Podophyllin, derived from Podophyllum peltatum and Podophyllum hexandrum, is a cytotoxic substance commonly employed to treat genital warts. Podophyllin has been used to treat various dermatological issues; however, there are potential side effects. To mitigate the adverse effects, clinical guidelines have been suggested based on the existing literature.

Clinical Guidelines for Applying Topical Podophyllin:

• Administer podophyllin in a clinical setting.
• Store it in narrow-mouthed containers to prevent evaporation and concentration increase; avoid using old or altered preparations.
• Apply the drug only onto the localized site, covering small areas of intact skin; use Vaseline around the lesion to prevent contact with normal skin.
• Keep the solution volume minimal (≤0.4-0.5 mL for Paeonia emodi-based podophyllin).
• Ensure proper drying of the solution; the test application should stay for 1 hour initially, then can be washed off.
• If the first application causes no inflammation, subsequent applications can be left on for 4 to 6 hours before removal.
• Suspect benzoin allergy if itching occurs.
• Avoid alcohol, general anesthesia and central nervous system (CNS) depressants for hours post-treatment.
• Do not use podophyllin during pregnancy.

Podophyllin resin, a proven cytotoxic agent, necessitates more research for broader dermatological use, especially in skin cancers. Enhanced availability of pure podophyllotoxin (Podofilox) is needed in India. Future research should investigate lower-concentration podophyllin use in other skin conditions – particularly pre-cancerous and malignant disorders.

Source:Singh A, Choudhary R, Ganguly S. Indian Dermatol Online J. 2022;13(1):167-71.