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THERAPEUTIC ROUND
Year : 2011  |  Volume : 56  |  Issue : 5  |  Page : 513-514
Plantar warts treated with topical adapalene


Senior Consultant Dermatologist, Indraprastha Apollo Hospital, New Delhi - 110074, India

Date of Web Publication4-Nov-2011

Correspondence Address:
Ramji Gupta
47-C Pocket B Sidharth Extention, New Delhi - 110 014
India
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DOI: 10.4103/0019-5154.87135

PMID: 22121266

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   Abstract 

Background: Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful. Purpose : The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts. Materials and Methods: A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts. Findings: Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene. Conclusion: Adapalene clears the plantar warts faster compared to other modalities available. Limitation: Need trial with large number of patients.


Keywords: Adapalene, occlusion, plantar warts, treatment


How to cite this article:
Gupta R. Plantar warts treated with topical adapalene. Indian J Dermatol 2011;56:513-4

How to cite this URL:
Gupta R. Plantar warts treated with topical adapalene. Indian J Dermatol [serial online] 2011 [cited 2014 Nov 23];56:513-4. Available from: http://www.e-ijd.org/text.asp?2011/56/5/513/87135



   Introduction Top


Various therapeutic measures used for treating plantar warts are not uniformly successful. Adapalene a naphthoic acid derivative with retinoid like activity is commonly used topically for the treatment of mild to moderate acne vulgaris. [1] It binds to sub-type Y retinoic acid receptors found predominantly in the epidermis [2] and modulate cellular differentiation. [3] It also exhibits anti-inflammatory and anti-keratinisation activity. [4] Recently, we have seen a female with 36 plantar warts of 2 months duration who was given adapalene with occlusive dressing. All warts cleared during the next 6 weeks with no recurrence during the next 1 year follow up. Subsequently, adapalene 0.1% gel was used topically with occlusion in 10 patient having 118 plantar warts with complete disappearance of the lesions in an average of 39±15.07 days.


   Materials and Methods Top


A 26-year-old female presented with multiple warts on her anterior part of left sole and 2 warts on her plantar surface of right big toe of 2 months duration. She was on topical adapalene 0.1% with occlusive dressing with polythene sheet 1 week. During the next 10 days, all warts started showing pigmentation. Adapalene occlusive dressing was continued with clearance of all the lesions during the next 21 days except one wart on each toe. Which also cleared during the next 21 days without any scar on the soles when adapalene was stopped. There was no recurrence of any wart during the next 1 year follow up. Subsequently, 10 patient with 118 plantar warts were included in this observational study. Diagnosis of plantar warts was made on clinical presentation. Before starting the treatment, informed consent was taken from all the patient and they were informed in details about the procedure. The patients who had systemic therapy in the past 8 weeks and pregnant women were excluded from the study. All topical treatments were stopped 2 weeks before entering into the study. All the patient who came were treated with adapalene gel 0.1% with occlusion. The treatment was continued till the clearance of all the warts.

The effect of the treatment was evaluated every week till the clearance of all warts, followed- by every month afterward.


   Results Top


Ten patient (M-7, F-3) having 118 warts were enrolled in this observational study. The mean age of the patient was 31.9 years and mean duration of the warts was 6.6 months. All warts disappeared in an average of 39 ± 15.07 days [Table 1]. There was no recurrence in the patient followed up for an average of 6.9 months.
Table 1: Details of patient treated with adapalene gel 0.1% with occlusion

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Thus, we found adapalene significantly effective in clearance of plantar warts. Compliances of the patient were also better.


   Side Effects Top


There was no side effect like irritation; erythema and scar formation seen in any patient.


   Discussion Top


In this observational study, topical adapalene aqueous gel 0.1% alone with occlusion was able to clear the plantar warts completely. Total time taken to clear the plantar warts was 39 ±15.07 days.

