Cantharidin Gel-forming Suspension
Cantharidin Gel-forming Suspension is a liquid vesicant medication comprised primarily of cantharidin and acetone. Cantharidin is a chemical derived from the secretions of one of several different types of blister beetles. When applied to the skin cantharidin causes blister formation.
Edge Pharma’s Cantharidin suspension has the same active ingredient as Cantharone® and Canthacur®. Due to compounding pharmacy regulations, US-based practices cannot purchase non-patient specific office use cantharidin from Canadian-based pharmacies. Cantharidin also cannot be purchased from traditional (503A) compounding pharmacies for office use, since these facilities do not maintain the proper process controls and undergo the required testing to ensure the product is safe for office use. Cantharidin from Edge allows practices to both be in compliance, as well as be secure the product is made in an FDA registered and inspected outsourcing facility.
Qualified practitioners can buy Cantharidin suspension in a 10 ml glass multi-dose bottle without providing patient names. Our online system makes purchasing cantharidin quick and easy.
- Cantharidin 0.7%
- Storage: room temperature
- Cantharidin 1.0%
- Salicylic Acid 30.0%
- Contains Podophyllum Resin
- Storage: room temperature
Cantharidin and HPV
Human Papilloma Virus (HPV) is the most common sexually transmitted disease worldwide, with an estimated 80% of individuals exposed by the age of 50.(1) Some 100 different types of HPV have been identified and of these 40 can affect the genital area. “Most HPV infections are self-limited and are asymptomatic or unrecognized.”(2) Condyloma Acuminatum (genital warts) are caused by HPV.(3)
Topical wart treatments for genital warts may include:
- Imiquimod (Aldara, Zyclara)
- Podophyllin and podofilox (Condylox)
- Trichloroacetic acid
- Sinecatechins (Veregen)(4)
Another treatment regimen, cantharidin and cantharidin combination products, work by causing skin to blister and then peel off. “They are used by doctors to remove external genital warts (i.e. warts on the penis or the vulva.)” Cantharidin, like other topical treatments, causes some local pain or blistering.(5)
A study published in a 2018 medical journal compared cantharidin 0.7% with trichloroacetic acid (TCA) on women with newly diagnosed genital warts. Half of the subjects were treated with cantharidin and half with TCA. Subjects were asked to return two weeks after the procedure for evaluation.(3)
A total of 15 warts were treated with cantharidin and 14 with TCA. The subjects treated with cantharidin had 100% clearance of warts compared with 66% clearance for those treated with TCA.(3)
The study concluded, “Further work and higher power studies are necessary to compare this modality to others as well as to determine if this treatment modality can be safely adapted for use on larger warts, warts closer to mucosal surfaces and on internal warts as these are harder to treat with conventional modalities.”(3)
(1 )Hathaway, Jon K. M.D., PhD, Clinical Obstetrics and Gynecology, HPV: Diagnosis, Prevention, and Treatment, https://pubmed.ncbi.nlm.nih.gov/
(2) Centers for Disease Control and Prevention, Human Papillomavirus (HPV) Infection, https://www.cdc.gov/
(3) Recanati, M. M.D., Kramer, K. M.D., et. al., Clinical and Experimental Obstetrics and Gynecology, Cantharidin is Superior to Trichloroacetic Acid for the Treatment of Non-mucosal Genital Warts: A Pilot Randomized Controlled Trial, https://www.ncbi.nlm.nih.gov/
(4) Mayo Clinic, Genital Warts: Diagnosis and Treatment, https://www.mayoclinic.org/
(5) Skin Care Alliance, Genital Warts: Diagnosis and Treatment, https://www.canadianskin.ca/
Cantharidin and Molluscum Contagiosum
Molluscum Contagiosum is a common viral infection of the skin, usually found in children. Adults with weakened immune systems can also be affected. Molluscum contagiosum results in round, painless bumps that range in size from a pinhead to a pencil eraser.(1)
Signs and symptoms of molluscum contagiosum include bumps on the skin that:
- Are raised, round, and flesh colored
- Are small — typically under about 1/4 inch (smaller than 6 millimeters) in diameter
- Characteristically have a small indentation (umbilication) or dot at the top near the center
- Can become red and inflamed
- May be itchy
- Can be easily removed by scratching or rubbing, which can spread the virus to adjacent skin
- Usually appear on the face, neck, armpits, arms, and tops of the hands in children(1)
Since molluscum contagiosum often spontaneously resolve, some clinicians recommend not treating them. The non-treatment approach has drawbacks in that some lesions can take several months or years to resolve, and there is a likelihood of transmission to others in the household, daycare facility, or school.(2) A study among 300 children who were not treated showed the average time for natural resolution of molluscum contagiosum was 13.3 months. In a 24-month period, transmission of molluscum contagiosum to other children in the household was recorded in 41 percent of cases.(2)
Topical cantharidin is commonly used to treat molluscum contagiosum.(3) Cantharidin is a keratolytic agent made from the blistering beetle. It causes a blister to develop on the bump, which resolves as the blister heals. Generally, cantharidin is applied in a provider’s office and then washed off with soap and water at home.(4)
A retrospective study reviewing charts of 300 children with molluscum contagiosum examined the efficacy of cantharidin treatment. With cantharidin therapy, 90 percent of children experienced clearing and 8 percent had improvement. A total of 95 percent of parents reported they would choose cantharidin again if their child needed treatment.(5)
(1) Mayo Clinic, Molluscum Contagiosum, https://www.mayoclinic.org
