An Bras Dermatol. 2012;87(4):585-9.
Treatment of common warts with the immune stimulant
Propionium bacterium parvum
Tratamento das verrugas vulgares com o imunoestimulante Propionium
Abstract: BACKGROUND: Warts are epithelial proliferations in the skin and mucous membrane caused by
various types of HPV . They can decrease spontaneously or increase in size and number according to the
patient's immune status. The Propionium bacterium parvum is a strong immune stimulant and immu-
ne modulator and has important effects in the immune system and it is able to produce antibodies in
OBJECTIVE: To show the efficacy of the Propionium bacterium parvum in saline solution in the treatment
of skin warts.
METHODS: A randomized double-blind study. Twenty patients with multiple warts were divided into two
groups: one received 0,1ml intradermal injection of placebo solution in just one of the warts and the
other received 0,1 ml of saline solution of Propionium bacterium parvum, one dose a month, for 3 to
RESULTS: Among the 20 patients who participated in the study, ten received the placebo and ten received
the saline solution with Propionium bacterium parvum. In 9 patients treated with the Propionium bac-
terium parvum solution the warts disappeared without scars and in 1 patient it decreased in size. In 9
patients who received the placebo no change to the warts was observed and in 1 it decreased in size.
CONCLUSIONS: The immune modulator and immune stimulant Propionium bacterium parvum produced
antibodies in the skin which destroyed the warts without scars, with statistically significant results
(P<0,001), and cured 90 % of the patients. We suggest the use of the immune stimulant in the treat-
ment of warts.
Keywords: Adjuvants, immunologic; Biological treatment; Immunologic factors; Immunotherapy;
Received on 30.03.2011.
Approved by the Advisory Board and accepted for publication on 08.06.2011.
* Work performed in the Medicine course - Dermatology outpatient´s clinic of the Fundação Universidade Regional de Blumenau (FURB) – Blumenau (SC), Brazil.
Financial Support: None.
Conflictc of Interests: None.
PhD in Dermatology – Full Professor at the Fundação Universidade Regional de Blumenau (FURB) – Blumenau (SC), Brazil.
©2012 by Anais Brasileiros de Dermatologia
An Bras Dermatol. 2012;87(4):585-9.
Warts are epithelial proliferations in the skin and
mucosa caused by various types of human papilloma
virus (HPV). Common warts are the most usual ones,
characterized by papules or nodules with a hard surface,
firm and hyperkeratotic consistency, found in any part of
the skin, however they are mostly found on the dorsum
of the hands and fingers. On the fingers they can be
located in the nail bed and the periungual folds.
They develop at any age and are more common
in children and adolescents. The lesion is auto-inocu-
lated and the incubation period varies from a few
weeks to over a year.
indirect, mostly by exposure in swimming pools,
sports precincts, beach and other places.
There are at least 70 types of HPV , but some of
them tend to be more frequent in some areas of the body
2. A correlation between HPV serotype and infected zone
might be possible; as such, palmoplantar lesions corres-
pond to serotype 2, mucosal and mucocutaneous lesions
to serotype 1, genital and perianal lesions to serotype 6
and periungual lesions to serotypes 2, 6, 10, 11.
According to the immunological status the
warts can regress spontaneously or increase in size
and number. Spontaneous regression depends on the
patient´s anti HPV immunity.
Forty-five percent (45%) of immune suppressed
patients due to renal transplantation have warts,
mainly common and plantar, less than five years after
the transplant, a percentage that increases to more
than 70% after this period.
Even in the XXI century, common warts are still
a challenge. Usually conservative therapy with topical
products like keratolytics and caustic agents are the
first option. If the topical agents fail, cryotherapy,
curettage, electrocoagulation, liquid nitrogen, surgi-
cal excision or laser therapy can be considered.
In some cases, due to pain and a great number
of lesions, these treatments are impractical.
However, all these treatments do not have com-
pletely satisfactory results. There is a high recurrence
rate after their utilization as well as, in most cases,
definitive scars and sequelae.
cause lesions that are more severe than the warts
performed and the results obtained, it should not be
forgotten that 30% of the warts disappear sponta-
neously within six months and the remaining ones
disappear spontaneously within 3 years. It seems that
the viral replication ceases and the warts fall.
