John R. Tkach, M.D.
300 North Willson, Suite 203B
Bozeman, MT 59715
(406) 587-5442

Poison Ivy Extract Immunotherapy of Warts

Patient Information Sheet

Immunotherapy of warts with 1-chloro-2, 4-dintrochlorobenzine (DNCB) was invented around 1972 by Dr. Henry Lewis, my mentor. He trained me in its use. DNCB is the most powerful allergen. Rubbed onto the skin, it will induce contact dermatitis within a few days to weeks. When rubbed onto warts, the allergic skin reaction, rash, signals a release of cytokines, mediators of inflammation. Lymphocytes migrate into the wart, and the wart is killed sort of as an innocent bystander of the inflammatory reaction.

However, it does not have to be DNCB. If you are already have a skin-rash-type allergy to a topical agent such as nickel, neomycin, lanolin, poison ivy, poison oak, poison sumac, chromium, formaldehyde, benzocaine, rubber, or ethylenediamine, etc., that substance could be tried. If you are already allergic to something, perhaps we can make use of that.

Are you allergic to any substances that come into contact with your skin? ___________________

If yes, what have you had allergic skin rashes to? ___________________________________________________________________

I used DNCB immunotherapy for warts until about 1985. I never saw it fail. But I have also had good results with other topical allergens. DNCB is awkward to use. It has fallen out of favor. I do not know anyone who still uses it. Dibutyl Squaric Acid Ester (DBSAE) has replaced it.

Some people do not have any topical allergies. For them, we must induce an allergy. The part of the immune system that is supposed to do this job and cure warts is called cell-mediated immunity. If a person is not naturally allergic to a topically applied substance, we can artificially induce a cell-mediated allergy to DBSAE.

But, good news. Many, but not all, people are allergic to poison ivy. Poison ivy is a naturally occurring plant. The waxy or oily coating of the leaves contains a mixture of chemicals called Rhus Antigen. This material is not available in the U.S. pharmaceutical marketplace.

This treatment is not approved by the Food and Drug Administration. It is not banned, it's just that no drug company has put out the $7 million plus needed to satisfy the FDA.

In 2011, a man came to me who had had massive plantar warts (warts on the bottom of the feet) for 18 years. Many doctors had treated him with many forms of treatment including intralesional Bleomycin, a powerful injected anticancer drug which I would never use. All these treatments had failed. Fortunately, he was severely allergic to poison ivy, just like me. We went to the Bear Trap on the Madison River in August and carefully collected samples of poison ivy leaves and white poison ivy berries. Bozeman pharmacist John Griffith made an extract from the raw plant material. The patient applied it to his warts at bedtime nightly for about 4-6 weeks. His warts went away without problems. Surprisingly, it did not irritate his skin.

This treatment is different from using the single agent Rhus antigen 3-pentadecylcatechol (PDC)(1) used for patch testing. What we are using is a complex mixture of all the components of the poison ivy plant. That may explain why it works so well and so smoothly. In Korea, studies of the antigen urushiol showed 5 naturally occurring variations of the molecule(2) in poison ivy leaves.

My experiences with poison ivy immunotherapy of warts have caused me to wonder if there might be a direct toxic action on the wart. That's just speculation.

Over the next year, I treated 12 patients with poison ivy. A few were not allergic to poison ivy and we had to switch to BDSAE, which did work. Poison ivy is easier to use that DBSAE and seems much less irritating.

More about poison ivy and allergic contact dermatitis:

About 50% - 75% of U.S. adults are clinically sensitive to poison ivy(3). Well, that's quite a spread. Why? People who live in cities do not get exposed to much poison ivy and only about 20% are allergic to poison ivy, but they can become allergic. People who live in the countryside are more likely to be exposed to poison ivy. Overall, 10% to 15% of people are tolerant and do not react.

I did an exhaustive literature search and found no articles about treating warts with poison ivy.

The poison ivy extract I prescribe is made by pharmacist John Griffith using a 50%-50% solvent mixture of acetone (finger nail polish remover) and ethanol (booze). This solvent is flammable. Keep it away from fire, matches, candles, flames, heaters, stoves, and sunlight. Do not eat this medicine. This preparation requires a doctor's prescription.

What You Will Do:

I will give you a prescription for the poison ivy extract. The only place you can get it is Medical Arts Pharmacy (406) 587-4597, 1-800-499-5607) in the same building as my office. Use a Q-tip at bedtime, dip it into the poison ivy extract. Cautiously rub it in well onto the wart. Let it dry. Get a small soft drink bottle and dispose of the Q-tip in that bottle. If you touch the material to other areas, you will break out with poison ivy. Be careful. For plantar warts, cover your foot with a white cotton sock. For hand warts, cover your hand with a white cotton glove. Do not spill the poison ivy extract. Secure the bottle.

Usually the warts shrivel up over 1-2 months. Sometimes the treatment does not work. If you have a little itching, that's okay. It means you are having an allergic reaction which is what we want. If you get too much reaction or react in unwanted areas, use the prescription I gave you for fluocinonide ointment 4 times a day. It should clear up in 2-4 days. Wet the rash and rub in fluocinonide four times a day.

Regular Visits: You should come back to see me every 3-4 weeks until the wart is gone.

If the reaction is too severe, we can have the pharmacy dilute it down.

I have read this information on poison ivy immunotherapy of warts. I understand the complications and do agree to my using poison ivy immunotherapy of warts.

 


Date / Patient's Signature

Key words: warts, plantar warts, stubborn warts, immunotherapy, poison ivy, poison oak, poison sumac, Toxicodendron dermatitis, Rhus dermatitis, Rhus antigen, contact dermatitis, urushiol

1. Watson, E. Sue, Toxicodendron Hyposensitization Programs, Clinics in Dermatology, 4(2) April-June 1986:160-170.
2. Cheong (S>H>, et al, Polymerized Urusjiol of the Commercially Available Rhus Product in Korea.
3. Gladman, Aaron, Toxicodendron Dermatitis: Poison Ivy, Oak, Sumac, Wilderness and Environmental Medicine, 17, 120-128 (2006)

The information provided in these patient information sheets is offered for general informational and educational purposes only; it is not offered as and does not constitute medical advice. In no way are any of the materials presented meant to be a substitute for professional medical care or attention by a qualified practitioner, nor should they be construed as such.

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