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PubMed1990

Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation.

Four hundred and fifty patients were enrolled into a randomised clinical trial in a public sexually transmitted diseases clinic to evaluate the efficacy of podophyllin, cryotherapy, and electrodesiccation for treatment of external genital warts. Complete clearance of warts was observed in 41%, 79%, and 94% of patients who received up to six weekly treatments of podophyllin, cryotherapy, and electrodesiccation, respectively. Relapses occurred in 25% of all patients, yielding 3 month clearance rates of 17%, 55%, and 71% for podophyllin, cryotherapy, and electrodesiccation, respectively. Wart volume and duration did not influence treatment outcome. Response to therapy was greater in women than in men, and did not differ by treatment modality. Electrodesiccation and cryotherapy were more effective than podophyllin for the treatment of external genital warts, but none of these three treatments were highly successful.

Adult↗
PubMed1996

Acute necrotizing myopathy and podophyllin toxicity. Report of a fatal case.

A 21 year old male ingested podophyllin in a suicide attempt. The disorder was marked by seizures, coma, peripheral neuropathy, renal failure and acute necrotizing myopathy, an unusual finding. The coma and systemic disturbances resolved within three weeks. The myopathy resolved in 7 weeks, demonstrating a high capacity of muscle recuperation. The sensorimotor peripheral neuropathy persisted until the patient's death 9 weeks after the ingestion, due to septicemia. This report confirms the transient central neurotoxicity of podophyllin and persistent peripheral neurotoxicity of podophyllin, and describes a reversible necrotizing myopathy associated to mitochondrial abnormalities, a still unreported feature of podophyllin toxicity.

Adult↗
PubMedDate not supplied

Combination therapy with podophyllin and vidarabine for human papillomavirus positive cervical intraepithelial neoplasia.

Our aim was to establish an effective non-surgical treatment for cervical intraepithelial neoplasia (CIN) through inactivation of human papillomavirus (HPV), the major etiological agent for this disease. We show that vidarabine, a DNA polymerase inhibitor, suppressed growth and HPV gene expression in human cervical keratinocytes immortalized by HPV or in cervical cancer cell lines. Expression of HPV-16 E6 and E7 proteins in normal cervical keratinocytes sensitized cells to apoptosis in the presence of podophyllin or vidarabine. We applied vidarabine ointment and/or podophyllin to cervical epithelium in 28 cases of CIN I-II to evaluate the therapeutic effectiveness of these agents. Co-application of vidarabine and podophyllin in six treatments caused regression of lesions cytologically and histologically, and disappearance of HPV-16 or -18 DNA in 17 of 21 (81%) women. Our results suggest that the combination of vidarabine and podophyllin therapy is an effective non-surgical treatment for HPV-positive CIN.

Adult↗
PubMed1987

Self-application of podophyllin resin for penile condylomata acuminata.

Two methods of podophyllin application, namely hospital-application (regimen A) and self-application (regimen B) of 25% podophyllin in tincture of benzoin compound for the treatment of penile condylomata were compared. The objective was to compare the response and safety of self-application with traditional hospital-application. A total of 100 men were selected, of which 64 were valid for evaluation of response. At six weeks' follow-up 66% and 72% of patients treated with regimen A and B, respectively were cured. Patients treated with regimen A were less compliant making only 58% of the required number of applications as compared with those treated with regimen B who made 92% of the applications. Of the patients successfully treated, 43% and 20% of those treated with regimens A and B, respectively were cured after only one or two applications (p greater than 0.1). Three patients--two treated with regimen A and one treated with regimen B suffered local reactions to the first application of podophyllin. All these patients recovered without sequelae. Self-application of podophyllin can therefore be used safely and effectively in selected men with penile condyloma acuminata.

Administration, Topical↗
PubMed2003

Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts.

