TREATING VERRUAE IN IMMUNOCOMPROMISED PATIENTS

Seth Orlow (J Am Derm 28:794, 1993) first reported his successful experiences treating warts in 36 children with cimetidine. In an effort to enlighten our profession, I re-reported my 5 year anecdotal experience in a larger sample size of pediatric patients (JAPMA 95(3):229-34, 2005). Griswold (J Immunology 132:3054, 1984) demonstrated Cimetidine’s immuno-modulatory effect in mice via T suppressor cell suppression. That’s the EBM behind cimetidine’s mechanism of action. 

 

15 years later, I’m happy to report cimetidine continues to work about 85 percent of the time in children under 18. This is a wonderful, non-invasive therapy that is perfect against multiple mosaic verrucae affecting large surface areas of the foot. It keeps your pediatric athletes on the playing field during sports season(s). I have, and do use it for adults with less frequency and reduced success rates, especially those over 200 pounds (FDA max allowance is 1,600 mg/day while therapeutic doses range from 20-25 mg/kg in divided doses). Since it has the ability to enhance T helper cell ratios, it stands to reason there’s a chance it could temporarily boost the immune system in someone who’s compromised. 

 

In these difficult cases, I’d strongly recommend conferring with the physician who’s treating the illness creating the immunocompromised state and ensure it assimilates with other concurrent meds. 

 

Barry Mullen, DPM, Hackettstown, NJ 

Courtesy of Barry Block, editor of PM News