Indian J Dermatol. 2011 Sep-Oct; 56(5): 513514.

PMCID: PMC3221211
doi: 10.4103/0019-5154.87135

PLANTAR WARTS TREATED WITH TOPICAL ADAPALENE

Ramji Gupta
From the Senior Consultant Dermatologist, Indraprastha Apollo Hospital, New Delhi - 110074, India
Address for correspondence:Dr. Ramji Gupta, 47-C Pocket B Sidharth Extention, New Delhi - 110 014, India. E-mail:
drramjigupta@yahoo.co.in

Received 2010 Aug; Accepted 2010 Sep.

Copyright : Indian Journal of Dermatology

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:
Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often
difficult and a challenging problem. Various therapeutic modalities available for treating this problem have
not been uniformly successful.

Purpose:
The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in
plantar warts.

Materials and Methods:

A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying
adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in
each patient. The effects of the treatment were evaluated every week till the clearance of all warts.

Findings:
Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 3915.07 days. There
was no side effects like scar formation, irritation, erythema or infection with adapalene.

Conclusion:
Adapalene clears the plantar warts faster compared to other modalities available.

Limitation:
Need trial with large number of patients.

Keywords: Adapalene, occlusion, plantar warts, treatment

Introduction
Various therapeutic measures used for treating plantar warts are not uniformly successful. Adapalene a
naphthoic acid derivative with retinoid like activity is commonly used topically for the treatment of mild to
moderate acne vulgaris.[1] It binds to sub-type Y retinoic acid receptors found predominantly in the
epidermis[2] and modulate cellular differentiation.[3] It also exhibits anti-inflammatory and anti-
keratinisation activity.[4] Recently, we have seen a female with 36 plantar warts of 2 months duration who
was given adapalene with occlusive dressing. All warts cleared during the next 6 weeks with no recurrence
during the next 1 year follow up. Subsequently, adapalene 0.1% gel was used topically with occlusion in
10 patient having 118 plantar warts with complete disappearance of the lesions in an average of 3915.07
days.

Materials and Methods

A 26-year-old female presented with multiple warts on her anterior part of left sole and 2 warts on her
plantar surface of right big toe of 2 months duration. She was on topical adapalene 0.1% with occlusive
dressing with polythene sheet 1 week. During the next 10 days, all warts started showing pigmentation.
Adapalene occlusive dressing was continued with clearance of all the lesions during the next 21 days
except one wart on each toe. Which also cleared during the next 21 days without any scar on the soles
when adapalene was stopped. There was no recurrence of any wart during the next 1 year follow up.
Subsequently, 10 patient with 118 plantar warts were included in this observational study. Diagnosis of
plantar warts was made on clinical presentation. Before starting the treatment, informed consent was taken
from all the patient and they were informed in details about the procedure. The patients who had systemic
therapy in the past 8 weeks and pregnant women were excluded from the study. All topical treatments
were stopped 2 weeks before entering into the study. All the patient who came were treated with adapalene
gel 0.1% with occlusion. The treatment was continued till the clearance of all the warts.

The effect of the treatment was evaluated every week till the clearance of all warts, followed- by every
month afterward.

Results
Ten patient (M-7, F-3) having 118 warts were enrolled in this observational study. The mean age of the
patient was 31.9 years and mean duration of the warts was 6.6 months. All warts disappeared in an average
of 39 15.07 days [Table 1]. There was no recurrence in the patient followed up for an average of 6.9
months.

Thus, we found adapalene significantly effective in clearance of plantar warts. Compliances of the patient
were also better.

Side Effects
There was no side effect like irritation; erythema and scar formation seen in any patient.

Discussion
In this observational study, topical adapalene aqueous gel 0.1% alone with occlusion was able to clear the
plantar warts completely. Total time taken to clear the plantar warts was 39 15.07 days.

Various immuno-modulating agents used for treatment of warts include oral cimetidine[5] levamisole,[6]
intralesional BCG vaccines, interferon, and imiquimod;[7] None is uniformly effective. The aim of using
immuno-therapy is to hasten the development of cell-mediated immune response to HPV and clear the
existing warts fast. In the present study, all the warts disappeared in about 6 weeks which clearly indicate
the development of cell-mediated immunity against the wart virus. Gelmetti et al.[8] used etretinate orally
in 20 children with good result. Choi et al.[9] used acitretin orally in an extensive and recalcitrant warts
with complete clearance. Euvrard et al.[10] used topical retinoid in warts and keratoses in transplant
recipient with good result.

In a comparative study by Parsad et al[5] cimetidine was able to clear lesion in 11 weeks in 31.5% of cases
only whereas cimetidine + levamisole took 7.8 weeks. Imiquimod, an immune modulator was reported to
clear the plantar warts when used with occlusion in 12 weeks.[7,11] In conclusion adapalene seems to be
an effective simple mode of therapy for treating plantar warts. However it needs to be tried in larger
number of patient.

Footnotes
Source of Support: Nil

Conflict of Interest: Nil.

References
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Figures and Tables

Table 1
Details of patient treated with adapalene gel 0.1% with occlusion

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