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Cantharidine

Author: Vanessa Ngan, Staff Writer, 2003.


Cantharidine — codes and concepts
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What is cantharidine?

Cantharidine is a substance derived from the blister beetle Cantharis vesicatoria. The Chinese have used this ancient medicine for thousands of years for a number of maladies. In the 1950's it was used in the US and other westernised countries to treat warts. However, in 1962 due to new manufacturing regulations, it lost its FDA approval and was removed from the market. This saw a decline in its use until recently where it is being re-evaluated as a viral wart remover that doesn't cause scarring.

Cantharidine is also known as Spanish Fly and its beetle juice sold as an aphrodisiac. The reality is that it is ineffective for this purpose and in fact if swallowed is poisonous and possibly even fatal.

How does cantharidine work and what is it used for?

Cantharidine is a vesicant that causes a blister to form on the wart or growth. This action lifts the wart off the skin and after a few days when the blister has dried the wart will come off. The action of cantharidine does not go beyond the epidermal cells, the basal layer remains intact hence no scarring. Cantharidine is sometimes effective in treating common viral warts and is very frequently effective for molluscum contagiosum. Both are viral skin infections that result in small, benign lesions.

Use of cantharidine

How to use cantharidine

Because of the toxic potential of cantharidine, it should only be used topically and in a professional office setting, applied to the lesions by a doctor.

Cantharidine should be used as follows.

  • First, the doctor pares or shaves the wart (this is not necessary for molluscum contagiosum).
  • Cantharidine (formulated with substances that create an oily or colloidal film) is accurately applied to the wart or molluscum.
  • The liquid is allowed to dry and then covered and sealed with nonporous tape for 4–6 hours.
  • The tape should then be removed and the area washed with soap and water.
  • A blister will form within 24–48 hours.
  • Over the next few days, the blister will dry and the lesion may fall off. If necessary the blistered lesion can be snipped off near the base (local anaesthetic may be required).
  • Healing is normally complete within 4–7 days.
  • Resistant warts or new molluscum lesions may require repeat treatment.

Precautions

Cantharidine should not be used on the following:

It should be used with caution in people with diabetes, peripheral vascular disease or other circulatory problems, as they are more likely to develop complications.

What are the side effects of cantharidine?

Usually, the application of cantharidine on a skin lesion is not painful but the resulting blister can sometimes be uncomfortable. In a small number of patients, a ring of small satellite warts surrounding an original viral wart may appear after cantharidine treatment. However, this complication can just as likely occur with other wart removal therapies.

There is the possibility of complications occurring if used to treat plantar warts on the soles of the feet. Isolated reports of inflammation of lymph vessels (lymphangitis) and cellulitis have been documented.

New Zealand approved datasheets are the official source of information for these prescription medicines, including approved uses and risk information. Check the individual New Zealand datasheet on the Medsafe website.

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Related information

 

References

  • Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications.
  • Chang MW. Cantharidin Revisited. Dermatological Society of Greater New York. Cantharidin.

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