Immunotherapy of HSV with ILCSTA

By Sandra Marchese Johnson, MD

Herpes simplex virus (HSV) infects about 16 percent of the population. It is one of the most common and recurrent viral infections.1 Most people treat HSV with oral antivirals or nutritional supplements, such as lysine. We have shown great success at treating another viral infection—warts—with intralesional Candida skin test antigen (ILCSTA) injections.2-8 In our clinic, we have anectodetally treated many patients who suffer with recurrent HSV with intralesional Candida immunotherapy.

The rationale behind immunotherapy to treat viral infections has been discussed at length in our prior publications.2-11 Briefly, in the case of warts, Human Papillomavirus (HPV) is able to evade the host immune system. By injecting something that the host immune system recognizes as abnormal, in this case Candida skin test antigen, there is epitope spreading and unveiling of HPV, so that the host immune system then recognizes HPV. We sought to discover if the same principle would hold true for other viral infections.

We have attempted immunotherapy with intralesional Candida skin test antigen for the treatment of molluscum and have been successful. Because the molluscum contagiosum virus (MCV), however, is usually self-limited and non-recurrent, we have not decided to publish these findings.

We have prospectively treated many patients with recurrent HSV with immunotherapy of intralesional Candida skin test antigen (ILCSTA). We present the results of three patients in hopes of someone initiating a clinical trial to further test this hypothesis.

1. A 66-year-old white man who suffered with more than six episodes of HSV of superior gluteal cleft for many years was injected with ILCSTA once and has not had a recurrence for more than 12 months.
2. A 70-year-old white woman who suffered with 10-12 episodes per year of herpes labialis for more than 40 years was injected with ILCSTA once and has not had a recurrence for more than three years.
3. A 15-year-old white man who suffered with recurrent Herpes labialis of more than six episodes per year was not responsive to oral Acyclovir, Famciclovir, or Valcyclovir. He was evaluated at Arkansas Children’s Hospital for immunodeficiency. He was injected twice with ILCSTA and now only suffers with about one to two episodes of HSV per year.

We hope by presenting these three cases of immune stimulation by ILCSTA to treat and prevent further recurrence of HSV that further research will be commenced to prove this hypothesis.

We also want to share this as an anecdotal low-risk inexpensive treatment option for patients suffering with recurrent HSV.

— Sandra Marchese Johnson MD, FAAD
Fort Smith, AR

1. Xu F, Sternberg MR, Kottiri BJ, et al. Trends in herpes simplex virus type 1 and type 2 seroprevalence in the United States. JAMA 2006;296:964--73.

2. Johnson SM, Roberson PK, Horn TD. Intralesional injection of mumps or candida antigens: a novel immnotherapy for warts. Arch Dermatol 2001;137:451-455.

3. Clifton MM, Johnson SM, Roberson PK, Kincannon J, Horn TD. Immunotherapy for recalcitrant warts in children using intralesional mumps or Candida antigens. Pediatric Dermatology 2003;20(3):268-271.

4. Kuykendall-Ivy TD, Johnson SM. Evidence-based review of management of nongenital cutaneous warts. Cutis 2003;71(3):213-222.

5. Clemons RT, Clemons-Miller A, Johnson SM, Williamson SK, Horn TD. Comparing therapy costs for physician treatment of warts. J Drugs Dermatol 2003;2(6):649-654.

6. Johnson SM, Horn TD. Intralesional Immunotherapy for warts using a combination of skin test antigens is a safe and effective therapy. J Drugs Dermatol 2004;3(3)263-265.

7. Johnson SM. A step-by-step plan to eradicate warts. Practical Dermatol 2004 (Aug) 44-48.

8. Horn, TD, Johnson SM, Helm RJ, Roberson PK. Intralesional immunotherapy of warts with Mumps, Candida, and Trichophyton skin test antigens: A single-blinded, randomized, and controlled trial. Arch Dermatol. 2005;141:589-594.

9. King M, Johnson SM, Horn TD. Intralesional immunotherapy for genital warts. Arch Dermatol 2005;141(12):1606-7.

10. Johnson SM, Brodell RT. Warts: A guide to their removal. Consultant 2005;45(8S):1-9

11. Bacelieri R. Johnson SM. Cutaneous warts: an evidence-based approach to therapy. American Family Physician. 72(4):647-52, 2005 Aug 15.


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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.