OBJECTIVES: To evaluate the efficacy and cost effectiveness of self applied podophyllotoxin 0.5% solution and podophyllotoxin 0.15% cream, compared to clinic applied 25% podophyllin in the treatment of genital warts over 4 weeks. METHODS: We conducted a randomised controlled trial in 358 immunocompetent men and women with genital warts of 3 months' duration or less. RESULTS: In the principal analysis both podophyllotoxin solution (OR 2.93, 95% CI 1.56 to 5.50) and podophyllotoxin cream (OR 1.97, 95% CI 1.04 to 3.70) were associated with significantly increased odds of remission of all warts compared to podophyllin. We performed two further analyses. When subjects defaulting from follow up were assumed to have been cured odds of remission of all warts were also significantly increased both for podophyllotoxin solution (OR 3.04, 95% CI 1.68 to 5.49) and for podophyllotoxin cream (OR 2.46, 95% CI 1.38 to 4.40). When subjects defaulting from follow up were assumed not to have been cured odds of remission of all warts were significantly increased for podophyllotoxin solution (OR 1.92, 95% CI 1.13 to 3.27), but not for podophyllotoxin cream (OR 1.17, 95% CI 0.69 to 2.00). Local side effects were seen in 24% of subjects, and recurrence of warts within 12 weeks of study entry in 43% of all initially cleared subjects, without statistically significant differences between the treatment groups. Direct, indirect, and total costs were similar across the three treatment groups. Podophyllotoxin solution was the most cost effective treatment, followed by podophyllotoxin cream, with podophyllin treatment being the least cost effective. CONCLUSIONS: Self treatment of anogenital warts with podophyllotoxin showed greater efficacy and cost effectiveness than clinic based treatment with podophyllin.

Adolescent↗
PubMed2001

Condyloma eradication: self-therapy with 0.15-0.5% podophyllotoxin versus 20-25% podophyllin preparations--an integrated safety assessment.

Topical application of podophyllin solution, long considered the therapy of first choice against condylomata acuminata, can no longer be recommended due to its low efficacy and gross toxicity. Self-treatment with 0.15-0.5% purified podophyllotoxin preparations, applied twice daily for 3 days, is now advocated as the alternative first-line therapy of choice, when significant improvement is conveniently, and cost-effectively, accomplished within a few weeks. This review provides a summary of the comparative efficacy and utility of podophyllin versus podophyllotoxin as well as a compilation of in vivo and in vitro safety evaluations. In light of overwhelming safety and efficacy data in favor of podophyllotoxin-derived products, it is concluded that podophyllin preparations have no place in the modern treatment portfolio for anogenital warts.

Administration, Topical↗
PubMed1985

Oxidized sterols inhibit the formation of podophyllin-induced metaphase figures in mouse vaginal epithelia.

The antimitotic activity of oxidized derivatives of cholesterol was investigated using an assay developed by Van Scott and Bonder. In this assay, a drug that has antimitotic activity and is not a metaphase-blocking agent will inhibit the formation of podophyllin-induced metaphase figures, as counted on histologic specimens. Mouse vaginal epithelia were classified as being estrogen or progesterone predominant on the basis of histologic criteria. Podophyllin-injected mice in the estrogenic phase of the estrus cycle demonstrated high metaphase-figure counts, with an average of 284.86 +/- 132.01. In this group, all intravaginally administered compounds, inhibited the formation of metaphase figures, including a propylene-glycol ethanol vehicle (60% suppression); thus, it is concluded that animals in this phase are not a suitable model for assaying antimitotic activity. Mice in the progesterone-predominant phase of the estrus cycle had lower counts of podophyllin-induced metaphase figures, i.e., 142.13 +/- 39.29. In this group, 25-OH-cholesterol was the most effective inhibitor (59% suppression), followed by 7-ketocholesterol (48% suppression) and methotrexate (40% suppression). Cholesterol (5% suppression) and vehicle (20% suppression) did not have any significant effects. Progesterone-predominant epithelium was only susceptible to methotrexate and oxidized sterols. This suggests that oxidized sterols may have antimitotic activity.

Animals↗
PubMed1985

Comparison of podophyllin application with simple surgical excision in clearance and recurrence of perianal condylomata acuminata.

60 patients with first-episode perianal condylomata acuminata were randomly assigned to podophyllin application or surgical excision. 58% of the male patients were homosexual and 33% of the female patients regularly had anal intercourse. Podophyllin completely cleared warts from 23 of 30 (76.6%) patients compared with 28 of 30 (93.3%) for surgical excision. After wart clearance the cumulative recurrence rates were 18% for surgical excision and 43% for podophyllin at 3 months (p less than 0.05), 22% and 56% at 6 months (p less than 0.01), 26% and 56% at 9 months (p less than 0.01), and 29% and 65% at 12 months (p less than 0.01). All patients were treated as outpatients and all surgical procedures were carried out under local anaesthesia. Both regimens were well tolerated.

Adolescent↗
PubMed1981

Podophyllin 10% and 25% in the treatment of ano-genital warts. A comparative double-blind study.

