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Topical cidofovir for the treatment of plantar warts: case report
Amelia Troncoso, Ramon Cuiña, Juliana Alvarez, Cristina Vazquez, Maria Teresa Inaraja, Francisco Allegue
Pharmacy, Hospital Meixoerio, Dermatology, Hospital Meixoeiro, Vigo, Spain
Background and Objective: Plantar warts are hyperkeratotic lesions on the plantar surface caused by infection with Human papillomavirus. Lesions caused by warts are commonly refractory to therapy and may become large and painful in immunodeficient patients. Cidofovir is a cytidine analogue with activity against a broad spectrum of DNA viruses. It is indicated for the treatment of cytomegalovirus retinitis in patients with acquired immunodeficiency syndrome and without renal dysfunction. We describe a case of plantar warts that was treated with topical cidofovir in a highly immunodeficient patient.
Results: A 29 years old woman, who received kidney transplant in 1996, presenting plantar warts refractory to conventional therapy since last four years. She was treated with topical 3% cidofovir cream twice daily. The treatment was authorised as compassionate use by the national regulatory agency on drugs. The glomerular filtration rate (GFR) was monitored in order to detect nephrotoxicity due to cidofovir.
The 3% cidofovir ointment was compounded as follows:
– Cidofovir 75 mg/ml 5 ml vial .…….. 20 ml
– Anhydrous Lanolin ……………………….. 5 g
– Beeler base …..sufficient to produce 50 g
It was packaged and labelled in a light-resistant containers and we assumed an expiration date of 3 months based on the duration of treatment and published studies. The quality controls of organoléptics properties were made according to the Good Manufacturing Practice (GMP)
After 10 weeks of therapy the patient did not show any improvement and developed severe local erosion, so treatment with cidofovir was withdrawn. Two weeks later this local erosion disappeared spontaneously. No systemic side effects were observed. The colour, texture and smell organoleptics characters were complied with GMPs.
Conclusions: There are not formal studies of optimal formulations or treatment regimens and further studies are needed to elucidate the role of cidofovir in treatment of plantar warts. The immunodeficiency of the patient and the large wart area could be related with the failure to the treatment.
Reference Alonso Diez M, de Miguel Cascón M, Sánchez Moreno H, González Mielgo FJ. Cidofovir tópico para tratamiento de lesiones cutáneas por Molluscum contagiosum y Papilomavirus humano. XLIV SEFH Congress.1999; 156–57
