Candida Albicans versus Candida Tropicalis Antigens in Treatment of Recalcitrant Wart

Background: Recalcitrant warts often require immune-based therapies, with Candida albicans antigen being the most used modality. Little is known about the clinical performance of Candida tropicalis as an alternative antigen despite biological similarities between the two species. This study aimed to compare the therapeutic response of intralesional Candida albicans versus Candida tropicalis in recalcitrant cutaneous warts.Methods: A prospective randomized clinical study was conducted on 116 patients with recalcitrant warts. Participants were assigned to 2 groups (n=58 in each): Group 1: received intralesional C. albicans and Group 2: received C. tropicalis antigen. Baseline characteristics, treatment outcomes, wart burden, and associations between clinical variables and therapeutic response were assessed.Results: Complete response was significantly higher in the C. albicans group than the C. tropicalis group (67.3% vs. 51.7%, p=0.021). The overall distribution of treatment outcomes also favored C. albicans. The number of warts did not influence treatment response (p=0.7103 for group comparison; p=0.49 for outcome association). Wart site showed a significant association with response (p=0.015), with higher clearance on fingers and hands, and lower clearance on the legs. Correlation analysis revealed only weak relationships among all studied variables, with no strong linear associations demonstrated.Conclusion: Intralesional Candida albicans produced a higher complete response rate than Candida tropicalis in recalcitrant warts. While C. tropicalis showed modest activity, its role in wart immunotherapy requires further evaluation. Larger studies are recommended to clarify its clinical value and to explore immunologic factors that may influence treatment outcomes.