Should we proceed with another round of candida injections for the remaining asymptomatic wart?

Management of Persistent Wart After Candida Antigen Injections

Another round of Candida antigen injections is recommended for the remaining wart on the pinky finger, as this treatment has shown high efficacy rates (74-87%) for complete clearance of warts. 1

Treatment Decision Algorithm

1. Assessment of Current Status

   • Single remaining wart on pinky finger
   • Asymptomatic (not itchy, not growing)
   • Previous Candida antigen injections were effective for other warts

2. Recommendation Based on Evidence

   • Continue with Candida antigen immunotherapy
   • British Association of Dermatologists' guidelines report clearance rates of 47-87% with intralesional Candida antigen therapy 1
   • Studies show that 74% of patients achieve complete clearance of treated warts with Candida antigen injections 2

3. Treatment Protocol

   • Inject Candida antigen directly into the remaining wart
   • Typical treatment involves injections at 2-3 week intervals
   • Continue until complete clearance or for a maximum of 5-6 treatments 3

Evidence Supporting This Approach

Intralesional Candida antigen therapy works by stimulating the host's cell-mediated immune system against HPV. The British Association of Dermatologists' guidelines note that intralesional Candida antigens have been used to induce wart clearance through antigenic stimulation of the host-cell-mediated immune system 1.

A retrospective study of 100 patients showed that 80% responded to Candida antigen therapy, with 39% demonstrating complete response and 41% showing partial response 4. Another study found that 74% of patients had complete clearing of the treated wart 2.

Advantages of Continuing Treatment

• Distant Effect: 78% of patients who experienced complete resolution of their treated wart also had resolution of untreated, distant warts 2
• Safety Profile: Injections are generally well-tolerated with minimal adverse events 4
• Consistency: Continuing the same treatment that has already shown effectiveness for this patient

Alternative Options (If Candida Injections Fail)

1. Cryotherapy with liquid nitrogen - Standard treatment for common warts 1
2. Topical treatments - Such as salicylic acid or trichloroacetic acid 1
3. Surgical removal - For persistent warts 1

Follow-Up Recommendations

• Re-evaluate after each injection session
• If no improvement after 3 sessions, consider alternative treatment approaches
• Complete clearance typically requires an average of 3-4 treatments 5

Important Considerations

• Watchful Waiting: Since the wart is asymptomatic, not growing, and not causing discomfort, watchful waiting could be an alternative approach, as many warts resolve spontaneously
• Treatment Completion: Continuing the treatment course that has already shown success is generally recommended rather than switching treatments mid-course
• Patient Preference: Consider patient's preference regarding continuing treatment versus observation

Given the previous success with Candida antigen injections in this patient and the high reported efficacy rates in the literature, continuing with another round of this immunotherapy is the most evidence-based approach for the remaining wart.