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April 2000

Treatment of Cutaneous Warts With Squaric Acid Dibutylester: A Decade of Experience

Arch Dermatol. 2000;136(4):557-558. doi:

Treatment of recurrent cutaneous warts is often troublesome. Contact immunotherapy with squaric acid dibutylester (SADBE) has been used with good results, but in a limited number of patients and without follow-up data.13

From January 1986 to December 1996, 568 patients (404 adults and 164 children) with multiple and resistant warts were enrolled at our institution to be treated with contact immunotherapy with SADBE. Included in the study were those patients who satisfied at least 2 of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient refusal to undergo any type of destructive or surgical treatment. Excluded from the study were patients with warts located exclusively on the face, children younger than 2 years, and pregnant or breastfeeding women. The first sensitization was carried out by topical application of 3% SADBE in acetone to the lesions. After 2 weeks, topical application of 70% salicylic acid in petroleum jelly under an occlusive dressing was performed for 2 to 3 consecutive days to reduce keratosis and optimize response to treatment. Subsequently, serial dilutions of SADBE (0.03%-3%) were applied to the lesions twice a week by trained clinical staff only. If after 10 weeks there were no clinical signs of improvement, the patient was considered a nonresponder and SADBE therapy was discontinued. Follow-up to 24 months from the time treatment ended was carried out for those cases that showed complete clearing.

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