

ORIGINAL ARTICLE Year : 2019 | Volume : 20 | Issue : 1 | Page : 29-31 Adapalene in the management of warts in pediatric population



Mrinal Gupta

Treatwell Skin Centre, Jammu, Jammu and Kashmir, India

Date of Web Publication 14-Dec-2018 Correspondence Address:

Dr. Mrinal Gupta

Treatwell Skin Centre, Canal Road, Jammu - 180 001, Jammu and Kashmir

India

Source of Support: None, Conflict of Interest: None Check

DOI: 10.4103/ijpd.IJPD_76_18

Abstract

Introduction: Warts are a common skin infection caused by human papillomavirus. Although any age group can be affected, plane warts and verruca vulgaris occur mostly in children and young adults. A large number of treatment modalities are available which include electrodessication, cryotherapy, topical imiquimod, tretinoin, and phenol application but most of these are not well tolerated by children owing to irritation or painful nature. Adapalene is a retinoid derivative with lesser irritant potential than tretinoin which has been tried in the management of warts. Aims: We carried out this study to assess the safety and efficacy of adapalene in the management of warts in the pediatric population. Materials and Methods: It was a prospective study carried out over a period of one and a ½ year where 50 patients in the age group of 3–18 years with different types of warts were included. After taking an informed consent from the attendants/parents of the patients, they were treated with topical bedtime application of adapalene 0.1% gel and were followed up every month for 3 months to assess the response. Exclusion criteria were extensive lesions, lesions on genitalia, eyelid involvement, secondary infection, or patients on any immunosuppressive therapies. Results: Out of 50 patients, 44 patients (M:F 25:19) completed the study. The age of patients varied from 3 to 18 years with a mean age of 11.3 ± 4.6 years. The most common type of warts in our study were plane warts in 61.36% (n = 27), followed by verruca vulgaris in 27.27% (n = 12) and plantar warts in 11.36% (n = 5). After 3 months of therapy, complete clearance of lesions was observed in 59.09% (n = 26) patients, partial clearance in 25% (n = 11) whereas no response was seen in 15.9% (n = 7) patients. Adverse effects in the form of erythema, irritation, and dryness were observed in six patients (13.64%). Conclusions: Adapalene can be used a safe and effective treatment modality in the management of plane and common warts especially in the pediatric age group.

Keywords: Adapalene, human papillomavirus, retinoids, warts

How to cite this article:

Gupta M. Adapalene in the management of warts in pediatric population. Indian J Paediatr Dermatol 2019;20:29-31

How to cite this URL:

Gupta M. Adapalene in the management of warts in pediatric population. Indian J Paediatr Dermatol [serial online] 2019 [cited 2020 Sep 24];20:29-31. Available from: http://www.ijpd.in/text.asp?2019/20/1/29/247560







Introduction



Warts are a benign proliferation of skin and mucosa that result from infection with human papillomavirus. Although any age group can be affected, plane warts and verruca vulgaris occur mostly in children and young adults and are uncommon in infants.[1] A variety of therapies exist for the treatment of warts. Destructive therapies include curettage, cryotherapy, electrodesiccation, and lasers; nonetheless, these are poorly tolerated in children. Other topical medications include salicylic acid, tretinoin, potassium hydroxide, trichloroacetic acid, and imiquimod; nevertheless, no therapy is universally effective.[1],[2],[3]



Adapalene is a retinoid derivative with lesser irritant potential which has been tried in the management of warts.[4],[5] We carried out this study to assess the safety and efficacy of adapalene in the management of warts in the pediatric population.





Materials and Methods



It was a prospective study carried out over a period of 18 months in our center in which 50 patients (M:F 27:23), with warts, aged between 3 and 18 years with mean age of 11.3 ± 4.6 years were included in this study. After taking an informed consent from the attendants/parents of the patients, the patients were treated with bedtime application of adapalene 0.1% gel over the lesions and were followed up every monthly for 3 months to assess the efficacy and safety. Exclusion criteria were extensive lesions, lesions on genitalia, eyelid involvement, secondary infection, or patients on any immunosuppressive therapies.





Results



At the end of 3 months, 44 patients (M:F 25:19) completed the study. The most common type of warts in our study were plane warts in 61.36% (n = 27), followed by verruca vulgaris in 27.27% (n = 12) and plantar warts in 11.36% (n = 5). Face was the most common site of involvement in 54.54% (n = 24), followed by hands and arms in 34.09% (n = 15) and feet in 11.36% (n = 5). The number of lesions per patient varied from 1 to 18 with a mean of 2.4 ± 1.45 lesions/patient and the duration of warts varied from 1 to 16 months.



