Using A Topical Acne Medication Off-Label For Plantar Warts

One of the most common questions people ask me after giving talks around the country is “How do you treat warts?” It is a tough question for me to answer because 1) I love treating warts so much that I could talk about them for much longer than anyone wants to hear and 2) I have access to treatments that are not commonplace.

One of the treatments I was exposed to during my dermatology fellowship was the use of topical retinoids for certain types of warts. Over the years, I have tried and had frustration with various topicals for plantar verrucae. Haven’t we all? A recent article piqued my interest in the use of retinoids for plantar warts again.

What is a retinoid? Topical forms are in common use for acne as retinoids alter keratinization in the epidermis, act as an anti-inflammatory and inhibit cell proliferation. While physicians use adapalene 0.1% gel (Differin gel, Galderma Laboratories) in the treatment of mild to moderate acne, a current article in the Indian Journal of Dermatology describes the use of this medication for plantar verrucae.¹

The randomized study involved 50 patients who had 424 plantar warts. Patients in Group A applied adapalene 0.1% gel twice daily under occlusion while group B patients received cryotherapy once every two weeks.¹ Patients had follow-up weekly until warts cleared and then reported for monthly visits for six months post-clearance to determine if there was any recurrence.

What were the results? Twenty-four out of 25 patients in Group A had complete clearance of 286 warts in about 36 days.¹ In Group B, 24 out of 25 patients developed complete clearance of 124 warts in 52 days. Group A patients experienced no adverse events while Group B patients had scarring, pain and redness (all the expected side effects with the use of cryotherapy). There was no recurrence in any patient. In this study, adapalene 0.1% gel seemed to clear warts faster and with fewer side effects than cryotherapy alone. 

What does this mean for you? It is a singular study that shows a promising therapy that one could use for patients who want a home treatment directed by a physician. Am I going to prescribe it for appropriate patients in my practice? Yes. However, in my experience when prescribing topical retinoids for other skin conditions (psoriasis, psoriatic nails, etc.), I have received pushback from both pharmacists and insurance companies alike. Remember, it is an off-label indication and you should discuss it as such. As it is an acne medication first and foremost, it may not be covered in an adult. (Those of us who are adult acne sufferers really do not appreciate that certain folks think acne disappears after age 18.)

If you have had experience with this medication for plantar verrucae, please share your comments below.

Reference

1. Gupta R, Gupta S. Topical adapalene in the treatment of plantar warts; randomized comparative open trial in comparison with cryotherapy. Indian J Dermatol. 2015; 60(1):102.