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THERAPY
Year : 1990  |  Volume : 56  |  Issue : 6  |  Page : 438-440

Immunotherapy of condyloma acuminatawrm dinitrochlrobenzene




Correspondence Address:
K C Shah


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  Abstract 

In a control study of 75 male patients of coudyloma acuminata Dinitrochlorobenzene. (DNCB) was used as immuno therapeutic agent. The DNCB was not found to be superior in curing the warts when compared with control groups. No serious side effects and toxic were observed with DNCB.


Keywords: Condyloma acuminata, immunotherapy, DNCB


How to cite this article:
Shah K C, Patel M R. Immunotherapy of condyloma acuminatawrm dinitrochlrobenzene. Indian J Dermatol Venereol Leprol 1990;56:438-40

How to cite this URL:
Shah K C, Patel M R. Immunotherapy of condyloma acuminatawrm dinitrochlrobenzene. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 May 31];56:438-40. Available from: http://www.ijdvl.com/text.asp?1990/56/6/438/3596


The present study was undertaken to find the usefulness of DNCB as a immuno­therapeutic agent in treatment of condyloma acuminata. Several authors[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] studied DNCB therapy of recalcitrant verrucae of different types and all of them found it beneficial.


  Materials and Methods Top


75 male patients with condyloma acuminata attending S.T.D. department of New Civil Hospital, Surat from January, 1985 to December, 1988 were included in the study. They were selected at random for the study and were divided equally into three groups. Each group consisted of 25 male patients between 20-35 years of age. Patients taking immunosuppressive treatment, malignancy and chronic systemic diseases were excluded from the study. Group-1 patients were treated with dinitrochlorobenzene (DNCB) immunotherapy for a period of 1-24 weeks. Second group patients were treated with local application of acetone after prior sensitization with DNCB for a similar period of time. The patients in third group were treated with local application of acetone for a similar period of time without prior sensitization with DNCB.

For the purpose of sensitization the method of Catalona[11] was followed. DNCB was dissolved in acetone to form a stock solution of 20 mg/ml.(2%) . From this solution, dilutions were made to form solution of 0.02% ( 20 mg/ 0.1 ml), 0.4% (40 mg/0.1 ml) and 0.06% (60 mg/0.1 ml). The solutions were stored in tightly packed amber coloured bottles and discarded at 15 days interval or if any change in colour was noticed.

The patients were sensitized by application of 0.1 ml of 2% DNCB solution to an area on volar aspect of the left upper arm, bounded by a polythene ring, 2 cm in diameter, 5-7 cm away from the cubital fossa. The DNCB was applied with tuberculin syringe uniformly over the whole area, allowed to dry and then with gauze piece and sealed with adhesive tape, for 24 hours. Patients were instructed to keep the area dry for 24 hours and were called after 14 days. After 14 days; challenge doses of 0.02% (20mg), 0.04% (40mg), and 0.06% (60mg) were applied to the backs of patients with same procedure as used for sensitization and after 48 hours the sites were inspected for the presence of delayed hypersensitivity reaction. The results were scored as 1+ representing erythema and oedema, 2+ showing vesicles in addition, and 3+ being a very severe reaction. No response was recorded as zero. All the 50 patients (Group 1 & 2) were sensitized with single application of DNCB.

DNCB and acetone were applied with a thin glass rod by second author. The concentration of DNCB solution was selected according to response at the challenge sites to prevent excessive pruritus, burning, bullous reaction or ulceration. Before starting the treatment all the patients were reassured about the potential for cure. All the patients were followed once weekly for 2 months after treatment.


  Results Top


Out of 25 patients in Group- 1,5 (20%) had complete regression of their verrucae. In Group- 2,6 (24%) patients got cured, while in Group- 3,4 (16%) patients had complete regression of their verrucae. [Table 1].

The side effects attributed to DNCB were mild and temporary. The lesions disappeared at the end` of therapy without scarring. Some degree of localised pruritus, oedema and erythema were regarded as normal reactions. These reactions were readily controlled with systemic antihistamines. Twenty one out of 50 patients of Group 2 sensitized with DNCB developed mild pruritus at the sites of sensitization and challenge. All the 50 patients in Group 1 and Group 2 developed localised bullous lesions followed by localised depigmentation at the site of sensitization. In all the patients pigmentation returned to normal .during the therapy.

Follow up examinations revealed recurrence of verrucae in 2 patients in Group 1 and in 3 patients in Group 2. No patients showed recurrence of verrucae in Group 3.

[Table - 1] showing relationship between duration of treatment and regression of verrucae in DNCB treated and control patients.

The results when compared are statistically not significant. P > 0.05.


  Comments Top


Several therapies were tried to stimulate patients immunity for the purpose of rejection of verrucae. Uncontrolled studies have found DNCB to be effective in different types of recalcitrant verrucae.

Dunagin WG and Millikan LE[5] reported 87% cure rate with DNCB for different type of warts including 1 case of condyloma acuminata resistant to other treatment. The lesions cleared at the end of 12 weeks after 3 applications of DNCB. The lesions were previously treated with podophyllin.

Naylor[10] studied diphenylcyclopropenone in therapy of different type of resistant verrucae and found 62% cure rate. His study also includes 2 cases of genital warts with cure rate zero.

In both the above studies the number of patients with condyloma acuminata was very small. Their studies were lacking control and included patients with different types of resistant verrucae.

Immunotherapy of condyloma acuminata with DNCB was not effective in our study.

 
  References Top

1.Lewis HM : Topical immunotherapy of refactory warts, Cutis, 1973 : 12 : 863 - 67.  Back to cited text no. 1    
2.Greenberg JH, Smith TL, Katz RM : Verruca vulgaris rejection, Arch Dermatol, 1973 : 107 : 580 - 582.  Back to cited text no. 2    
3.Buckner D, Price N : Immuno- therapy of verrucae vulgaris with Dinitrochlorobenzene, Brit. J Dermatol, 1978;98:451-455.  Back to cited text no. 3    
4.Beverly B, Kenneth W : Dinitrochlorobenzene Immunotherapy of human warts, Cutis, 1981;27:389-392.  Back to cited text no. 4    
5.Dunagin WG,.Millikan LE : Dinitrochlorobenzene immunotherapy for verrucae resistant to standard treatment modalities, J Amer Acad Dermatol, 1982; 6 : 40-45.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Eriksen K : Treatment of common warts by induced allergic inflammation, Dermatologica, 1980;160:161­166.  Back to cited text no. 6    
7.Lee S : Therapeutic effect of DNCB on verruca plana and verruca vulgaris, Internat J Dermatol, 1984;23:624-626  Back to cited text no. 7    
8.Bekhor PS : Topical DNCB therapy for resistant warts, Austr J Dermatol, 1978:19:28-30.  Back to cited text no. 8    
9.Johansson E, Forstrom L : Dinitrochlorobenzene (DNCB) Treatment of viral warts, Acta Derm Ven, 1984;64:529-533  Back to cited text no. 9    
10.Naylor : Contact immunotherapy of resistant warts, J Amer Acad Dermatol, 1988;19:679-683.  Back to cited text no. 10    
11.Catalona : A method for dinitrochlorobenzene contact sensitization, N Eng J Med, 1972;286:399­402.  Back to cited text no. 11    


    Tables

[Table - 1]

This article has been cited by
1 Topical immunomodulators in dermatology
Khandpur, S., Sharma, V.K., Sumanth, K.
Journal of Postgraduate Medicine. 2004; 50(2): 131-139
[Pubmed]



 

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