Podophyllin is a cytotoxic material extracted from Podophyllum peltatum and Podophyllum hexandrum and is widely employed for treating genital warts. 

 It has shown comparable efficacy to 10% KOH in treating molluscum contagiosum in a recent study from Iraq. Also, a case report by Sharquie (2014) showed the successful use of podophyllin 25% gel for treating keratoacanthoma. Presently, podophyllin resin is used successfully to treat anogenital warts. However, only Podofilox 0.5% gel has received FDA approval to treat anogenital warts. 

Relying on the available literature, the present study proposed a clinical guideline to minimize the side effects, which is as follows-

• Podophyllin application should be an office procedure.
• Store it in narrow-mouthed bottles to prevent evaporation which may lead to an increased concentration of Podophyllin. Discard old, discolored, dried, or gritty preparations.
• Limit drug applications to small areas of intact skin and apply Vaseline in the periphery of the lesion so that normal skin is not affected.
• Keep the volume of the solution applied minimal (≤ 0.4–0.5 mL for P. emodi–based Podophyllin).
• Allow the solution to dry properly. Keep the initial test application in place for one hour and then wash it off.
• In case of an uneventful first application without any inflammation, leave the resin for 4–6 h before washing off on subsequent applications.
• Suspect an allergic reaction to benzoin if pruritis develops.
• Dont use alcoholic beverages, general anesthesia, and CNS depressants for several hours after treatment.
• Dont use Podophyllin during pregnancy.

Singh A, Choudhary R, Ganguly S. Podophyllin in Dermatology: Revisiting a Historical Drug. Indian Dermatol Online J. 2022 Jan 24;13(1):167-171. doi: 10.4103/idoj.idoj_225_21. PMID: 35198500; PMCID: PMC8809147.