After 3 months of therapy, complete clearance of lesions was observed in 59.09% (n = 26) patients, partial clearance in 25% (n = 11) whereas no response was seen in 15.9% (n = 7) patients. Maximal response was seen among patients with plane warts with 77.78% (n = 21) patients showing complete clearance while among patients with plantar warts, only 14.29% (n = 1) patients showed complete clearance [Table 1]. Adverse effects in the form of erythema, irritation, and dryness were observed in six patients (13.64%). Almost all adverse effects were seen in patients with facial plane warts (66.67%, n = 4). All side effects were minimal and did not require discontinuation of therapy and were managed with the application of topical emollients. Table 1: Treatment response among different types of warts after 3 months of therapy



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Discussion



Warts are a common infection seen in the pediatric population and pose a therapeutic challenge as the conventional therapies are often painful and are not well tolerated by children or have an unsatisfactory response rate; henceforth, no treatment is universally accepted in the pediatric age group. The ideal agent for children should be effective, less irritant, well tolerated, and easily available, which can be conveniently applied. Adapalene is a third-generation retinoid with the ability to alter keratinization and affinity for retinoic acid receptor gamma. It has been found to have keratolytic effect that leads to the destruction of virus-infected cells and also its irritating effect that induces inflammatory response and immune reactions, so causing resolution of warts.[6],[7] A few studies have demonstrated the efficacy and safety of adapalene 0.1% gel in the management of warts.[4],[5]



Various studies investigate different modalities of topical treatment in plane warts. Rodriguez found that the use of glycolic acid 15% in combination with salicylic acid 2% give 100% clearance of plane warts after 8 weeks.[8] Kubeyinje reported that 84.6% clearance was noticed after 12 weeks with tretinoin cream.[9] Salk used 5-fluorouracil (5-FU) cream for 12 weeks with 95% clearance.[10] The irritation potential of these agents does not make them the ideal therapeutic agents for children. In our study, we observed 77.78% resolution of plane warts with adapalene application and the adverse effects were also minimal, seen in only 13.63% of patients. The adverse effects with adapalene were also minimal such as erythema, irritation, and dryness which could be easily managed with emollient application.



The higher response rate in plane warts could be compared to less hyperkeratosis in this subtype leading to increased absorption and efficacy as compared to verruca vulgaris and plantar warts where stronger agents such as salicylic acid and 5-FU could be more effective.



Treatment options such as extirpation, electrodessication, cryosurgery, trichloroacetic acid, and potassium hydroxide application are the commonly used techniques, but they can cause irritation and pain and can lead to scarring, so their use in children is not universally accepted. Adapalene can be used a safer alternative to other modalities in the treatment of warts especially in children.



This study had certain limitations. First of all, it was a single centered trial conducted in a limited population size, and the dropout rate was quite high. Moreover, application of adapalene was not carried out under medical supervision as the patients were sent home and had to apply it by themselves.





Conclusions



Adapalene can be used a safe and effective treatment modality in the management of plane and common warts especially in the pediatric age group, but its role in plantar warts needs further study.



Financial support and sponsorship



Nil.



Conflicts of interest



There are no conflicts of interest.







References

1.

Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: Systematic review. BMJ 2002;325:461. 2.

Bacelieri R, Johnson SM. Cutaneous warts: An evidence-based approach to therapy. Am Fam Physician 2005;72:647-52. 3.

Sterling JC, Handfield-Jones S, Hudson PM; British Association of Dermatologists. Guidelines for the management of cutaneous warts. Br J Dermatol 2001;144:4-11. 4.

[PUBMED] [Full text] Gupta R, Gupta S. Topical adapalene in the treatment of plantar warts; randomized comparative open trial in comparison with cryo-therapy. Indian J Dermatol 2015;60:102. 5.

Al-Hilo MM, Al-Saedy SJ, Jawad WA. Treatment of plane wart with topical adapaline gel 0.1%: An open therapeutic trial. JAMS 2013;2:87-98. 6. et al. The in vivo and in vitro anti-inflammatory activity of CD271: A new retinoid-like modulator of cell differentiation. Agents Actions 1990;29:56-8.

Hensby C, Cavey D, Bouclier M, Chatelus A, Algate D, Eustache J,Theandanti-inflammatory activity of CD271: A new retinoid-like modulator of cell differentiation. Agents Actions 1990;29:56-8. 7.

Asselineau D, Cavey MT, Shroot B, Darmon M. Control of epidermal differentiation by a retinoid analogue unable to bind to cytosolic retinoic acid-binding proteins (CRABP). J Invest Dermatol 1992;98:128-34. 8.

Rodríguez-Cerdeira C, Sánchez-Blanco E. Glycolic acid 15% plus salicylic acid 2%: A new therapeutic pearl for facial flat warts. J Clin Aesthet Dermatol 2011;4:62-4. 9.

Kubeyinje EP. Evaluation of the efficacy and safety of 0.05% tretinoin cream in the treatment of plane warts in Arab children. J Dermatol Treat 1996;7:21-2. 10.

Salk RS, Grogan KA, Chang TJ. Topical 5% 5-fluorouracil cream in the treatment of plantar warts: A prospective, randomized, and controlled clinical study. J Drugs Dermatol 2006;5:418-24.







Tables

[Table 1]



