Cantharidin-Podophyllin-Salicylic Acid Formulation as a First-Line Treatment for Plantar Warts? A Case Report with Multiple Plantar Warts of Human Papillomavirus Biotype 27 and Previous Failed Treatments

Abstract

Patient: Female, 53-year-old Final Diagnosis: Plantar warts of human papillomavirus biotype 27 Symptoms: Pain Medication: — Clinical Procedure: Treatment of plantar warts Specialty: Podiatry Objective: Unusual clinical course Background: Plantar warts are benign skin tumors caused by the human papillomavirus (HPV). There are multiple treatments, but none ensure absolute success. Successful treatment depends on several factors, such as the location, number of lesions, HPV biotype, and the patient’s health condition. This report presents a 53-year-old woman who had multiple recalcitrant plantar warts with HPV biotype 27 that were treated using a cantharidin-podophyllin-salicylic acid (CPS) formulation after 2 failed treatments. Case Report: A 53-year-old woman was seen on October 25, 2021. She had 6 plantar warts due to HPV biotype 27, which was confirmed by polymerase chain reaction using a sample of hyperkeratosis scales obtained from the wart after debridement. Five cryotherapy sessions were applied, without clinical improvement. Two sessions of nitric-acid–zinc complex were then applied, from which the patient reported severe pain, without clinical improvement. Finally, 3 sessions of CPS formulation were applied, and the HPV remitted in all warts. Conclusions: Conservative treatments, such as cryotherapy, have not been effective in a case of multiple recalcitrant plan-tar warts. The combined action of the 3 compounds of CPS formulation was key in the resolution of this case. Plantar wart treatment should be easy to apply, effective, fast, and efficient. In cases of recalcitrant or numerous warts, treatment should be more aggressive from the beginning if the patient’s lifestyle allows it. It would be interesting to conduct randomized clinical trials to find out which patients could be indicated for the CPS formulation as a first line of treatment.

Cryotherapy versus topical nitric‐zinc complex solution for the treatment of plantar warts: A randomized controlled trial

“…Liquid nitrogen was applied using CryoPen b® (HO Equipments). CryoPen® is an instrument designed to directly apply N 2 in its liquid phase, capable of reaching temperatures as low as −89°C 19 . Following the removal of hyperkeratotic tissue, the gas was evaporated directly onto the treatment area, maintaining a distance of 0.5–4 mm from the wart and applying it at a 45° angle for 15 s. After 30 s, the gas was further applied to the wart's surface for an additional 15 s. Subsequently, the lesion was covered with a nonadherent dressing, and patients were instructed to keep it on for 24 h.…”

“…Verrutop ® is an aqueous solution containing organic acids (lactic, oxalic, and acetic acid), nitric acid, zinc, and copper salts. 19 Following scalpel debridement of the keratinized surface of the wart, the product was applied as follows: first, the ampoule (0.1 mL) of Verrutop ® was broken, and the solution was loaded into one of the applicators provided with the product. It was then applied by direct contact with small touches over the entire surface of the lesion.…”

Does HPV biotype influence the characteristics and evolution of plantar warts?

“…For this purpose, the center's medical records were reviewed and a record was made in an Excel spreadsheet (Microsoft® Excel® 365 MSO version 2309). All patients with clinical signs of plantar wart (hyperkeratosis, punctate bleeding on debriding of the hyperkeratotic tissue, alteration of the normal dermatoglyph or pain on lateral compression of the wart) [10][11][12] who had undergone a microbiological study by PCR test for HPV were selected. The protocol was approved by the medical ethics committee of the Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC) (protocol number 20/013-E).…”