Various immuno-modulating agents used for treatment of warts include oral cimetidine [5] levamisole, [6] intralesional BCG vaccines, interferon, and imiquimod; [7] None is uniformly effective. The aim of using immuno-therapy is to hasten the development of cell-mediated immune response to HPV and clear the existing warts fast. In the present study, all the warts disappeared in about 6 weeks which clearly indicate the development of cell-mediated immunity against the wart virus. Gelmetti et al.[8] used etretinate orally in 20 children with good result. Choi et al.[9] used acitretin orally in an extensive and recalcitrant warts with complete clearance. Euvrard et al.[10] used topical retinoid in warts and keratoses in transplant recipient with good result.

In a comparative study by Parsad et al[5] cimetidine was able to clear lesion in 11 weeks in 31.5% of cases only whereas cimetidine + levamisole took 7.8 weeks. Imiquimod, an immune modulator was reported to clear the plantar warts when used with occlusion in 12 weeks. [7],[11] In conclusion adapalene seems to be an effective simple mode of therapy for treating plantar warts. However it needs to be tried in larger number of patient.

 
   References Top

1.Brogden RN, Goa KL. Adapalene, a review of its pharmacological properties and clinical potential in the management of mild to moderate acne. Drugs 1997;53:511-19.  Back to cited text no. 1
    
2.Bernard BA. Adapalene a new chemical entity with retinoid activity. Skin Pharmacol 1993;6:61-9.  Back to cited text no. 2
[PUBMED]    
3.Asselineau D, Cavey D, Shroot B, Dermon M. Control of epidermal differentiation by a retinoid analogue unable to cytosolic retinoic acid- binding proteins [CRABP]. J Invest Dermatol 1992;98;128-34.   Back to cited text no. 3
    
4.Hensby C, Cavy D, Bouclier M. The in vivo and in vitro anti-inflammatory activity of CD271: A new retinoid-like modulator of cell differentiation. Agents Actions 1990;29:56-8.  Back to cited text no. 4
    
5.Parsad D, Saini R, Negi KS. Comparison of combination of cimetidine and levamisole with cimetidine alone in the treatment of recalcitrant warts. Australas J Dermatol 1999;40:93-5.  Back to cited text no. 5
[PUBMED]  [FULLTEXT]  
6.Amer M, Tosson Z, Soliman A, Selim AG, Salem A, Al- Gendy AA. Verrucae treated by levamisol. Int J Dermatol 1991:30:738-40.  Back to cited text no. 6
    
7.Tucker SB, Ali A, Ransdell BL. Plantar wart treatment with combination imiquimod and salicylic acid pads-Case Reports. J Drug Dermatol, Jan, 2003.  Back to cited text no. 7
    
8.Gelmetti C, Cerri, Schiuma AA Menni S. Treatment of extensive warts with etretinate: A clinical trial in 20 children. Pediatr Dermatol 1987;4:254-8.  Back to cited text no. 8
    
9.Choi YL, Lee KJ, Kim WS, Lee DY, Lee JH, Lee ES, et al. Treatment of extensive and recalcitrant viral warts with acitretin. Int J Dermatol 2006;45:480-2.  Back to cited text no. 9
[PUBMED]  [FULLTEXT]  
10.Euvrard S, Verschoore M, Touraine JL, Dureau G, Cochat P, Czernielewski J, et al. Topical retinoids for warts and keratoses in transplant recipients. Lancet 1992;340:48-9.   Back to cited text no. 10
[PUBMED]  [FULLTEXT]  
11.Sparling JD, Cheketts SR, Chapman MS. Imiquimod for plantar and periungual warts. Cutis 2001;68:397-9.  Back to cited text no. 11
    



 
 
    Tables

  [Table 1]

This article has been cited by
1 British Association of Dermatologistsę guidelines for the management of cutaneous warts 2014
J.C. Sterling,S. Gibbs,S.S. Haque Hussain,M.F. Mohd Mustapa,S.E. Handfield-Jones
British Journal of Dermatology. 2014; : n/a
[Pubmed]



 

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    Abstract
   Introduction
    Materials and Me...
   Results
   Side Effects
   Discussion
    References
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