(2) Del Rosso, J. D.O., Kircik, L. M.D., Journal of Clinical and Aesthetic Dermatology, Topical Cantharidin in the Management of Molluscum Contagiosum: Preliminary Assessment of an Ether-free, Pharmaceutical-grade Formulation, https://www.ncbi.nlm.nih.gov/
(3) Vakharia, P. M.D., Chopra, R. American Journal of Clinical Dermatology, Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Wars: A Systematic Review, https://pubmed.ncbi.nlm.nih.gov/
(4) The Society for Pediatric Dermatology, Molluscum Contagiosum, https://pedsderm.net/
(5) Silverberg, N., Sidbury, R. Mancini, A., Journal of American Academic Dermatology, Childhood Molluscum Contagiosum: Experience with Cantharidin Therapy in 300 Patients, https://pubmed.ncbi.nlm.nih.gov/
Plantar warts, or Verruca Plantaris, can affect anyone, yet there are risk factors that make them more likely, according to a leading medical center. Plantar warts are most likely to affect:
- Children and teenagers
- People with weakened immune systems
- People who have had plantar warts before
- People who walk barefoot where exposure to a wart-causing virus is common, such as locker rooms(1)
Plantar warts often go away on their own, however, “wart treatment is indicated for numerous reasons including irritation, pain, cosmetic embarrassment and risk of transmission.”(2)
A retrospective study published in a leading podiatry journal reviewed records of 144 patients with plantar warts who were treated with a compounded solution of cantharidin, podophyllotoxin, and salicylic acid. It was the initial treatment for 92 of the 144 patients. After six months, 95.8% of the patients experienced complete eradication of the plantar warts. The study concluded the compounded topical solution was “safe and effective,” and that it is a “promising alternative treatment modality for plantar warts.”(3)
(1) Mayo Clinic, Plantar Warts, https://www.mayoclinic.org/
(2) Weber, C. D.P.M., Hoffman, K. D.P.M., Podiatry Today, How to Treat Recalcitrant Plantar Warts, https://www.podiatrytoday.com/
(3) Vallejo, R. DPM, PhD, Iglesias, M. PhD, et. al., Journal of the American Podiatric Medical Association, Application of Cantharidin and Podophyllotoxin for the Treatment of Plantar Warts, https://pubmed.ncbi.nlm.nih.gov/
1) Al-Dawsari NA, Masterpol KS. "Cantharidin in Dermatology." PubMed.gov. https://www.ncbi.nlm.nih.gov/pubmed/27319954
"Cantharidin is natural toxin produced by the blistering beetle. It has both vesicant and keratolytic features by inducing acanthloysis through targeting the desmosomal dense plaque, leading to detachment of the desmosomes from the tonofilaments. There are two available liquid preparations for dermatologic use, Canthacur (0.7% cantharidin) and Canthacur PS (1% cantharidin 30%/salicylic acid/2% podophylotoxin). The former preparation is indicated for the treatment of common warts, periungual warts, and molluscum contagiosum, while the more potent latter preparation is indicated only for plantar warts. Both preparations provide painless applications with outcomes similar to other treatment modalities for warts and molluscum contagiosum; however, neither is approved by the Food and Drug Administration (FDA)."
2) Kartal Durmazlar, Selda Pelinxs, Damla Atacan, and Fatma Eskioglu. "Cantharidin treatment for recalcitrant facial flat warts: a preliminary study." Journal of Dermatological Treatment 20.2 (2009): 114-119.
"All the patients were clinically cured within 16 weeks and the number of required sessions for complete clearance was 2.6 ± 1.18."
"Cantharidin therapy was well tolerated, with mild adverse events related to skin. Conclusion: Cantharidin is safe and effective when applied to flat warts without occlusion for 4–6 hours every 3 weeks till clear."
3) Torbeck, Richard; Pan, Michael; de Moll, Ellen; & Levitt, Jacob. "Cantharidin: A Comprehensive Review of the Clinical Literature." Dermatology Online Journal, 20(6). doj_22861. (2014) Retrieved from: http://escholarship.org/
"The incidence of adverse effects associated with cantharidin for MC are: blistering (92%), erythema (37%), pain (14%), burning (10%), and pruritus (6%). Despite these adverse effects, 95% of parents polled stated they would choose cantharidin for MC treatment."
"Cantharidin has been used to manage flat, palpebral, plantar, periungual, and subungual warts in an office setting."
"When compared to cryotherapy, cantharidin required fewer treatments to achieve resolution (4.14 vs. 2.71). The rate of recurrence with cantharidin treatment was low, with no recurrences at six months in 144 patients with flat warts and only 1 recurrence at 1 year for digital/periungual warts."
"Potential novel applications of cantharidin include application in acquired perforating dermatosis, acute herpes zoster, and leishmaniasis."
4) López López, D., Vilar Fernández, J. M., Losa Iglesias, M. E., Álvarez Castro, C., Romero Morales, C., García Sánchez, M. M. and Becerro de Bengoa Vallejo, R. (2016), "Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Warts: A Systematic Review. 29: 269–273. doi:10.1111/dth.12356
"All patients reported treatment, supporting our results that CPS [Cantharidin-Podophylotoxin-Salicylic Acid] is a safe and efficacious treatment modality for RPW and should be considered when symptomatic infection necessitates treatment."
5) Vakharia PP, Chopra R, Silverberg NB, Silverberg JI, Am J Clin Dermatol. 2018 Dec, "Safety and Effectiveness of Cantharidin–Podophylotoxin–Salicylic Acid in the Treatment of Recalcitrant Plantar Warts: A Systematic Review. https://www.ncbi.nlm.nih.gov/
"Topical cantharidin demonstrated clearance of warts, particularly in combination with podophyllotixin and salicylic acid, and modest benefit for pediatric molluscum contagiosum with good tolerability and safety."
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