MIAMI BEACH (FRONTLINE MEDICAL NEWS) – Two novel therapies have potential for the treatment of genital warts, according to Dr. Theodore Rosen.

The first of these “way-off-label” treatments involves application of 5% potassium hydroxide (KOH) solution daily for 12 weeks, said Dr. Rosen, professor of dermatology at Baylor College of Medicine in Houston, Tex.

In a randomized, open-label study of 60 patients conducted in Turkey, researchers compared the KOH treatment with a 10% salicylic acid and 0.5% 5-fluorouracil compound available outside of the United States. The compound used in the study is similar to the WartPEEL (MedCara Pharmaceuticals) product available in the United States, Dr. Rosen said at the South Beach Symposium.

Both treatments were associated with a significant decrease in the number of lesions, and the outcomes were similar in both groups at 12 weeks (mean decrease from 17.03 to 3.73 lesions with KOH and from 16.13 to 3.10 with the 5-FU product). The investigators reported that excellent clearance was achieved by 70% and 76.7% of patients in the KOH and 5-FU groups, respectively, and marked improvement was seen in 13.3% and 20% of patients in the groups, respectively ( Int. J. Dermatol. 2014; 53:1145-50 ).

No difference was seen between the groups in the rate of relapse at 16 weeks, and no serious adverse events were reported.

“This is a dirt-cheap way to treat genital warts,” Dr. Rosen said, adding that clinicians can simply give patients 5% KOH in a small bottle and instruct them to apply it once daily.

A second potential – but “not-so-dirt-cheap” – treatment worth noting is ingenol mebutate , based on findings from another small study, Dr. Rosen said.

Ingenol mebutate ( Picato ), which is approved for the treatment of actinic keratosis, was shown in 10 patients with human papillomovirus-6–positive genital warts to provide complete clearance with a single application.

The treatment was compared with vehicle in each patient – ingenol mebutate was applied to one affected area, and vehicle was applied to another affected area. The areas with active treatment were completely clear within 3-7 days, and the areas where vehicle was applied were not clear. No recurrence was noted at 3 months in the areas treated with ingenol mebutate.

Not surprisingly, the treatment was associated with mild to moderate burning, but it is a “very, very interesting, very short treatment,” Dr. Rosen said.

Dr. Rosen reported having no relevant disclosures.


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