Prigent F, Iborra C, Meslay C
Service de Dermatologie, Centre hospitalier de Saint-Cloud.
Ann Dermatol Venereol. 1996;123(10):644-6.
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.
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.
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.
最近推出了一种20%（质量分数）的戊二醛商业制剂用于治疗跖疣。戊二醛的鼻咽喉肺部毒性是众所周知的。也可能发生过敏性皮肤反应。我们报告一例在正常使用该产品过程中右大脚趾牙髓坏死的病例。
一名7岁儿童因右大脚趾严重、干性且疼痛的牙髓坏死前来就诊。临床检查提示为腐蚀性病变。唯一可能有问题的因素是每天应用20%（质量分数）的戊二醛溶液，持续8周。在开始戊二醛治疗前立即局部应用液氮可能是一个促成因素。经过6周的局部抗生素治疗，病变并未完全愈合。
在法国，通常不用20%（质量分数）的戊二醛治疗疣。在英国广泛使用，在浓度低于10%（质量分数）时显然没有发生重大事故。日本一组最近的报告表明20%（质量分数）的戊二醛有效且安全，这引起了对该治疗方法的新兴趣：此前从未有过坏死的报告。在我们的病例中，坏死发生在产品正常使用之后。腐蚀性作用似乎占主导（浓度、pH值的作用？）。也有因致敏导致的事件报告。此类重复病例导致该产品于1995年12月退出市场。
