Use of Topical Nitric–Zinc Complex Solution to Treat Palmoplantar and Periungual Warts in a Pediatric Population

Abstract

Introduction: Nitric-zinc complex solution (NZCS) is a topically applied solution containing nitric acid, zinc, copper, and organic acids that induce a painless caustic effect on ''difficult-to-treat'' warts, including palmoplantar and periungual locations. The objective of the present prospective clinical study was to describe the efficacy and tolerability of NZCS in the treatment of palmoplantar and periungual warts in children. Methods: Eligible patients were immunocompetent children and adolescents, with at least one palmoplantar or periungual wart. NZCS was topically applied every 2 weeks in clinic. Efficacy was recorded by clinical evaluation, and acceptability assessments were measured using a visual analogue scale (VAS). Results: Pediatric patients (N = 12) were equally distributed by gender, and the mean age was 9.60 ± 3.34 years. The youngest patient was 4 years old. A total of 31 warts were identified: 24 periungual warts (77.4%), 2 palmar warts (6.45%), and 5 plantar warts (16.12%). We observed complete resolution in 83.9% of the warts treated with NZCS, achieving total cure considered as therapy success in 87.5% of periungual warts and 71% of palmoplantar warts, with a mean of 6.0 treatment sessions. The esthetic results evaluated by the investigator were considered excellent in 83.3% of cases and good in 16.7%. In 100% of the completely resolved cases, no scars, erythema, hyperpigmentation, hypopigmentation, or hypertrophy in the area surrounding the treated warts were observed by the investigator. The esthetic results evaluated by the patients or parents/guardians were excellent. Pain and burning sensation were minimal and well tolerated. No clinically relevant adverse events were reported. Conclusion: NZCS was an effective treatment of warts in this pediatric population. The painlessness, simplicity, and twice-monthly dosing regimen of this treatment represents an advantage over standard approaches.

Treatment of cutaneous viral warts in children: A review

“…There is limited data on the efficacy and safety of other topical therapies for the treatment of warts in children. Reported clearance rates were 99% for formalin with or without curettage, 83.9% for nitric‐zinc complex solution, 81.8% for pyruvic acid, 78.3% for promicid gel under occlusion, 73.3% for promicid gel without occlusion, 59.3% for monochloroacetic acid (MCA), 56.3% for silver nitrate, 42.9% to 100% for retinoids (including adapalene) and 22.2% for cantharidin 12‐14,17,24,26,33,36‐39 Side effects reported in some of the studies included pain (75.8%) and blistering (36.7%) with MCA 24 and pain, stinging or soreness with promicid gel (33.9%) 39 . No side effects were reported in studies for nitric‐zinc complex solution or adapalene gel 26,37 …”

Cryotherapy versus topical nitric‐zinc complex solution for the treatment of plantar warts: A randomized controlled trial

“…To the best of our knowledge, only one randomized clinical trial has been published to date on treating AGW with the nitric–zinc complex, 12 making the present study the first clinical trial to evaluate its efficacy in plantar warts. Notably, case series examining the treatment of palmoplantar warts with the zinc–nitric complex have reported very high cure rates, with Cusini et al 14 observing a 100% cure rate and Giacaman et al 15 reporting a cure rate of 71%. Furthermore, Giacaman et al observed an 87.5% cure rate for periungual warts 15 .…”

Treatment of Warts in Pediatrics: A Review

“…Another study of 12 pediatric subjects used nitric zinc complex solution to treat periungual warts, palmar warts, and plantar warts and found 83.9% clearance. Some patients experienced mild burning sensation and pain [29]. This presents as an easily accessible and safe option for the pediatric population.…”