• Knowledgebase: Information on Specific Illnesses

    Here you will find discussions of specific illnesses and their management.

    9. What Medicines Can Help Warts Go Away? - Top

    This article from Dermatology Times discusses some medicines that are being used to treat warts sometimes:

    Wart Tx in need of more research.
    Author/s: Andrew Bowser
    Issue: April, 2001

    New York -- While immunomodulatory therapies represent an alternative to more commonly used and painful destructive modalities for warts and molluscum, questions of cost and observations of variable clinical success illustrate the need for more thorough research, Helen T. Shin, M.D., said.

    "Placebo-controlled studies with larger numbers of pediatric subjects are needed to prove the efficacy of these immunomodulatory therapies," said Dr. Shin, a pediatric dermatology fellow at the NYU School of Medicine.

    Three of the most popular effective treatments are cimetidine (Tagamet), imiquimod (Aldara), and squaric acid dibutyl ester (SADBE). Although the exact mechanism of action is not known, these therapies are thought to enhance the immune system to help eradicate human papilloma virus and poxvirus.

    SADBE, a potent topical sensitizer, works by inducing a type IV hypersensitivity reaction, enhancing spontaneous regression of warts. It has been used for wart treatment in adults, and was safe for long-term treatment of children in studies of alopecia areata.

    Micali et al. (Pediatr Dermatol 2000;17:315-318) reported on 148 children age 2 to 16 initially sensitized with 3 percent SADBE and then treated with SADBE 0.3 percent to 3 percent twice weekly, until clinical resolution or until 10 weeks of therapy had been administered. To optimize penetration, 70 percent salicylic acid in Vaseline was applied two days prior to therapy.

    Complete clearance was seen in 124 children (84 percent), and at 24 months 101 of these children had not had a recurrence. The authors suggested this resolution rate, higher than in previous studies, was due to higher dosing and frequency.

    Since twice-weekly visits to the clinic would be onerous for many parents, Silverberg et al. (JAAD, 2000;42:803-808) looked at home application three to seven nights per week (after initial sensitization). This open label, retrospective analysis included 61 children with warts. Complete clearing was seen in 35 children (58 percent) and partial clearing in 11 (18 percent).

    Cimetidine, a type 2 histamine receptor antagonist that has been shown to augment cell-mediated immunity, is not approved for children under 16 years but can be used safely in children for mastocytosis and suppression of gastric acid secretion at doses of 30 to 40 mg/kg/day. Side effects, which are rare, include diarrhea, nausea and vomiting, and gynecomastia.

    In open label studies of warts, complete clearance rates of more than 80 percent were seen, though placebo controlled studies have yielded markedly lower success rates of up to 37 percent.

    Efficacy examined

    A group from St. Louis recently reported on a double-blind trial including 46 patients at least 16 years of age randomized to cimetidine 2,400 mg/day (22 to 46 mg/kg/day) or placebo for 12 weeks. Though there was a trend toward efficacy in younger subjects, efficacy was not statistically superior to placebo. The complete response rate was 26 percent for active treatment and 21 percent for placebo (Rogers CJ et al., JAAD, 1999;41:123-127).

    Variable success has been seen with cimetidine used for molluscum. Dohil and Prendiville reported (Pediatric Dermatol 1996;13:310-312) on 13 patients given a two month course at 40 mg/kg/day. Nine had complete clearance.

    In practice, patients with warts or molluscum can be started at a dose of 40mg/kg/day, according to Dr. Shin. If lesions respond, therapy can be continued until all lesions are cleared. However, if after two months there is no response, therapy should be discontinued.

    While imiquimod is FDA-approved for anogenital warts in adults, efficacy has been suggested in extragenital cutaneous warts as well. Hengge et al. (Ann Intern Med 2000; 132:95) reported that, in an open label trial, 50 percent or greater reduction in wart size was seen among 28 out of 50 patients with warts treated for a mean of 9.5 weeks; about half had complete clearance. Fifteen molluscum patients were also treated; eight had complete clearance and another four had at least 50 percent reduction in wart size. The only recurrence reported was in a patient with molluscum after 16 week follow-up.

    COPYRIGHT 2001 Advanstar Communications, Inc.

    COPYRIGHT 2001 Gale Group
    - Updated: September 25, 2002

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