About the Treatment
WP is applied by the patient at home and oftentimes is successfully completed with no follow-up visit if the case is not extensive, if treatment days are not routinely skipped, and if the patient stops at the appropriate time (ie, not too early). For most patients, one to two follow-up visits help ensure a high success rate. Good patient education is essential, especially for extensive and widespread cases.
It is important to understand that the WP vehicle (Remedium delivery system) is just as crucial to the effectiveness of the treatment as the active ingredients. A waterproof tape also comes with the treatment to improve maceration and penetration in hyperkeratotic warts. How WP works is best understood by examining its unique properties.
Selectivity. WP is selective in two ways. First, it’s fast-drying adhesive gel stays on the wart if allowed to fully dry (approximately 10-15 minutes) and has minimal contact with normal skin. Second, on the microlevel, as an antineoplastic antimetabolite, 5-FU prevents cell replication and proliferation, thereby destroying rapidly growing wart cells faster than healthy cells.6,7
Occlusion and sustained release. Both occlusion and sustained release amplify the effects of topical medication. The sustained-release adhesive gel of WP contains both of these properties. When combined with the waterproof tape, maceration is increased, therefore further enhancing the penetration of the treatment (note: this is only recommended for hyperkeratotic warts on thick skinned areas).
Adhesive vehicle. The patented delivery system is a hybrid of a gel and a glue. It fully dries in 10 to 15 minutes, yet still releases the medication over a period (ie, overnight). The adhesive vehicle also does not dry so hard that it is difficult to remove. With the 5-FU/SA firmly adherent to the wart through the adhesive vehicle, the irritation, erosion, and inflammation so commonly seen with other topical wart medications is minimized.
Synergy. In order to be successful, a wart treatment must penetrate and destroy the hyperkeratotic layers of the wart and prevent recurrence of this fast-growing lesion. All of the above factors work synergistically to overcome a wart’s defensive barriers to eliminate the lesion while doing minimal damage to normal, perilesional skin.
A 32-year-old man presented with extensive periungual warts on multiple bilateral fingers. The growths were most severe on his left fifth finger, where the patient complained his nail was becoming loose (Figure 1). Occupationally, he was a truck driver and wore gloves most of the day with intermittent heavy lifting. He also reported having moderately sweaty palms. Previously, the warts failed to respond to over-the-counter wart remover and multiple sessions of cryotherapy administered by his primary care provider. The patient reported moderate pain in several warts as well as embarrassment and social stigmatization.
The patient was instructed to apply WP at night, allowing it to fully dry, followed by washing it off in the morning. Due to the thickness of the wart, the patient was advised to apply the waterproof tape at night after the WP dried as well as during the day after WP was washed off. He was advised to return in 5 days.
Six days later, the patient returned stating he had used the WP every night and used the tape night and day (Figure 2). He stated he was able to work without pain and experienced no discomfort.
Due to the development of thick macerated skin, curettage was performed on day 6 of treatment (Figure 3). It was unclear at the end of curettage whether any wart remained. The patient was advised to discontinue WP but continue to wear the tape at night to aid in debridement, and he was to return for follow up in 1 week. At that follow-up, the patient reported that the remaining macerated tissue had either fallen off or was about to fall off and he picked it off with his fingers or a tweezer. Closer inspection revealed residual wart (Figure 4), and the patient was advised to repeat WP treatment for 5 days with tape in the evening only.