American Journal of Clinical Dermatology

, Volume 19, Issue 6, pp 791–803 | Cite as

Efficacy and Safety of Topical Cantharidin Treatment for Molluscum Contagiosum and Warts: A Systematic Review

  • Paras P. Vakharia
  • Rishi Chopra
  • Nanette B. Silverberg
  • Jonathan I. SilverbergEmail author
Systematic Review


Background and Objective

Topical cantharidin is routinely used for the treatment of molluscum contagiosum and warts. The objective of this systematic review is to assess the efficacy and safety of topical cantharidin treatment for molluscum contagiosum and warts.


We performed a systematic review of studies assessing topical cantharidin treatment of molluscum contagiosum or warts. We searched the databases of Cochrane, EMBASE, GREAT, LILACS, MEDLINE, and Scopus. Two authors performed the study selection and data extraction.


Twenty studies (1958–2018) met inclusion/exclusion criteria. Twelve studies assessed warts, and eight studies assessed molluscum contagiosum. Overall, 1752 patients were included (range 0.3–62 years; specified in 15 studies). Clearance rates with topical cantharidin for molluscum contagiosum were variable (range 15.4–100%). Significant clearance of warts with maintenance of clearance was demonstrated with topical cantharidin alone. Topical cantharidin in combination with podophyllotoxin and salicylic acid demonstrated efficacy for plantar warts (pediatric and adult; clearance rate range 81–100%; four studies had 100% clearance), with the majority clearing after a single treatment. Satisfaction with cantharidin therapy was high, especially in molluscum contagiosum. Pain (7–85.7%), blistering (10–100%), and hyper-/hypopigmentation (1.8–53.3%) were the most commonly occurring adverse effects with cantharidin treatment.


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.


Author Contributions

JIS had full access to all the data in the study and takes responsibility for the integrity of the data and accuracy of the data analysis. JIS and NBS provided the study concept and design. PV and RC obtained the data. All authors analyzed and interpreted the data, drafted the manuscript, and critically revised the manuscript for important intellectual content. PV and JIS conducted the statistical analysis. JIS obtained the funding.

Compliance with Ethical Standards


This publication was made possible with support from the Agency for Healthcare Research and Quality (Grant no. K12 HS023011) and the Dermatology Foundation.

Conflict of interest

Jonathan I. Silverberg, Nanette B. Silverberg, Paras P. Vakharia, and Rishi Chopra have no conflicts of interest directly relevant to the content of this article.

Ethics Approval

This study was exempt from institutional review board approval.

Supplementary material

40257_2018_375_MOESM1_ESM.pdf (414 kb)
Supplementary material 1 (PDF 413 kb)


