BNF for Children 2011-2012

BNFC 2011–2012 13.7 Preparations for warts and calluses 581SILVER NITRATECautions protect surrounding skin and avoid brokenskin; not suitable for application to face, ano-genitalregion, or large areasSide-effects chemical burns on surrounding skin;stains skin and fabricLicensed use no age range specified by manufacturerIndication and doseCommon warts and verrucasApply moistened caustic pencil tip for 1–2 minutes;repeat after 24 hours up to max. 3 applications forwarts or max. 6 applications for verrucasInstructions in proprietary packs generally incorporateadvice to remove dead skin before use by gentle filingand to cover with adhesive dressing after applicationIndication and doseExternal genital and perianal warts (for use underspecialist supervision only)Apply thinly 3 times a week at night until lesionsresolve (max. 16 weeks)Important Should be rubbed in and allowed to stay onthe treated area for 6–10 hours then washed off with mildsoap and water (uncircumcised males treating wartsunder foreskin should wash the area daily). The creamshould be washed off before sexual contactAldara c (Meda) ACream, imiquimod 5%, net price 12-sachet pack =£48.34. Label: 10, patient information leafletExcipients include benzyl alcohol, cetyl alcohol, hydroxybenzoates(parabens), polysorbate 60, stearyl alcoholCondoms may damage latex condoms and diaphragmsUmbilical granulomasApply moistened caustic pencil tip (usually containingsilver nitrate 40%) for 1–2 minutes whileprotecting surrounding skin with soft paraffinSilver nitrate (Non-proprietary)Caustic pencil, tip containing silver nitrate 40%,potassium nitrate 60%, net price = 93pAVOCA c (Bray)Caustic pencil, tip containing silver nitrate 95%,potassium nitrate 5%, net price, treatment pack(including emery file, 6 adhesive dressings and protectorpads) = £1.94.Anogenital wartsAnogenital warts (condylomata acuminata) in childrenare often asymptomatic and require only a simplebarrier preparation. If treatment is required it shouldbe supervised by a hospital specialist. Persistent wartson genital skin may require treatment with cryotherapyor other forms of physical ablation under general anaesthesia.Podophyllotoxin (the major active ingredient of podophyllum),or imiquimod are used to treat external anogenitalwarts; these preparations can cause considerableirritation of the treated area and are therefore suitableonly for children who are able to cooperate with thetreatment.IMIQUIMODCautions avoid normal or broken skin and openwounds; not suitable for internal genital warts; uncircumcisedmales (risk of phimosis or stricture of foreskin);autoimmune disease; immunosuppressedpatientsPregnancy no evidence of teratogenicity or toxicity inanimal studies; manufacturer advises cautionBreast-feeding no information availableSide-effects local reactions (including itching, burningsensation, erythema, erosion, oedema, excoriation,and scabbing); headache; influenza-like symptoms;myalgia; less commonly local ulceration andalopecia; rarely Stevens-Johnson syndrome andcutaneous lupus erythematosus-like effect; very rarelydysuria in females; permanent hypopigmentation orhyperpigmentation reportedLicensed use not licensed for use in childrenPODOPHYLLOTOXINCautions see notes above; avoid normal skin and openwounds; keep away from face; very irritant to eyesPregnancy avoidBreast-feeding avoidSide-effects local irritationLicensed use not licensed for use in childrenIndication and doseSee under preparations (for use under specialistsupervision only)Condyline c (Nycomed) ASolution, podophyllotoxin 0.5% in alcoholic basis, netprice 3.5 mL (with applicators) = £14.49. Label: 15DoseCondylomata acuminata affecting the penis or thefemale external genitaliaChild 2–18 years (see notes above) apply twice daily for3 consecutive days; treatment may be repeated at weeklyintervals if necessary for a total of five 3-day treatmentcourses; direct medical supervision for lesions in thefemale and for lesions greater than 4 cm 2 in the male;max. 50 single applications (‘loops’) per session (consultproduct literature)Warticon c (GSK) ACream, podophyllotoxin 0.15%, net price 5 g (withmirror) = £14.86Excipients include butylated hydroxyanisole, cetyl alcohol, hydroxybenzoates(parabens), sorbic acid, stearyl alcoholDoseCondylomata acuminata affecting the penis or thefemale external genitaliaChild 2–18 years (see notes above) apply twice daily for3 consecutive days; treatment may be repeated at weeklyintervals if necessary for a total of four 3-day treatmentcourses; direct medical supervision for lesions greaterthan 4 cm 2Solution, blue, podophyllotoxin 0.5% in alcoholicbasis, net price 3 mL (with applicators) = £12.38.Label: 15DoseCondylomata acuminata affecting the penis or thefemale external genitaliaChild 2–18 years (see notes above) apply twice daily for3 consecutive days; treatment may be repeated at weeklyintervals if necessary for a total of four 3-day treatmentcourses; direct medical supervision for lesions greaterthan 4 cm 2 ; max. 50 single applications (‘loops’) persession (consult product literature)13 Skin