How does podophyllotoxin work and what is it used for?
Podophyllin The herbal extract known as podophyllin is a crude, non-standardised, and impure resin preparation obtained from the rhizomes of the Podophyllum plant species P peltatum, or P emodi. The antiwart ingredients are antimitotically acting lignans, 5 of which podophyllotoxin is the most potent.
Toxic ingredients often cause unpredictable and severe local toxicity including painful burns and ulcerations. Podophyllin is unstable during clinic storage, with frequent crystallisation and formation of inactive picroisomers of lignans.
The resin must be washed off 4—6 hours after application; use of a protective inert ointment for the surrounding skin is recommended. There is a risk of systemic hpv bőrváltozások, as ingredients at high concentrations may be absorbed and distributed to vital organs including the gastrointestinal mucosa, the kidneys, the bone marrow, and the CNS.
Of greatest concern are condylom podophilin number of case reports revealing that following podophyllin painting of large condylomas, after subdermal injection into plantar warts, or following accidental ingestion, podophyllin may cause fatal or near fatal intoxication 9— 17 due to CNS influence, coma, respiratory depression, etc, and cardiovascular crisis.
There is no known antidote. Irreversible peripheral neuropathy is a sequel in survivors. Warnings against use of volumes exceeding 0.
A formal regulatory review and safety evaluation of podophyllin has never been performed, although mutagenicity, carcinogenicity, and reproductive toxicity studies indicate that podophyllin is potentially very dangerous. In mice, podophyllin seems teratogenic, inducing a high frequency of fetal mortality; in rats no condylom podophilin influence has been demonstrated.
Such quantities are far below levels of clinical significance 10 ; cancer patients receiving daily intravenous injections of 0. Severe reactions such as pain requiring discontinuation of therapy are rare. Methyl-rosaniline added to taint the solution optimised compliance by enabling visualisation of treated warts.
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- These types can be commonly identified before or at the same time anogenital warts are detected
The currently licensed 0. View this table: View popup Table 1 Condyloma eradication following self therapy with podophyllotoxin condylom podophilin with podophyllin office therapy; complete cure rates at 3—4 months' follow up With the exception of a few early US based studies 31, 32 when compliance problems might have existed because of use of a colourless podophyllotoxin solution, well controlled studies on the cyclical use of 3 condylom podophilin courses of a 0. Randomised prospective studies table 1 demonstrate that the 0.
Cost calculations show that although podophyllin is cheap to produce, it is less cost effective when compared with podophyllotoxin home therapy. The experimental toxicology data, published in further detail elsewhere, 24 are briefly compiled in the current survey.
This article has been cited by other articles in PMC. Abstract 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. Selected References These references are in PubMed.
Toxicity studies Oral bioavailability in dogs following high doses 1. Only doses of 1. In mice, both kidney and biliary excretion occurs; after 24 hours all organs and body fluids with the exception of the liver, the intestines, and urine are cleared.
Carcinogenicity and genotoxicity Rats and mice receiving up to 0. In Salmonella typhimurium podophyllin induced up to PHA stimulated human lymphocyte cultures exposed to podophyllotoxin for 25 hours did not show any clastogenic effect. No mutagenic potential has been detected in ovarian and lymphoma cell cultures, and no single strand DNA breakage has been detected in human cell cultures.
Local sensitisation potential In the guinea pig maximisation test 0.
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Pregnant rats and their offspring were followed after oral administration of 0. There were no influences on fertility, gestation, mating, litter size, embryonic or fetal development, or perinatal and postnatal behaviour.
A negative influence was observed in the offspring exposed to the highest dose 2.
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- Podophyllin resin is a substance derived from the roots of the mayapple plant Podophyllum peltatum that grows in the wild in eastern North America.
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Although reproductive toxicity studies in animals have not shown teratogenicity and the half life appears to condylom podophilin short and systemic elimination occurs within a few days, we still believe that podophyllotoxin should be avoided during pregnancy since the possibility cannot be excluded that the drug might accumulate in the human fetus. As a further precaution, we also recommend that conception should paraziták jatra avoided during the week following completion of podophyllotoxin therapy.
The effective treatment is a multidisciplinary challenge; topical treatments are usually ineffective, and surgical resection has significant morbidity. The aim of the present study was to assess its response and tolerability.
Conclusions Use of the crude herbal remedy podophyllin is associated with low production costs, but the cost benefit versus the risk ratio of the product is highly questionable. Further podophyllin use is not only redundant but should be abandoned in favour of its modern pharmaceutical replacement—that is, podophyllotoxin preparations with well defined pharmacokinetic, metabolic, and toxicity safety profiles.
The number horizontal bar along top is annotated by the patient samples. The red color indicates an increases in the expression of genes, and the blue color indicates a decrease in gene expression. This implied that podophyllin might affect the expression of genes involved in inflammatory pathway. However, none of the inflammatory genes were found to be differentially expressed if was adjusted Figure S4Table S5.
Podophyllotoxin solution and cream have been documented as safe and effective for self therapy of anogenital warts table 2 and are recommended as first line therapy. View this table:.