In topical treatments, either podophyllin (10-25% solution) or trichloracetic acid (TCA; 80-90% solution) is painted on external warts on the genitals and near the anus, either alone or in combination with liquid nitrogen. The treatments are applied only to the warts and not to the surrounding, normal skin, since they can be irritating to normal tissue. These treatments destroy the skin cells where the virus is located, and podophyllin also prevents wart cells from dividing.
Podophyllin, which has been used as a treatment for warts for half a century, is applied only to visible external warts. It is not used on warts on the mucosal skin (as in the inner labia, vagina, or urethra), because it can be absorbed into the system and cause side effects. Application of podophyllin is usually not painful, although it must be washed off four to six hours after application in order to avoid irritation of the skin. A follow-up visit for repeat treatment is recommended in one or two weeks if the wart does not clear up. This method of treatment has a clearance rate of 32-79 percent and a recurrence rate of 27-65 percent. It should not be used during pregnancy.
Milder-strength podophyllin is available by prescription as either a solution or a gel. Called podofilox (0.5% podophyllin), it is used primarily to treat external genital warts and is most effective for small warts. Podofilox is applied to the warts twice a day for three days (without washing it off), followed by a four-day period of no treatment. This cycle can be repeated for up to a total of four weeks. If the warts are not gone by then, stronger treatment must be obtained from a health care provider. (For larger warts, stronger treatment may be necessary from the start.) Podofilox is not recommended for warts that are difficult to reach.
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