[Cutaneous necrosis secondary to topical treatment of wart with 20 p. 100 glutaraldehyde solution].

INTRODUCTION

A commercial 20 p. 100 formulation of glutaraldehyde was recently introduced for the treatment of plantar warts. The rhinopharyngopulmonary toxicity of glutaraldehyde is well known. Allergic skin reactions may also occur. We report a case of necrosis of the pulp of the greater toe during normal use of this product.

CASE REPORT

A 7-year-old child consulted for major, dry and painful necrosis of the pulp of the greater right toe. Clinical examination suggested a caustic lesion. The only agent which could be incriminated was a daily application of a 20 p. 100 glutaraldehyde solution every day for 8 weeks. Local application of liquid nitrogen immediately before beginning the glutaraldehyde treatment may have been a favoring factor. After 6 weeks of local antibiotherapy, the lesion had not completely healed.

DISCUSSION

In France, warts are not usually treated with 20 p. 100 glutaraldehyde. Used extensively in Great Britain, there have apparently been no major accident at concentrations under 10 p. 100. The recent report by a Japanese group indicating the efficacy and safety of 20 p. 100 glutaraldehyde has led to renewed interest in this treatment: necrosis has never been reported. In our case the necrosis occurred after normal use of the product. The caustic effect appears to dominate (role of concentration, pH?). Incidents due to sensitization have also been reported. Repeated cases of this type have led to the withdrawal of the product from the market in December 1995.