Topical adapalene in the treatment of plantar warts; Randomized comparative open trial in comparison with cryo-therapy

Abstract

Background:Various therapeutic modalities, which are available for treating plantar wart, have not been successful every time.Aims:To evaluate topical adapalene under occlusion in the treatment of plantar warts and compare it with cryo-therapy.Materials and Methods:50 patients with 424 plantar warts were included in this single center, two arm, prospective, randomized, control, open study. Patients were allocated randomly into two groups consisting of 25 patients each. Group A patients having 299 plantar warts were treated using adapalene gel 0.1% under occlusion while Group B patients having 125 warts were treated using cryo-therapy. All the patients were evaluated weekly till the clearance of all the warts and the results compared.Result:All the warts of 25 patients of Group A that were treated using adapalene gel 0.1% cleared in 36.71 ± 19.24 (55.95-17.47) days except those in one patient. In Group B, warts in all except one treated by cryo-therapy cleared in 52.17 ± 30.06 (82.23-22.11) days. There were no side effects like scar formation, irritation, erythema, or infections with adapalene group while in the cryo group scar was seen in 2 patients, pain in 24, erythema in 10, and infection in 3 patients.Conclusion:Adapalene gel 0.1% under occlusion is an effective, safe and easy to use treatment for plantar warts and may help clear lesions faster than cryo-therapy.

Recent Advances Regarding the Therapeutic Potential of Adapalene

“…Other results revealed the efficacy and safety of 0.1% ADP gel in combination with mometasone furoate 0.1% cream for alopecia areata treatment [ 20 ]. In addition, 0.1% ADP gel is a safe [ 18 ] treatment for plantar warts and may help eliminate lesions faster than cryotherapy or other modalities available [ 19 ]. The 0.3% ADP has been recommended as an effective and safe treatment in Chilean women with cutaneous photoaging [ 21 ].…”

“…Numerous reviews have been focused on ADP and comparative studies of retinoids [ 1 , 3 , 5 , 10 , 11 , 12 , 13 , 14 , 15 ]. Due to favorable clinical observations, ADP is increasingly used off-label as in the treatment of lichen spinulosus [ 16 ], childhood acanthosis nigricans [ 17 ], plantar warts [ 18 , 19 ], alopecia areata [ 20 ], and many other conditions which will be addressed in an individual section of this review.…”

Occlusion therapy in inflammatory cutaneous diseases

“…Most of the authors changed dressings on the seventh day, evaluated clinical condition, and some biopsied the lesions for pathology and/or immunohistology/immunoreactivity/electron microscopy as per their pre-defined protocol. Gupta & Gupta, 2015 utilized plastic wraps for occluding adapalene 0.1% gel on plantar warts till clearance (Table 1). "Prolonged occlusive" treatment has been contrasted with the more common "occlusive therapy with a plastic wrap" that simply increases absorption of topical corticosteroids (or topical medication), and usually lasts only a few hours (Thomsen, 1997).…”

“…Then the authors used 0.1% mometasone furoate under occlusion for 2 weeks which led to complete resolution and efficacy was present up to 3 months follow up. Gupta & Gupta, 2015 In this nonrandomized study, topical adapalene 0.1% gel under occlusion with plastic wraps was compared with cryotherapy with N 2 O gas at −94 C. The patients were followed for 6 months postclearance. Though all patients (except one) cleared in both groups, time to clear was significantly less in adapalene group (36.71 days) versus cryotherapy group (52.17 days).…”

EFFICACY OF ORAL ZINC SULPHATE VERSUS TOPICAL APPLICATION OF SALICYLIC ACID (16.7%) & LACTIC ACID (16.7%) COMBINATION IN THE TREATMENT OF PLANTAR WARTS

“…their natural course usually being shorter in children than adults, although resolution may take several years. The treatment of PW has involved several different modes, including ablative therapy and other options that modify the immune response 7,8 . The topical application of salicylic and lactic acid combination in a collodion is a common form of treatment with once daily application.…”