The following study found that SADBE topical immunotherapy is a safe, effective option for home therapy of warts in children -“Squaric acid immunotherapy for warts in children (J Am Acad Dermatol. 2000 May;42(5 Pt 1):803-8).

BACKGROUND: Warts are a common pediatric skin infection caused by human papillomavirus (HPV). Spontaneous clearance of warts involves anti-HPV immunity, which may be enhanced by contact sensitizers. Squaric acid dibutylester (SADBE) is a nonmutagenic sensitizing agent useful for immunotherapy of alopecia areata.

OBJECTIVE: We hypothesized that SADBE home application might be effective therapy for warts.

METHODS: An open-label, retrospective study of 61 children with warts was performed. Sensitization with 2% SADBE on the forearm was followed with home application of 0.2% SADBE to warts 3 to 7 nights per week for at least 3 months.

RESULTS: Complete clearing occurred in 34 patients (58%), with a mean duration of therapy of 7 weeks. Partial clearing occurred in 11 (18%), and no response in 14 (24%). Clearance correlated with plantar distribution, wart duration under 2 years (P <.05), and first-line therapy with SADBE. Mild side effects occurred in one third of patients, were limited most commonly to mild erythema at the site of sensitization, and necessitated discontinuation of therapy in only 2 patients.

CONCLUSION: SADBE topical immunotherapy is a safe, effective option for home therapy of warts in children. PMID: 10775858

The following study found that topical immunotherapy with SADBE (squaric acid dibutylester) is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children -“Use of squaric acid dibutylester (SADBE) for cutaneous warts in children” (Pediatr Dermatol. 2000 Jul-Aug;17(4):315-8).

“We evaluated the efficacy of squaric acid dibutylester (SADBE) contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satisfied at least two of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or parent refusal to undergo destructive or surgical treatment. Excluded from the study were children with single warts or with flat warts located exclusively on the face and children less than 2 years of age.

Treatment consisted of twice weekly applications of serial dilutions of SADBE (0.03-3%) for no more than 10 weeks. Of the 148 children who completed the study, 124 (84%) showed complete clinical resolution with no significant side effects. Of those with total clinical resolution, 101 completed a 24-month follow-up with no relapses. Twenty-four (16%) children were nonrespondent. No apparent correlation between treatment response and age, gender, anatomic site, lesion type, or atopy was found.

Contact immunotherapy with SADBE is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children.” PMID: 10990585

We can compound squaric acid dibutylester into a topical solution in a variety of strengths.

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