الفهرس 
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Abstract
Summary and conclusion
Viral warts are common, benign and frequently self-limiting skin lesions caused by the human papillomavirus. Plantar wart is the wart variant affecting sole of the foot. It is characterized by presence of a protective horny ring of hyperkeratosis surrounding the wart tissue, making its elimination a therapeutic challenge.
Several physical and chemical destructive agents have been adopted for elimination of plantar warts with variable success rates. Emergence of immunotherapy has added a valuable weapon in warts’ elimination and stimulation HPV-directed immunity. Spontaneous resolution of warts indicates the role of the immune system, particularly cell-mediated immunity (CMI).
Intralesional candida antigen utilizes the ability of the immune system to stimulate a delayed-type hypersensitivity response to various antigens and also the wart tissue. This therapy has been found to be associated with the production of Th1 cytokines that activate cytotoxic and natural killer cells to eradicate HPV infection. This clears not only the local warts but also distant warts, unlike traditional wart therapies.
Acyclovir is a purine nucleoside analogue, that acts as a selective inhibitor of herpes virus. It acts selectivity due to the ability of these viruses to code for a viral thymidine kinase that able to phosphorylate acyclovir to acyclovir monophosphate, that converted to acyclovir triphosphate by cellular enzymes. Acyclovir triphosphate binds to and inactivates the DNA polymerases of the infected cells.
The suggested mechanism of action that when acyclovir injected on the warts induce a hemorrhagic eschar that appeared after several days and later desquamated leaving normal skin markings, also Suppress HPV by possible phosphorylation of the drug by cellular enzymes and then inhibit integration of viral DNA and the replication of cellular DNA of the infected keratinocytes, acting as antiviral and an antineoplastic drug. In addition, it may induce apoptosis of the HPV-infected cells in a similar mode of action as cidofovir.
Patients were randomly assigned to either receive intralesional acyclovir or intralesional candida antigen. 20 patients in each arm reached the primary end point of the study. Both arms were comparable regarding Patients’ socio-demographic data, duration of warts and total number of warts. Number of injected warts and total number of sessions in both arms were also comparable. 65% of acyclovir treated patients and 70% of candida antigen patients showed complete response (complete wart elimination).
This difference between both arms in cure rate was not statistically significant. also, as regard side effect, we reported mild self- limited side effect that not necessitating stop of treatment, in candida group as pain during injection reported in all cases, hemorrhagic escar in 9 cases (45%), localized edema and erythema in 9 cases (45%), flu like symptoms in 9 cases (45%), abscess formation only in one case (5%).
Similarly in acyclovir group we reported few side effects also, as pain during injection then hemorrhagic escar in in100 % of the patient, localized edema and erythema in 85% of the patient patients.
To conclude, both Intralesional acyclovir and candida antigen appear to be effective as a treatment modality for plantar warts. While Intralesional candida antigen showed a slightly higher wart cure rate. and nearly the same side effect reported in both.