Healing is complete 4 to 7 days after application. The degree of blistering is controlled by instructing the patient to wash the treated site with soap and water after a specified length of time, usually in the range of 2 to 6 hours. Blistering may be intensified by lengthening the contact time or by occlusion with nonporous tape to increase percutaneous absorption. Fair-skinned individuals tend to blister more easily, and contact time should be adjusted accordingly.
Retreatment may be done as early as 1 week. Warts are treated more intensively. Warts are pared, followed by cantharidin application to the wart and a 1-mm rim of normal skin, and occluded with nonporous tape. Cantharidin is washed off in 4 hours. If necessary, paring and retreatment are done in 1 to 2 weeks, with contact time increased if needed. In our experience, pain and excessive blistering are exceedingly rare when these guidelines are followed. Cantharidin should be applied only in the office by a physician 26 or under the direct supervision of a physician.
Although 1 report advocates home use of cantharidin for warts, we believe that home use should be strictly avoided, 28 because severe blistering can result from improper use, 24 and because ingestion, especially by children, can be fatal.
Treatment of mucous membranes is contraindicated owing to increased propensity for blistering. When cantharidin is used appropriately, complications are exceedingly rare. Mild to moderate pain, temporary erythema, a transient burning sensation, and pruritis may occur. Ring warts occurred in 1 of patients in one study 28 and in 3 of 61 patients in another.
Postinflammatory hypopigmentation or hyperpigmentation can take weeks to months to resolve. Informed consent should also include mention of this temporary but potentially distressing effect.
The treatment of plantar warts may have a higher rate of significant complications. Lymphangitis developed 30 hours later.
Treated areas were rinsed 4 to 6 hours after application. No cases of systemic toxic reactions were noted. Poisoning usually results after aphrodisiac ingestion.
With cantharidin ingestion, a burning sensation of the lips, mouth, and pharynx occurs within minutes. Total loss of normal mucosa of the gastrointestinal tract may occur. To the best of our knowledge, there have been no reports of cantharidin intoxication caused by the reasonable application of cantharidin solution by a physician.
The treatment of cantharidin intoxication is largely supportive. There is no known antidote. The skin should then be cleaned thoroughly with soap and water. A topical steroid may be applied to intact skin if it is symptomatic. For oral ingestions, several support measures may be taken. If possible, the patient should swallow generous quantities of water but should avoid fatty foods such as milk because they increase cantharidin absorption.
Gastric lavage is recommended in patients who present early and do not have severe esophageal involvement. Activated charcoal may also be administered, although there is no evidence that cantharidin binds to this material. Cantharidin has been demonstrated to act as a vasoconstrictor and positive inotrope in guinea pig 46 and human cardiac 47 tissue in vitro.
These effects are mediated in part by cantharidin's action as a protein phosphatase inhibitor. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Download PDF Top of Article Abstract Blister beetles and spanish fly Historical and folk uses of cantharidin Cantharidin and the fda Mechanism of action Dermatological uses of cantharidin Cantharidin poisoning Treatment of cantharidin poisoning Investigative uses of cantharidin Article Information References.
South Med J. J Am Acad Dermatol. Wang GS Medical uses of mylabris in ancient China and recent studies. J Ethnopharmacol. Beijing, China Cultural Objects Publishers;. Med Sci Law. Not Available, Encyclopedia Britannica. Vol th ed. Chicago, Ill Encyclopedia Britannica Inc; Am J Emerg Med. Arch Intern Med. Nicholls LTeare D Poisoning by cantharidin. Lecutier M A case of cantharidin poisoning. Depending on their size and location, they may, or may not be painful. If the wart is not tender, treatment is not always necessary, and the wart could resolve on its own over the course of several months.
If painful, several treatment options are available. Treatment Options. Warts live on the outer layer of skin, making them difficult to treat. The body has a difficult time recognizing the virus, so treatment is often aimed at topical treatments that cause direct trauma to the wart.
In a previous blog , I discussed ten different treatment options for warts. Of the ten mentioned, one of my favorites to use is Cantharidin. For the specific purposing of treating plantar warts, it only dates back to the s 1,2. When topically applied, cantharidin acts as a blistering agent, separating the viral epidermal skin tissue layer from the underlying, unaffected tissue layers. FDA Regulations. In , the FDA removed Cantharidin from the market because the manufacturers failed to submit efficacy data for the product 1,2.
The FDA now routinely proposes substances to be included on the Bulk Substance List, which makes them eligible for compounding by pharmacists; however, according to this document , as of this month, it appears that Cantharidin continues to only be nominated and not accepted to that list. It causes a blister to develop on the bump, which resolves as the blister heals. A retrospective study reviewing charts of children with molluscum contagiosum examined the efficacy of cantharidin treatment.
With cantharidin therapy, 90 percent of children experienced clearing and 8 percent had improvement. A total of 95 percent of parents reported they would choose cantharidin again if their child needed treatment. Mancini, A. Plantar warts, or Verruca Plantaris, can affect anyone, yet there are risk factors that make them more likely, according to a leading medical center.
Plantar warts are most likely to affect:. A retrospective study published in a leading podiatry journal reviewed records of patients with plantar warts who were treated with a compounded solution of cantharidin, podophyllotoxin, and salicylic acid.
It was the initial treatment for 92 of the patients. After six months, PhD, et. It has both vesicant and keratolytic features by inducing acanthloysis through targeting the desmosomal dense plaque, leading to detachment of the desmosomes from the tonofilaments. There are two available liquid preparations for dermatologic use, Canthacur 0.
The former preparation is indicated for the treatment of common warts, periungual warts, and molluscum contagiosum, while the more potent latter preparation is indicated only for plantar warts.
Both preparations provide painless applications with outcomes similar to other treatment modalities for warts and molluscum contagiosum; however, neither is approved by the Food and Drug Administration FDA. Conclusion: Cantharidin is safe and effective when applied to flat warts without occlusion for 4—6 hours every 3 weeks till clear. We are currently licensed to sell to all US states except Alabama and Virginia. To purchase cantharidin please fill in the registration form.
Medical, DEA, or hospital pharmacy licenses will be required.
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