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2001 Blackwell Science Ltd International Journal of Dermatology 2001, 40, 415419
416 Pharmacology and therapeutics Formipuncture technique for common warts Bhat, Vidya, and Kamath
Number of Number of patients Total Table 3 Complete clinical resolution of warts at 3 months
applications
Group I % Group II % Number of patients
1 2 2
2 1 1 3 5
3 1 2 3 4 10
4 1 1 2 5 4 13
5 1 2 1 4
6 1 8 9
7 1 2 10 13
8 2 11 13
9 1 14 15
10 1 1
11
12 1 1
Results of group II were not tabulated as only three patients showed complete resolution before 12 applications.
International Journal of Dermatology 2001, 40, 415419 2001 Blackwell Science Ltd
Bhat, Vidya, and Kamath Formipuncture technique for common warts Pharmacology and therapeutics 417
Discussion
2001 Blackwell Science Ltd International Journal of Dermatology 2001, 40, 415419
418 Pharmacology and therapeutics Formipuncture technique for common warts Bhat, Vidya, and Kamath
Figure 4 Same case as in Fig. 3 after four applications of Figure 6 Same case as in Fig. 5 after three applications of
formic acid formic acid
less caustic than trichloroacetic acid. In the eld of produce the resolution of warts. Induction of immunity
dermatology, 8% formic acid has been shown to be useful may also be considered as a possible mechanism of action,
as a post-pediculocide nit removal system.8 We have used as in squaric acid dibutylester contact immunotherapy for
85% formic acid in the treatment of warts. the treatment of recalcitrant warts.11 Although 85%
The mechanism of action of salicylic acid in warts formic acid is caustic, careful application over the wart
involves keratolysis of virally infected tissues.3 Trichloro- area only prevents its harmful effects on the skin.
acetic acid and bichloroacetic acid are powerful irritants We believe that 85% formic acid application can serve as
that work by hydrolyzing the cellular proteins, leading to a safe, cheap, and effective alternative in the treatment of
inammation and cell death. The exact mechanism of common warts. A multicenter trial with 85% formic acid
action of formic acid is not known. It probably acts in a application for common warts may help to standardize the
manner similar to formalin which causes destruction of the treatment regimen and safety.
wart-infected tissue by dehydration.9 After application of
formic acid, the wart becomes slightly whitish in color and
the supercial layer peels off indicating a keratolytic effect. References
Formic acid puncture may also help in inducing regression 1 Jaiswal AK, Singh GM. Pattern of skin diseases in Kashmir
of the warts. Regression of plane warts following region of India. Ind J Dermatol Venereol Leprol 1999; 65:
spontaneous inammation has been reported.10 In our 258260.
study, however, the placebo group, who also underwent 2 Nair SP, Nair TVG. Pattern of dermatological diseases in
puncture with a needle, did not show the resolution of Trivandrum. Ind J Dermatol Venereol Leprol 1999; 65:
warts, indicating that puncture alone is not sufcient to 261263.
International Journal of Dermatology 2001, 40, 415419 2001 Blackwell Science Ltd
Bhat, Vidya, and Kamath Formipuncture technique for common warts Pharmacology and therapeutics 419
3 Goldfarb MT, Gupta AK, Gupta AM, Sawchuk WS. Ofce Pharmacopoeia, 31st edn. London: Royal Pharmaceutical
therapy for human papilloma virus infection in nongenital Society, 1996: 1707.
sites. Dermatol Clin 1991; 9: 287296. 8 Defelice RNJ, Rumseld J, Pharm D, et al. Clinical
4 Lowy RD, Androphy JE. Warts. In: Fitzpatrick TB, Eissen evaluation of an after pediculocide nit removal system. Int
AZ, Wolff K et al., eds. Dermatology in General Medicine, J Dermatol 1989; 28: 468470.
Vol. 2, 4th edn. New York: McGraw-Hill, 1993: 9 Luciano CS. Verruca plantaris. A comparison of its
26112621. understanding and treatment. J Am Podiatr Assoc 1977;
5 Orlow JS, Paller A. Cimetidine therapy for multiple viral 67: 858.
warts in children. J Am Acad Dermatol 1993; 28: 10 Tagami H, Ogino A, Takigawa M, et al. Regression of
794796. plane warts following spontaneous inammation. Br J
6 Rao DS, Modithaya BS, Gonsalves RA. Carboxylic acids. Dermatol 1974; 90: 147154.
In: Rao DS, ed. Chemistry. Mangalore: Deepa, 1998: 11 Lee AN, Mallor SB. Contact immunotherapy with squaric
330350. acid dibutylester for the treatment of recalcitrant warts. J
7 Reynolds EFJ, ed. Formic acid. In: Martindale, The Extra Am Acad Dermatol 1999; 41: 595599.
2001 Blackwell Science Ltd International Journal of Dermatology 2001, 40, 415419
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