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Warts (plantar, heavily keratinized): Topical: Using a wooden applicator stick, apply the product sparingly (single layer only) to the wart and a 1-3 mm margin around the wart. Re-evaluate in 1-2 weeks; retreat in similar fashion if wart tissue remains. For large mosaic warts, treat a portion of the wart at a time; ≥3 treatments may be necessary.

Molluscum contagiosum: Topical (Canthacur-PS®): Apply thin film to each lesion then re-evaluate in 1 week. Treat new lesions in similar fashion; resistant lesions should be retreated and covered with occlusive tape for 6-8 hours then remove tape. Dosing: Pediatric Topical: Children ≥12 years: Refer to adult dosing. Dosing: Geriatric Refer to adult dosing. Dosing: Renal Impairment No dosage adjustment provided in manufacturer’s labeling. Dosing: Hepatic Impairment No dosage adjustment provided in manufacturer’s labeling. Dosage Forms: Canada Excipient information presented when available (limited, particularly for generics); consult specific product labeling. Liquid: Canthacur-PS®: Cantharidin 1%, podophyllin 5%, and salicylic acid 30% in a film-forming vehicle (7.5 mL) Cantharone® Plus: Cantharidin 1%, podophyllin 2%, and salicylic acid 30% in a film-forming vehicle (7.5 mL) Product Availability Not available in the U.S. Administration 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. 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 8-24 hours). Within 24 hours, a blister forms which is often painful and inflamed. Reevaluate in 1-2 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 retreatment. 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 retreatment is rarely necessary. Reevaluate in 4 weeks. Usual healing time is within 1-3 weeks. Apply a mild antimicrobial agent until treated area heals. Mild analgesics (eg, acetaminophen or aspirin with or without codeine) 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 10-15 minutes. If persistent pain, puncture blister then apply antimicrobial and cover with sterile dressing (eg, BAND-AID®). Use For removal of warts especially plantar, mosaic, and periungual; recommended for resistant and heavily keratinized warts; useful where painless application is desired. Canthacur-PS® is also indicated for removal of molluscum contagiosum. Adverse Reactions Significant Frequency not defined.

Mild analgesics (eg, acetaminophen or aspirin with or without codeine) 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 10-15 minutes. If persistent pain, puncture blister then apply antimicrobial and cover with sterile dressing (eg, BAND-AID®). Use For removal of warts especially plantar, mosaic, and periungual; recommended for resistant and heavily keratinized warts; useful where painless application is desired. Canthacur-PS® is also indicated for removal of molluscum contagiosum. Adverse Reactions Significant Frequency not defined. Dermatologic: Annular warts Local: Burning, extreme tenderness, pain, tingling Miscellaneous: Chemical lymphangitis Contraindications Hypersensitivity to any component of the formulation; use in diabetics or individuals with impaired peripheral circulation; use near eyes or on face or mucous membranes; in anogenital, intertriginous or axilla areas Canthacur-PS®: Additional contraindication: Ethanol consumption for several hours after treatment Warnings/Precautions

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. Pregnancy Implications Reports of podophyllin use in pregnant women have shown evidence of fetal abnormalities, fetal death, and stillbirth; use is not recommended. Lactation Excretion in breast milk unknown/not recommended Monitoring Parameters Treated areas for adequate healing; pain and tolerability of treatment International Brand Names Canthacur-PS (TR) Mechanism of Action 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. Use of UpToDate is subject to the Subscription and License Agreement . Topic 17053 Version 6.0 © 2013 UpToDate, Inc. All rights reserved. | Subscription and License Agreement | Release: 21.6- C21.56 Licensed to: AsanBook Dig. Med. Lib. | Support Tag: [1005-122.72.76.133-50E636C042-S244013.14]