What is the role of systemic agents in the treatment of nongenital warts?

Updated: Sep 25, 2020
  • Author: Philip D Shenefelt, MD, MS; Chief Editor: William D James, MD  more...
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Systemic agents that have been used to treat warts include cimetidine, retinoids, and intravenous cidofovir.

Cimetidine is a type-2 histamine receptor antagonist commonly used to treat peptic ulcer disease. Because of its immunomodulatory effects at higher doses, cimetidine was considered a possible treatment for warts; however, results have varied. Double-blind placebo-controlled studies have shown no benefit. [26]

Retinoids are synthetic vitamin A analogs that may help with extensive disabling hyperkeratotic warts in immunocompromised patients. They may help alleviate pain and facilitate the use of other treatments. Retinoids also have helped reduce the number of lesions in immunosuppressed renal transplant patients. The limiting side effects include liver function abnormalities, increased serum lipid levels, and teratogenicity.

Other reports have described intravenous cidofovir used for the treatment of extensive, disfiguring, and refractory warts. [27, 28, 29] This should be used with caution because of the risk of nephrotoxicity. Another report describes treatment failure. [30]

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