Podowart

Podowart is a paint made in India that contains podophyllum resin dissolved in a benzoin tincture base. Podophyllum resin is a crude plant extract from the rhizome of the mayapple. Its main active component, podophyllotoxin, stops the division of the rapidly multiplying cells in a wart, so the treated tissue dies off and is gradually shed over the following days. The resin has traditionally been applied to external anogenital warts caused by the human papillomavirus. The benzoin base dries to a film that helps hold the resin on the wart and limits spread to nearby skin. It is an imported generic, and the picture on this page shows the manufacturer's own pack.

The paint comes in 10 ml bottles, offered as single bottles or in packs of 2, 3, 4, 5 or 6. Only a very small amount is needed for each application, so one bottle normally lasts a long time. Keep the bottle tightly closed, upright and out of the reach of children, as the solution is poisonous if swallowed. The tincture base is flammable, so it should be kept away from naked flames and not applied near a source of heat.

Unlike modern self-applied products, podophyllum resin has traditionally been painted onto warts by a clinician rather than at home. The surrounding healthy skin is protected first, for example with petroleum jelly, and the paint is applied sparingly to the warts alone and allowed to dry. It is then washed off with soap and water after a few hours, starting with a short contact time to judge the reaction. Treatment is repeated no more than once a week, and only a limited area is treated at each session because the resin can be absorbed and cause toxicity. If the warts have not cleared after several sessions, a different approach is usually chosen. Sexual partners may also need checking, and condoms reduce, though do not remove, the chance of passing the virus on.

Podowart is not licensed by the MHRA. Crude podophyllum resin preparations have largely been replaced in UK practice by purified podophyllotoxin, which has a more predictable strength. Licensed UK podophyllotoxin products, such as Warticon cream and solution, are prescription-only medicines (POM) intended for patients to apply themselves. Cryotherapy and imiquimod cream are other common options at sexual health clinics. Which treatment suits a particular person, and whether resin paint is appropriate at all, is for the doctor or prescriber to decide.

Podophyllum resin must not be used during pregnancy or breastfeeding, as it is harmful to the unborn baby. It is unsuitable for children, for warts that are bleeding, inflamed or recently biopsied, for moles and birthmarks, and for warts inside the vagina, the urethra, the anal canal or the mouth. It should not be used on large areas or very many warts at once. Anyone with diabetes, poor circulation or a weakened immune system needs individual assessment. Keep it well away from the eyes.

Burning, soreness, redness and itching at the treated site are expected, and shallow ulceration or skin erosion may follow as the wart breaks down. Too much paint, application to broken skin or leaving it on too long can lead to absorption into the body, causing nausea, vomiting, abdominal pain, diarrhoea, numbness, confusion or, in severe cases, effects on the blood and nerves; these need urgent medical attention. Suspected reactions can be reported through the Yellow Card scheme.