Immune modulators are substances that act on
the immune system and have the ability to increase
the host´s resistance. Over the past few years they
have been used in the treatment of many human ill-
nesses, particularly from viral and neoplastic origin.
1Contamination can be direct or
7As such, many of them
3 Nevertheless, regardless of the treatment
Immune stimulants are substances that operate like
the immune modulators.
Coryneobacterium parvum, also known as
Propionibacterium acnes or Propionium bacterium
parvum is a gram positive, pleomorphic, strictly anae-
It shows a potent stimulant effect in the reticu-
loendothelial system and because of that it has been
used in recent years as an antibacterial and adjuvant
immune stimulant to chemotherapy in numerous
Propionium bacterium parvum stimulates the
activity of natural killer cells (NK), by releasing inter-
feron and tumor necrosis factor.
Specific responses to the antigen prepared with
dead Propionium bacterium parvum have been stu-
died, including immediate and late hypersensitivity
reactions, as well as erythematous reactions, which
disappear 48 hours after the injection.
due to the inflammation generated by the comple-
ment activation by the antigen-antibody complex or
by products found in the antigen preparation.
Due to the dissatisfaction in relation to existing
treatments and after studies showing that the
Propionium bacterium parvum is a potent immune
stimulant, our study shows that it can be used for that
purpose, in a treatment which aims to eliminate com-
mon warts reaching only the virus, without destroying
the surrounding tissues and, consequently, without
leaving scars or sequelae.
11,12,13It can be parenterally or topically admi-
13This can be
This was a randomized double-blind clinical
trial, with at least 20 volunteers. A double study is a
study with human being where neither the patient nor
the examiner knows what is being used as variable in
any given moment (placebo or immune stimulant). A
randomized study is an experimental study where the
use of medications is tested, and the incidence of the
disease is verified in the group which received the
medication and in the one which received the placebo.
The study was approved by the Ethics
Committee of the Universidade Regional de
Blumenau, according to the protocol number 025/06.
The patients with common warts were infor-
med about the technical and scientific basis of the
research project, through an informed consent form.
The information collected and the clinical
observations from the lesions examination will be
filed and in possession only of those involved with the
An Bras Dermatol. 2012;87(4):585-9.
Treatment of common warts with the immune stimulant Propionium bacterium parvum 587
project and the patients, if they want it. They will be
available for technical and scientific purposes only.
28 volunteers with viral warts were studied,
from both sexes, at the Dermatology Outpatients´
Clinic of the Universidade Regional de Blumenau,
who agreed with the intraepidermal test after reading
the informed consent form. In case the patient with
warts was younger than 18 years, the informed con-
sent form was signed by the guardian.
The protocol used for the patients with com-
mon warts consisted of:
Identification (sex, age and origin);
l Lesion examination; number and location of
General questions in order to get inclusion
and exclusion criteria into the research.
The visit included an initial consultation with
anamnesis and examination of the lesion, clinical
diagnosis and discussion of the case.
The patient could agree to take part in the
study immediately or after some time or refuse parti-
Application of the medication and placebo
Intradermal application of 0,1 ml of the subs-
tance (drug or placebo) in only one wart, even if the
patient had various lesions (Figure 1).
The patient would return to the dermatology
outpatients´ clinic of the Universidade Regional de
Blumenau every 30-40 days so that subsequent appli-
cations could be done, in a total of 3 to 5 (if necessa-
ry) and for follow-up of the progress of the lesions,
aiming at verifying the efficacy of the product (thera-
peutic assessment) (Figures 2, 3, 4 and 5).
A mild local reaction could develop, which was
desired in order to demonstrate the antigen-antibody
complex formation. All the applications were perfor-
med only by the physician responsible for the
research, and were free of charge.
The patients who received the placebo substance
were also treated, at the end of the study, with the propo-
sed drug (Propionium bacterium parvum), at no cost.
