Version May 2024
Note: Applied by physician only. Treatment should be initiated on 1 to 2 lesions until sensitivity to treatment is established. Refer to Administration for detailed application information.
Warts (plantar, heavily keratinized): Topical: Using a wooden applicator stick, apply the product sparingly (single layer only) to the wart and a 1 to 3 mm margin around the wart. Re-evaluate in 1 to 2 weeks; re-treat in similar fashion if wart tissue remains. For large mosaic warts, treat a portion of the wart at a time.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
Warts (plantar, heavily keratinized): Topical: Children ≥12 years: Refer to adult dosing.
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
The following adverse drug reactions are derived from product labeling unless otherwise specified.
Postmarketing:
Dermatologic: Burning sensation of skin (Nguyen 2019), cicatrix of skin (Nguyen 2019), dyschromia (Nguyen 2019), pruritus (Nguyen 2019), skin blister (Nguyen 2019)
Local: Local irritation (Nguyen 2019), local pain (Nguyen 2019), localized erythema (Nguyen 2019)
Use in diabetic patients or individuals with impaired peripheral circulation; use near eyes or on face or mucous membranes; in anogenital, intertriginous or axilla areas.
Concerns related to adverse effects:
• Dermatologic: Strong vesicant that may cause blistering of normal skin or mucous membranes; reactions may be more severe in patients with fair complexion and/or blue eyes. Do not apply to irritated or inflamed skin. Residual pigmentation has been reported (rarely) with use.
Special populations:
• Children: Avoid use in young children (<12 years of age); pain management may be difficult in this population.
Other warnings/precautions:
• Appropriate personnel: Should be applied only by a physician; not recommended for dispensing to patient.
• Appropriate use: For external use only; may be fatal if ingested. Not for use in the eyes, on face, or mucous membranes, birthmarks or moles, warts with hair growth, or anogenital area. Do not reapply to the same lesion >1 time per week. Avoid treating large areas with 1 application as this may increase systemic absorption and cause excessive discomfort. Do not use in combination with other chemical wart therapies.
Not available in the US
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Liquid, External:
Cantharone Plus: Cantharidin 1%, podophyllin 2%, and salicylic acid 30% (1.5 mL, 7.5 mL) [contains alcohol, usp]
Topical: Shake well prior to use. For external use only; may be fatal if ingested. Not for use in or near the eyes, on face or mucous membranes, birthmarks or moles, warts with hair growth, or anogenital area. Do not apply to inflamed or irritated skin. Avoid treating large areas with 1 application as this may increase systemic absorption and cause excessive discomfort. If contact with healthy skin, wipe off with acetone, alcohol, or tape remover, then wash area with warm soapy water and thoroughly rinse. If contact with mucous membranes or eyes, flush with water, remove precipitated film, then flush with water for additional 15 minutes. Use a mild antibacterial cleanser until area has healed.
Method A (no curettage): No cutting or prior treatment is required. Occasionally, nails must be trimmed to expose subungual warts to medication. Using a wooden applicator stick or cotton swab, apply to lesion(s). Allow to dry for a few minutes. Cover with a piece of nonporous plastic adhesive tape for at least 4 hours (up to 8 to 24 hours). Within 24 hours, a blister forms which is often painful and inflamed. Reevaluate in 1 to 2 weeks. During this period the patient may or may not do periodic soaks as preferred by physician. Remove necrotic tissue and treat as before if any viable wart tissue remains. Allow tissue to re-epithelialize before re-treatment.
Method B (with curettage): Proceed as in Method A except have patient return in 1 day for curettage. Local anesthesia may be necessary. Treatment with this method (next day curettage) enhances identification of tissue planes, increases separability of wart tissue, and re-treatment is rarely necessary. Reevaluate in 4 weeks. Usual healing time is within 1 to 3 weeks.
Mild analgesics may be necessary. To minimize pain after application, bandage should be removed shortly after symptom onset and after allowing sufficient time for absorption, and (if needed) the area then soaked in cool water for 10 to 15 minutes. If persistent pain, puncture blister then apply antimicrobial and cover with sterile dressing (eg, BAND-AID).
Topical: For external use only; may be fatal if ingested. Not for use in or near the eyes, on face or mucous membranes, birthmarks or moles, warts with hair growth, or anogenital area. Shake well prior to use. Do not apply to inflamed or irritated skin. Avoid treating large areas with 1 application as this may increase systemic absorption and cause excessive discomfort. If contact with healthy skin, wipe off with acetone, alcohol, or tape remover, then wash area with warm soapy water and thoroughly rinse. If contact with mucous membranes or eyes, flush with water, remove precipitated film, then flush with water for additional 15 minutes.
No curettage method: No cutting or prior treatment is required. Occasionally, nails must be trimmed to expose subungual warts to medication. Using a wooden applicator stick or cotton swab, apply to lesion(s). Allow to dry for a few minutes. Cover with a piece of nonporous plastic adhesive tape for at least 4 hours (up to 8 to 24 hours). Within 24 hours, a blister forms which is often painful and inflamed. Reevaluate in 1 to 2 weeks. During this period the patient may or may not do periodic soaks as preferred by physician. Remove necrotic tissue and treat as before if any viable wart tissue remains. Allow tissue to re-epithelialize before re-treatment.
Curettage method: Proceed as in no curettage except have patient return in 1 day for curettage. Local anesthesia may be necessary. Treatment with this method (next day curettage) enhances identification of tissue planes, increases separability of wart tissue, and re-treatment is rarely necessary. Reevaluate in 4 weeks. Usual healing time is within 1 to 3 weeks. Apply a mild antimicrobial agent until treated area heals.
Mild analgesics (eg, acetaminophen or aspirin) may be necessary. To minimize pain after application, bandage should be removed shortly after symptom onset and after allowing sufficient time for absorption, and (if needed) the area then soaked in cool water for 10 to 15 minutes. If persistent pain, puncture blister then apply antimicrobial and cover with sterile bandage.
Note: Not approved in the United States.
Warts (plantar, heavily keratinized): Removal of warts, especially plantar and periungual and resistant and heavily keratinized warts; useful where painless application is desired.
KIDs List: Salicylates, when used in pediatric patients <18 years of age with suspicion of viral illness (influenza, chickenpox), are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be used with caution due to risk of Reye syndrome (weak recommendation; very low quality of evidence) (PPA [Meyers 2020]).
Reports of podophyllin use in pregnant women have shown evidence of fetal abnormalities, fetal death, and stillbirth; use is not recommended.
Treated areas for adequate healing; pain and tolerability of treatment
Salicylic acid is a keratolytic that produces desquamation of hyperkeratotic epithelium via dissolution of the intercellular cement which causes the cornified tissue to swell, soften, macerate, and desquamate. Podophyllin directly affects epithelial cell metabolism by arresting mitosis through binding to a protein subunit of spindle microtubules (tubulin). Cantharidin is a vesicant thought to cause wart exfoliation via its acantholytic actions.
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