Podophyllotoxin

How it works

It binds tubulin and arrests cell division in metaphase, causing necrosis of the wart tissue.

Prescribing in practice

• It is contraindicated in pregnancy because of potential toxicity, and effective contraception should be ensured in those who could become pregnant.
• Apply precisely to the wart, protecting surrounding healthy skin, and respect the limit on the area treated per application to reduce systemic absorption and local irritation.
• Treatment is given in cycles of several days followed by a rest period, repeated as directed; local irritation, erosion and soreness are common.

Monitoring

Review treated warts for response and the surrounding skin for irritation, and reassess if warts persist after the recommended cycles.

Counselling the patient

• Do not use if you are or might be pregnant.
• Apply only to the warts and protect the normal skin around them.
• Follow the treat-and-rest cycle exactly as instructed and expect some soreness.

Evidence & guidelines

Podophyllotoxin is a recognised patient-applied first-line treatment option for external anogenital warts in UK and dermatology guidance.