One hundred and forty male patients with ano-genital warts were randomly allocated to a double-blind study of 10% and 25% podophyllin in tincture of benzoin compound. One hundred and nine patients attended for a three-month period of surveillance. Only 24 (22%) patients were free of warts after having podophyllin treatment alone, 12 each after treatment with 10% and 25% podophyllin. There was no significant difference in the number of applications needed with each treatment. Neither hypersensitivity nor chemical ulceration occurred.

Anus Diseases↗
PubMed1991

A comparison of interferon alfa-2a and podophyllin in the treatment of primary condylomata acuminata. The Condylomata International Collaborative Study Group.

OBJECTIVES: to compare the response to treatment and recurrence rate of condylomata accuminata using subcutaneous injection of interferon alfa 2a 1.5 million units three times weekly for four weeks, or podophyllin resin 25% applied to lesions twice weekly for up to six weeks. DESIGN: Randomised open study. SETTING: Multicentre European study in genitourinary medicine, dermatovenereology, and gynaecology departments. PATIENTS: 87 males and 67 females with condylomata acuminata for less than six months and no history of previous treatment. MAIN OUTCOME MEASURES: Complete clearance of lesions and evidence of recurrence at three months and nine months after treatment commenced. RESULTS: A complete response was achieved at three months in 15 of 64 (23%) in the interferon treated group, and 31 of 69 (45%) in the podophyllin treated group (p = 0.003). At nine months 10 of 13 patients in the interferon group and 22 of 30 patients in the podophyllin group remained completely clear of lesions.

Administration, Topical↗
PubMed1982

Neurologic manifestations of podophyllin toxicity.

A young woman presented with podophyllin intoxication following topical application of podophyllin resin to genital condylomata acuminata. The disorder was marked by hallucinatory psychosis, bone marrow depression, and mild hepatic dysfunction. The psychosis and systemic disturbances resolved within 3 weeks, but were followed by autonomic and sensorimotor peripheral neuropathy. This case illustrates the transient central neurotoxicity and persistent peripheral neurotoxicity of podophyllin.

Adult↗
PubMed1983

The use of podophyllin in the treatment of keratoacanthoma.

Keratoacanthoma can be treated successfully with podophyllin, which has been used in cutaneous tumors for well over a century and has been in use for a much longer time. Podophyllin is useful alone, with cautery and curettage, or with radiotherapy.

Adult↗
PubMed2001

Podophyllin office therapy against condyloma should be abandoned.

Podophyllin, a crude plant extract with low efficacy, high toxicity, and a serious mutagenicity profile does not comply with the WHO guidelines for plant derived treatments and should be removed from clinical treatment protocols. Home treatment with pharmaceutical products based on podophyllotoxin-the purified, standardised active antiwart ingredient of podophyllin-represents safe and effective first line therapy for patients with anogenital warts.

Condylomata Acuminata↗
PubMed1981

Delirium induced by topical application of podophyllin: a case report.

The authors describe a patient who developed delirium secondary to the topical absorption of podophyllin; this may be the first known case of delirium after topical application of the drug. Other serious medical and neurological complications of podophyllin poisoning are also discussed.

Administration, Topical↗
PubMed1990

Accidental poisoning with podophyllin.

Podophyllin is available without prescription and is commonly used in the topical treatment of warts. We describe a case of accidental ingestion of podophyllin, mistaken for cough linctus, and its resultant toxicity.

Humans↗
PubMed1984

Coma and neuropathy after ingestion of herbal laxative containing podophyllin.

A case of poisoning caused by an excessive dose of herbal laxative tablets is reported. The patient's symptoms included coma and prolonged peripheral neuropathy. The clinical features were characteristic of podophyllin poisoning. Podophyllin was a component of the laxative tablets, but the container gave no indication of their potential toxicity. Methods of reducing the risk of inadvertent poisoning by herbal remedies are suggested.

Adult↗
PubMed1991

[Accidental poisoning with podophyllin: a case with study of peripheral nerve].

A 53 year-old veterinary surgeon accidentally ingested 0.8 g of podophyllin. Twelve hours later, he was deeply comatose, with clinical and EMG signs of extensive axonal sensorimotor and autonomic peripheral neuropathy. In addition, transient bone marrow and hepatic toxicity occurred. The coma lasted 2 weeks. Systemic and neurological disturbances started to improve at 3 months post-onset, but the patient died four months later from gastro-intestinal bleeding. Sural nerve biopsy showed loss of myelinated fibers and signs of axonal degeneration with type E teased fibers. The cytoplasm of Schwann and endothelial cells was vacuolated and swelled. Diffuse interstitial aedema was noted. Podophyllin acts as a spindle poison, binds microtubular proteins and inhibits axoplasmic flow.

Accidents↗