Distribution of the patients
In half the patients the drug being studied was
applied, and in the other half the placebo. This divi-
sion was performed by order of agreement to partici-
pate in the project, that is, in the first patient who
agreed the substance from the bottle with the blue
label was applied, in the second the substance from
the bottle with the orange label. From then on all odd
patients (third, fifth, seventh,...) received the substan-
ce from the bottle with the blue label and all the even
patients (forth, sixth, eighth,…) the substance from
the bottle with the orange label.
Division of the substances into drug and placebo
The division of the substances into drug or pla-
cebo was done at the outpatients´ clinic pharmacy of
the Universidade Regional de Blumenau, by the phar-
macist in charge, who also signed the informed con-
sent form. The pharmacist in charge made the division
of the substances by using colored labels on the bottles
of the products to be used. Half the bottles received
the blue label and the other the orange, and only the
pharmacist in charge knew which of the two colors
indicated the bottle with the drug (Propionium bacte-
rium parvum) or with the placebo (saline solution).
Therefore, both the patients and the research
FIGURE 1: Application technique of the immune stimulant
FIGURE 2: Common warts - all the fingers. Patient with
common warts in all fingers
An Bras Dermatol. 2012;87(4):585-9.
physician did not know which one was the effective
drug and which one the placebo.
The drugs used
The effective drug of Propionium bacterium
parvum diluted in phenicated saline solution and buf-
fered to pH 7,2 and the placebo, a phenicated saline
solution buffered to pH 7,2 were prepared and provi-
ded free of charge by the laboratory RVP special mani-
pulations, under the supervision of the pharmacist,
Dr. Eliana Alves da Silva (CRF/SP - 19329).
The bottles were properly stored, at 10º C,
according to manufacturing instructions.
Individuals with a clinical diagnosis of common
wart, from both sexes, regardless of age or race, previous-
ly informed about the nature of the procedures and with
formal approval (through the informed consent form).
Individuals with previous history of allergy of
any kind, pregnant or lactating women, individuals
with history of immune suppressive disease, using cor-
ticosteroids and/or other immune suppressive drugs.
The Fisher´s Exact Test was used to get the p-
value, considering the low number of patients studied
(up to 20 frequencies).
There were 28 volunteers, and 20 completed
the treatment and 8 gave up the participation in the
The location of the warts found in the patients
who responded positively to the treatment were mos-
tly (64,3%) in the hands (fingers and nail bed), and in
the lower limbs (legs and feet) with 35,7%.
The results were reported to the pharmacist
who then identified the substances used and infor-
med that the blue bottles had the saline solution with
Propionium bacterium parvum and the orange ones
only contained the saline solution (placebo).
The results then considered can be found in
table 1, and the statistical analysis by the Fisher´s
Exact Test showed a significance of P<0,001, which
enables us to claim that the drug had a highly positive
result when compared with the placebo.
The patients who had all their warts cured, with
no scar, with the application in only one of them and
fall of the remaining lesions, needed the following
doses: one SC application of 0,5 ml = 2 patients, 2
applications (1 every 30 days) = 3 patients and 3
applications in 3 patients .
The patient who did not respond to the medi-
cation received the three scheduled doses by the pro-
tocol. The volunteer who received the placebo and
whose wart decreased received three doses of it.
FIGURE 3: Cured after two doses of the immune stimulant
FIGURE 4: Common wart
- finger. Patient with
common wart in the first
FIGURE 5: Patient cured
after two doses. Patient
cured with two doses of
the immune stimulant
An Bras Dermatol. 2012;87(4):585-9.
The usual treatment of common warts aims at
destroying them by various highly aggressive methods
which leave unavoidable sequelae like scars and
deformations. There is also a high recurrence rate
after these treatments and we should consider that
30% of the warts disappear spontaneously.
All these procedures seek to destroy not only
the virus but also the tissue which they parasite.
Scientifically and in a logic manner we should
look for alternative therapies which combat the HPV
that causes the warts like vaccines, immune stimulants
and other procedures which allow the human body´s
own immune defenses to destroy the virus, like the case
of the genital HPV vaccine, a cervix cancer precursor.