  1. 1.
    Silverberg NB. Pediatric molluscum contagiosum: optimal treatment strategies. Pediatr Drugs. 2003;5:505–12.CrossRefGoogle Scholar
  2. 2.
    López López D, Vilar Fernandez JM, Losa Iglesias ME, Alvarez Castro C, Romero Morales C, Garcia Sanchez MM, et al. Safety and effectiveness of cantharidin-podophylotoxin-salicylic acid in the treatment of recalcitrant plantar warts. Dermatol Ther. 2016;29:269–73.CrossRefGoogle Scholar
  3. 3.
    Cohen BA, Honig P, Androphy E. Anogenital warts in children: clinical and virologic evaluation for sexual abuse. Arch Dermatol. 1990;126:1575–80.CrossRefGoogle Scholar
  4. 4.
    Gottlieb SL, Myskowski PL. Molluscum contagiosum. Int J Dermatol. 1994;33:453–61.CrossRefGoogle Scholar
  5. 5.
    Gibbs S, Harvey I, Sterling J, Stark R. Local treatments for cutaneous warts: systematic review. BMJ. 2002;325:461.CrossRefGoogle Scholar
  6. 6.
    Gibbs S, Harvey I. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2006;(3):CD001781.Google Scholar
  7. 7.
    Kwok CS, Gibbs S, Bennett C, Holland R, Abbott R. Topical treatments for cutaneous warts. Cochrane Database Syst Rev. 2012;(9):CD001781.Google Scholar
  8. 8.
    Ting PT, Dytoc MT. Therapy of external anogenital warts and molluscum contagiosum: a literature review. Dermatol Ther. 2004;17:68–101.CrossRefGoogle Scholar
  9. 9.
    Epstein WL, Kligman AM. Treatment of warts with cantharidin. AMA Arch Derm. 1958;77:508–11.CrossRefGoogle Scholar
  10. 10.
    Nankervis H, Pynn EV, Boyle RJ, Rushton L, Williams HC, Hewson DM, et al. House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst Rev. 2015;(1):CD008426.Google Scholar
  11. 11.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6:e1000100.CrossRefGoogle Scholar
  12. 12.
    Funt TR. Cantharidin treatment of molluscum contagiosum. Arch Dermatol. 1961;83:504–5.CrossRefGoogle Scholar
  13. 13.
    Silverberg NB, Sidbury R, Mancini AJ. Childhood molluscum contagiosum: experience with cantharidin therapy in 300 patients. J Am Acad Dermatol. 2000;43:503–7.CrossRefGoogle Scholar
  14. 14.
    Ross GL, Orchard DC. Combination topical treatment of molluscum contagiosum with cantharidin and imiquimod 5% in children: a case series of 16 patients. Australas J Dermatol. 2004;45:100–2.CrossRefGoogle Scholar
  15. 15.
    Hanna D, Hatami A, Powell J, Marcoux D, Maari C, Savard P, et al. A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children. Pediatr Dermatol. 2006;23:574–9.CrossRefGoogle Scholar
  16. 16.
    Cathcart S, Coloe J, Morrell DS. Parental satisfaction, efficacy, and adverse events in 54 patients treated with cantharidin for molluscum contagiosum infection. Clin Pediatr (Phila). 2009;48:161–5.CrossRefGoogle Scholar
  17. 17.
    Jahnke MN, Hwang S, Griffith JL, Shwayder T. Cantharidin for treatment of facial molluscum contagiosum: a retrospective review. J Am Acad Dermatol. 2018;78:198–200.CrossRefGoogle Scholar
  18. 18.
    Moye VA, Cathcart S, Morrell DS. Safety of cantharidin: a retrospective review of cantharidin treatment in 405 children with molluscum contagiosum. Pediatr Dermatol. 2014;31:450–4.CrossRefGoogle Scholar
  19. 19.
    Epstein JH, Epstein WL. Cantharidin treatment of digital and periungual warts. Calif Med. 1960;93:11–2.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Rosenberg EW, Amonette RA, Gardner JH. Cantharidin treatment of warts at home. Arch Dermatol. 1977;113:1134.CrossRefGoogle Scholar
  21. 21.
    Kartal Durmazlar SP, Atacan D, Eskioglu F. Cantharidin treatment for recalcitrant facial flat warts: a preliminary study. J Dermatolog Treat. 2009;20:114–9.CrossRefGoogle Scholar
  22. 22.
    Panzer HM. Cantharidin: a useful agent in the local treatment of warts. J Germantown Hosp. 1961;2:82–6.PubMedGoogle Scholar
  23. 23.
    Coskey RJ. Treatment of plantar warts in children with a salicylic acid-podophyllin-cantharidin product. Pediatr Dermatol. 1984;2:71–3.CrossRefGoogle Scholar
  24. 24.
    Becerro de Bengoa Vallejo R, Losa Iglesias ME, Gomez-Martin B, Sanchez Gomez R, Saez Crespo A. Application of cantharidin and podophyllotoxin for the treatment of plantar warts. J Am Podiatr Med Assoc. 2008;98:445–50.CrossRefGoogle Scholar
  25. 25.
    Kacar N, Tasli L, Korkmaz S, Ergin S, Erdogan BS. Cantharidin-podophylotoxin-salicylic acid versus cryotherapy in the treatment of plantar warts: a randomized prospective study. J Eur Acad Dermatol Venereol. 2012;26:889–93.CrossRefGoogle Scholar
  26. 26.
    López-López D, Agrasar-Cruz C, Bautista-Casasnovas A, Alvarez-Castro CJ. Application of cantharidin, podophyllotoxin, and salicylic acid in recalcitrant plantar warts: a preliminary study [in Spanish]. Gac Med Mex. 2015;151:14–9.PubMedGoogle Scholar
  27. 27.
    Ghonemy S. Treatment of recalcitrant plantar warts with long-pulsed Nd:YAG laser versus cantharidin-podophylline resin-salicylic acid. J Cosmet Laser Ther. 2017;19:347–52.CrossRefGoogle Scholar
  28. 28.
    Meymandi S, Vaseli B, Aflatoonian M, Abroud F. Efficacy of cryotherapy combined with topical cantharidin application versus cryotherapy and placebo in the treatment of verruca vulgaris: a randomized, controlled clinical trial. JPAD. 2017;27:42–7.Google Scholar
  29. 29.
    Weller R, O’Callaghan CJ, MacSween RM, White MI. Scarring in Molluscum contagiosum: comparison of physical expression and phenol ablation. BMJ. 1999;319:1540.CrossRefGoogle Scholar
  30. 30.
    Moed L, Shwayder TA, Chang MW. Cantharidin revisited: a blistering defense of an ancient medicine. Arch Dermatol. 2001;137:1357–60.CrossRefGoogle Scholar
  31. 31.
    Stazzone AM, Borgs P, Witte CL, Witte MH. Lymphangitis and refractory lymphedema after treatment with topical cantharidin. Arch Dermatol. 1998;134:104–6.CrossRefGoogle Scholar
  32. 32.
    US Food and Drug Administtration. Transcript of the February 24, 2015, meeting of the Pharmacy Compounding Advisory Committee. Available from: Accessed Mar 2018.
  33. 33.
    Coloe Dosal J, Stewart PW, Lin JA, Williams CS, Morrell DS. Cantharidin for the treatment of molluscum contagiosum: a prospective, double-blinded, placebo-controlled trial. Pediatr Dermatol. 2014;31:440–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Paras P. Vakharia
    • 1
  • Rishi Chopra
    • 1
  • Nanette B. Silverberg
    • 2
  • Jonathan I. Silverberg
    • 3
    • 4
    Email author
  1. 1.Department of DermatologyNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Department of DermatologyMount Sinai West of the Icahn School of MedicineNew YorkUSA
  3. 3.Department of Dermatology, Preventive Medicine and Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA
  4. 4.Northwestern Medicine Multidisciplinary Eczema CenterChicagoUSA

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