The treatment of viral warts with topical cidofovir 1%: our experience of seven paediatric patients

Abstract

Conflicts of interest: none declared. Sir, Warts caused by human papillomavirus (HPV) can represent a therapeutic challenge. Recently topical, intralesional and intravenous cidofovir has been reported for treatment of viral warts in children1–4 and adults.5 6–7 Cidofovir is a potent nucleoside analogue antiviral agent, which acts as a competitive inhibitor of DNA polymerase.8 Cidofovir is licensed for parenteral treatment of cytomegalovirus retinitis in patients with acquired immune deficiency syndrome. We present a series of seven children treated with topical cidofovir 1% ointment for severe recalcitrant viral warts that were limiting quality of life. Cidofovir 1% in Unguentum M® ointment (Reckitt Benckiser, Hull, U.K.) was compounded from the injectable cidofovir 75 mg mL−1 (Vistide®, Gilead, Foster City, CA, U.S.A.) by St Mary’s Pharmaceutical Unit, Cardiff. The ointment was applied in a thin layer to each individual wart at night; the area was occluded with a simple dressing. Of the seven children four were male and ages ranged from 9 to 12 years. Five children had warts on their hands and two on their feet. All children had failed to respond to at least two other forms of therapy (Table 1). The warts had persisted for a mean of 2 years (range 1·5–3).