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Podophyllum

Podophyllum is a genus of plant also known as May apple or footleaf, whose root and root stem are used to make medicine. Podophyllum is highly toxic when taken orally. Nevertheless, some people take podophyllum orally for jaundice, liver problems, fever, syphilis, hair loss and cancer. Podophyllum is also used to evacuate the bowels, to kill parasitic worms in the intestines and to treat snake bites. Some people use podophyllum to induce abortion. Podophyllum was also formerly used as a laxative until these products were withdrawn from the market due to safety concerns.

Podophyllum is applied directly to the skin to remove warts, including plantar warts and sexually transmitted warts. It is also applied directly to the affected areas to treat white spots on the tongue and mouth, which may be a precursor to cancer.

Podophyllum is used intravaginally to treat gynecological infections.

How does Podophyllum work?

Podophyllum can stop cell division and tissue growth. It may also have laxative effects.

How effective is Podophyllum?

Podophyllum is likely to be effective when used to treat genital warts. Applying Podophyllum resin, also known as podophyllin, in the form of a 10% to 25% suspension in a benzoin tincture directly to the affected area is effective in removing warts caused by the papilloma virus. However, podophyllotoxin, a chemical contained in Podophyllum, is usually used directly as it is less toxic and more effective.

There is not enough scientific data to make a statement about the effectiveness of Podophyllum on raised areas of the mouth and tongue in people with immune system disorders (oral hairy leukoplakia). New research suggests that a single application of a 25% Podophyllum resin benzoin tincture to the affected area can initiate the healing process of wounds caused by oral hairy leukoplakia. There is not enough information regarding the effectiveness of Podophyllum for liver problems and cancer. Further scientific research is needed to evaluate the effectiveness of Podophyllum in these applications.

Safety and side effects

Podophyllum is not safe when taken orally. Podophyllum is toxic. It can cause nausea, vomiting, dizziness, headaches, convulsions, fever, vision changes and hallucinations, low blood pressure, bone marrow problems, paralysis, coma, liver problems and kidney problems. It can take up to 13 hours for symptoms of intoxication to appear. There have been reports of some deaths caused by Podophyllum. Podophyllum poisoning has been successfully treated in some cases using activated charcoal.

Podophyllum applied by a doctor in low concentrations to undamaged skin appears to be safe and harmless for most people. However, it should be washed off within four to six hours after application. The use of Podophyllum on the skin in higher concentrations or on large areas of the body is not safe and harmless. Podophyllum is absorbed through the skin and can have the same harmful effects as orally ingested Podophyllum. Podophyllotoxin, a chemical contained in Podophyllum, is safer and has largely replaced Podophyllum as a treatment.

Precautions and warnings

Pregnancy and lactation: Oral ingestion of Podophyllum or application of Podophyllum to the skin is not safe during pregnancy. There have been reports of deaths and multiple birth defects in babies whose mothers used Podophyllum during pregnancy.

Podophyllum is also not safe to use during breastfeeding. The poison contained in Podophyllum can endanger both mother and breastfed child.

Interactions

There is currently no information on interactions between Podophyllum and medications or supplements.

Dosage

The following dosages have been investigated in scientific studies:

Applied to the skin

  • Podophyllum should not be used for self-medication. Using Podophyllum on too large an area or applying it to fragile skin can increase the risk of poisoning. It is safer to use podophyllotoxin (one of the chemicals contained in Podophyllum).
  • For genital warts caused by the papilloma virus (HPV): A 0.5% podophyllotoxin gel is used twice daily for three days in a row and repeated for 2 to 4 cycles. Podophyllotoxin is a chemical extracted from Podophyllum. Podophyllotoxin may be more effective than Podophyllum and is less toxic.

References

  1. Cassidy DE, Drewry J, Fanning JP. Podophyllum toxicity: a report of a fatal case and a review of the literature. J Toxicol Clin Toxicol 1982;19:35-44.
  2. Frasca T, Brett AS, Yoo SD. Mandrake toxicity. A case of mistaken identity. Arch Intern Med 1997;157:2007-9.
  3. Gupta D, Arora R, Garg AP, Goel HC. Radiation protection of HepG2 cells by Podophyllum hexandrum Royale. Mol Cell Biochem 2003;250:27-40.
  4. Lacey CJ, Goodall RL, Tennvall GR, et al. Randomized controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts. Sex Transm Infect 2003;79:270-5.
  5. Longstaff E, von Krogh G. Condyloma eradication: self-therapy with 0.15-0.5% podophyllotoxin versus 20-25% podophyllin preparations--an integrated safety assessment. Regul Toxicol Pharmacol 2001;33:117-37.
  6. Lozada-Nur F, Costa C. Retrospective findings of the clinical benefits of podophyllum resin 25% sol on hairy leukoplakia. Clinical results in nine patients. Oral Surg Oral Med Oral Pathol 1992;73:555-8.
  7. Mack RB. Living mortals run mad. Mandrake (podophyllum) poisoning. N C Med J 1992;53:98-9.
  8. Prem Kumar I, Rana SV, Samanta N, Goel HC. Enhancement of radiation-induced apoptosis by Podophyllum hexandrum. J Pharm Pharmacol 2003;55:1267-73.
  9. Rosenstein G, Rosenstein H, Freeman M, Weston N. Podophyllum-a dangerous laxative. Pediatrics 1976;57:419-21.
  10. Schwartz J, Norton SA. Useful plants of dermatology. VI. the mayapple (Podophyllum). J Am Acad Dermatol 2002;47:774-5.
  11. Wiley DJ, Douglas J, Beutner K, et al. External genital warts: diagnosis, treatment, and prevention. Clin Infect Dis 2002;35:S210-24.