Podophyllin On Genital Warts:

PROCEDURE:

VIVA QUESTIONS:

Q#1🔲What is the causative organism of anogenital warts?

HPV types 6 and 11

Q#2🔲Mode of transmission other than sexual?

HPV is spread by direct skin-to-skin contact or any other contact involving the genital area (eg, hand-to-genital contact), also vertical transmission

Q#3🔲How to treat genital warts?

Various options to treat genital warts..

➡️Medical treatments —

🔸Podophyllin 0.15% twice daily for 3 days in a week for 4 weeks

🔸trichloroacetic acid 

 🔸Imiquimod 5% or 3.75% 3 times per week for 16 weeks

🔸interferon

➡️Surgical treatment —

🔸Cryotherapy (only therapy that is safe in pregnancy)

🔸Electrocautery

🔸Excision using Anaesthesia

🔸PDT

🔸Laser

Q#4🔲

GENITAL WARTS FOLLOW-UP…

Patient should be asked to come for follow up visits as ordered by physician and for next 3 – 6months after treatment as most of the warts come back within this time period..

Q#5🔲 GENITAL WARTS PREVENTION?

HPV vaccine — Two vaccines, quadrivalent (commercial name Gardasil) and 9-valent (commercial name Gardasil 9), are available for prevention of genital warts.

Q#6🔲MECHANISM OF ACTION of Podophyllin?

🟠*Mechanism of Action*

▪️It inhibits the formation of microtubules.

◾️It also suppresses cellular nucleoside transport.

◾️Cause  the arrest of cells in metaphase of the cell cycle hence causes reduced cell division

Q#7🔲 How will we prepare the solution?

Podophyllin resin 25% topical solution USP prepared by mixing 25 grams of podophyllin resin in alcohol +10 grams of the alcohol-soluble extract of benzoin and finally Add alcohol to make 100 ml.

Q#8🔲 Commercially available preparations??

🟠Preparations Available in Pakistan are

🔸Podophyllin 25% solution in tincture benzoin

🔸25% podophyllin ointment

Or 🔸podophyllin 25gm in 100ml of tincture benzoin

Or Podophyllin [Cream 0.15 %w/w]

Brand Name:

WARTEC  

GLAXOSMITHKLINE  

Price /810

Other preparations used worldwide are:

🔸Podofilox 0.5% gel.

🔸Cantharidin 1%, podophyllin 2%, salicylic acid 30% (CPS1) solution.

Q#9🔲 Indications for the use of podophyllin??

*Clinical Uses*

🟠Presently, podophyllin  is used successfully for the topical treatment of anogenital warts. However, only Podofilox 0.5% gel has received FDA approval to be used in the treatment of anogenital warts.

🟠*List of various dermatoses where Podophyllin has been used*

🔸*Viral Infections*

Condyloma acuminata

Verruca vulgaris

Plantar and periungual warts

Molluscum contagiosum

🔸*Fungal Infections*       

Tinea capitis

🔸*Benign Dermatoses*

Acanthosis nigricans

Black hairy tongue

Contact dermatitis

Lichen simplex chronicus

Pyogenic granuloma

Seborrheic keratosis

🔸*Premalignant*

*Dermatoses* 

AK

Arsenical keratosis

Bowen’s disease

Keratoacanthoma

🔸**Malignant Dermatoses       **

Bcc

Scc

Mycosis fungoides

🔲*Contraindications *

🔸Pregnancy

🔸Lactation

🔸Drug hypersensitivity

🟠 Important points:

🔶 It should be performed as an office procedure.

🔸Do vaginal examination and proctoscopy also while examining the affected site

🔸The volume of the solution applied should be kept minimal (≤ 0.4–0.5 mL)

🔸The solution should be allowed to dry properly, and the initial test application should remain in place for 1 h, and then can be washed off.

🔸Alcoholic beverages, general anaesthesia, and CNS depressants should not be used for several hours after treatment.

*Side effects*

*⚫️*Early symptoms of too much medicine being absorbed into the body**

Abdominal or stomach pain

clumsiness or unsteadiness

confusion

decreased or loss of reflexes

diarrhea (may be severe and continuing)

excitement, irritability, or nervousness

hallucinations (seeing, hearing, or feeling things that are not there)

muscle weakness

nausea or vomiting

sore throat and fever

unusual bleeding or bruising

*⚫️*Late symptoms of too much medicine being absorbed into the body**

Constipation

convulsions (seizures)

difficult or painful urination

difficulty in breathing

dizziness or lightheadedness, especially when getting up from a lying or sitting position

drowsiness

fast heartbeat.

Podophyllin Application for Genital Warts

CONSULTANT REVIEW:

*Patient Identification and Consent*

Question:

How would you confirm the patient’s identity and obtain informed consent before the procedure?

Confirm the patient’s identity by asking their name, date of birth, and cross-checking with their medical records.

Explain the procedure, including the purpose, process, benefits, and potential risks of podophyllin application.

Answer any questions the patient might have.

Obtain verbal and written consent from the patient before proceeding.

*Preparation of Materials*

Question:

What materials and equipment are necessary for the application of podophyllin?

Podophyllin resin solution (usually 10-25%)

Applicators (cotton-tipped swabs or small brushes)

Gloves (non-sterile)

Gauze or tissues

Mild soap and water or saline solution for cleaning the area

Timer or clock to monitor application time

Patient’s medical records and consent form

*Patient Positioning and Preparation*

Question:

Describe how you would prepare the patient and the area for podophyllin application?

Position the patient comfortably, usually in a supine or lithotomy position for genital warts.

Expose the area to be treated while maintaining patient privacy.

Clean the area with mild soap and water or saline solution and dry it thoroughly.

Wear gloves to maintain hygiene and prevent self-contamination.

*Application Technique*

Question:

Demonstrate the correct technique for applying podophyllin to genital warts.

Dip the applicator (cotton-tipped swab or small brush) into the podophyllin solution.

Apply a thin layer of podophyllin directly to the wart(s), ensuring not to touch the surrounding healthy skin.

Allow the solution to air dry before the patient gets dressed.

Dispose of the applicator and any other disposable materials in appropriate medical waste containers.

Remove gloves and perform hand hygiene.

*Post-Application Care and Instructions*

Question:

What aftercare instructions would you provide to the patient following podophyllin application?

Advise the patient to wash off the podophyllin after 1-4 hours as per the specific guidance provided.

Inform the patient about potential side effects such as redness, swelling, burning, and pain at the application site.

Advise the patient to avoid sexual contact until the area has healed to prevent irritation and transmission.

Schedule a follow-up appointment to assess the effectiveness and need for additional treatment.

Instruct the patient to contact the clinic if they experience severe pain, signs of infection, or other concerning symptoms.

*Managing Adverse Reactions*

Question:

How would you manage an adverse reaction if the patient reports severe irritation or ulceration at the application site during follow-up?

Assess the severity of the reaction through visual inspection and patient history.

Clean the affected area with mild soap and water or saline solution.

Apply a soothing ointment or cream (e.g., hydrocortisone) to reduce inflammation.

Advise the patient to avoid using podophyllin until the area has fully healed.

Consider prescribing an alternative treatment for warts if necessary.

Document the adverse reaction and treatment provided in the patient’s medical records.