The spontaneous regression and the “home
remedies” which induce the patient to believe in the
cure of the warts, show a natural increase of the anti-
bodies which combat the virus and promote its elimi-
nation without causing sequelae. It seems that the
virus replication ceases and the wart falls.
We then decided to look for an immune stimu-
lant capable of increasing the antibodies in the place
where the warts develop. The stimulus to antibody
formation at the place of the lesion allows their con-
tact with the antigen (HPV virus) with consequent for-
mation of specific antibodies which replicate and
spread to the body, destroying all other lesions.
Propionium bacterium parvum was already
used in order to increase the natural killer cells through
the release of interferon and tumor necrosis factor.
Propionium bacterium parvum is produced by
a French pharmaceutical laboratory as a stimulant vac-
cine and that is the reason we chose it for this research.
The double-blind randomized clinical study
allows the patient´s psychological influence on the
fall of the common warts to be ruled out and avoids
misinterpretation by the researchers.
The results obtained with this experience ena-
ble us to indicate the immune stimulant therapy as an
option in the treatment of common warts, having the
advantage of not leaving scarring sequelae and immu-
nizing indirectly to the type of virus found.
The immune modulator and immune stimulant
Propionium bacterium parvum produced a statisti-
cally significance response (P<0,001), with cure of
90% of the patients submitted to the therapy. The use
of immune stimulants is a proven indication in the
treatment of common warts, due to their high efficacy
and because they are a less aggressive method. q
Rua Curt Hering, 20 - Centro
8901030 Blumenau, SC
Sampaio SAP , Rivitti EA. Dermatologia Básica. 3 ed. São Paulo: Ed Artes Médicas;
2008. p. 565-7.
Verbov J. How to manage warts. Arch Dis Child. 1999;80:97-9.
Rodríguez C, Sánchez L, Minaya G, Vasquez J, Reymer D, Macher C. Tratamiento de
lãs verrugas vulgares em niños com la hemolinfa del insecto Epicauta sp. Dermatol.
Beliaeva TL. [The population incidence of warts]. Vestn Dermatol Venerol. 1990;2: 55-8.
Silverberg NB, Lim JK, Paller AS, Mancini AJ. Square acid immunotherapy for warts
in children. J Am Acad Dermatol. 2000;42:803- 8.
Siegfried EC. Warts on children: an approach to therapy. Pediatric Ann. 1996;25:79- 90.
Torrelo A. What`s new in treatment of viral warts in children. Pediatr Dermatol.
Santana CF, Asfora JJ, Lins LP , Lopes CAC, Santos ER. Efeitos imunoestimulantes do
Corynebacterium parvum em pacientes portadores de neoplasias malígnas. Rev Inst
Megid J, Dias Junior JG; Aguiar DM, Nardi Júnior G, Silva WB, Ribeiro MG.
Tratamento da papilomatose canina com Propionibacterium acnes. Arq Bras Med Vet
Kalis C, Gumenscheimer M, Freudenberg N, Tchaptchet S, Fejer G, Heit A, et al.
Requirement for TLR9 in the immunomodulatory activity of Propionibacterium acnes.
J Immunolol. 2005;174:4295-300.
Sljivic VS, Watson SR. The adjuvant effect of corynebecterium parvum: T cell
dependence of macrophage activation. J Exp Med. 1977;145:45-57.
Adlam C, Scott MT. Lymphoreticular stimulatory properties of Corynebacterium
parvum and related bacteria. J Med Microbiol. 1973;6:261-74.
Cantrell JL, Wheat RW. Antitumor activity and lymphoreticular stimulation properties
of fractions isolated from Corynebacterium parvum. Cancer Res. 1979;39:3554-63.
How to cite this article: Nasser N. Treatment of common warts with the Propionium bacterium parvum immune
stimulant. An Bras Dermatol. 2012;87(4):585-9.
TABLE 1: Result of the subcutaneous applications of the immune stimulant (Propionium bacterium parvum)
and placebo in common warts
BottlesCured warts Decreased wartsWarts with no change Total
* Fischer´s Exact Test - P<0,001
Treatment of common warts with the immune stimulant Propionium bacterium parvum 589