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Is Local Wart Therapy With Podophyllotoxin Safe During Pregnancy? Interview with:
Niklas Worm Andersson, MD
Department of Clinical Pharmacology,
Copenhagen University Hospital Bispebjerg and Frederiksberg,
Copenhagen NV, Denmark What is the background for this study? What is Podophyllotoxin used for?

Response: Podophyllotoxin is an antimitotic agent primarily used in the local treatment of anogenital warts, which are among the most prevalent sexually transmitted diseases worldwide. Most women affected by anogenital warts are of childbearing age and during pregnancy, they may become symptomatic, enlarge, or multiply. While podophyllotoxin is part of first-line treatment of anogenital warts for the non-pregnant population, it is contraindicated during pregnancy. Fetal safety data are limited and to our knowledge, no previous human data exist to help inform on this issue. What are the main findings?

Response: From a nationwide source cohort of more than 1.6 million pregnancies in Denmark, we identified up to 1896 pregnancies exposed to podophyllotoxin and these were matched with up to 18960 unexposed pregnancies (the exact size of the study cohort depending on the specific outcome analyses).

We found no association between local podophyllotoxin exposure during pregnancy and adverse fetal outcomes, including major birth defects, spontaneous abortions, preterm births, small-for-gestational-age size, and stillbirths. What should readers take away from your report?

Response: This study provides reassuring data on the fetal safety of local podophyllotoxin use in pregnancy. While this study may help guide future recommendations for clinical decision-making, as this is the first observational study to examine this issue, the results should be confirmed in other independent populations. What recommendations do you have for future research as a result of this work? 

Response: Additional studies are needed to confirm and expand on these findings, in particular, regarding the risk of individual birth defects. 

No conflicts of interest. 


Andersson NW, Andersen JT. Association Between Fetal Safety Outcomes and Exposure to Local Podophyllotoxin During Pregnancy. JAMA Dermatol. Published online January 08, 2020. doi:


Last Modified: Jan 8, 2020 @ 8:16 pm 

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