
immune system to other entities such
melanocytes or nevus cells. Thus, resulting in
the onset of vitiligo and halo nevi.
A seven year old female with no significant past
medical history presented with a single verruca
vulgaris on the left anterior medial malleolus. The
lesion was pared with a 15 blade and treated with
liquid nitrogen. The lesion was also injected with 0.1
ml of Candida antigen. At the first visit, a normal
appearing congenital nevus was also noted on the right
distal posterior upper arm measuring 3.5 cm by 1.5 cm.
The patient returned for follow up a month later. The
verruca vulgaris was treated with a second 0.1 ml
Candida antigen injection. Her congenital nevus
developed a surrounding area of depigmentation. At
her third follow up visit a month later; her verruca was
treated with a third Candida antigen injection of 0.1
ml. At this visit, her other benign appearing nevi
developed areas of surrounding depigmentation in
addition to her congenital nevus seen in Figure 1 and
2. At her fourth follow up appointment one month
later, the verruca was again treated with a fourth
Candida antigen injection of 0.1 ml. The patient did
not return for five months. At that time, the verruca
had resolved. The perilesional depigmentation of the
congenital nevus remained and the pigmented area had
regressed to measure 3.1 cm by 1.2 cm. Similarly, her
other small nevi showed perilesional depigmentation
and regression. Two of her nevi had completely
regressed leaving areas of depigmentation seen in
Figure 3. She was seen six months later in which her
congenital nevus continued regressing, seen in Figure
4. She also began to develop larger areas of
depigmentation in which topical steroids were
prescribed to halt the progression.
Figure 1 – Regression of her
congenital nevus at third visit
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Figure 4 – Regression of her congenital nevus at the
sixth visit
Figure 5 - Depigmented patch from the sixth visit
References
Figure 3 - Complete regression of nevi at fourth visit
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