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GARLIC CLOVES FOR VERRUCA VULGARIS
To the Editor:
Warts (verruca vulgaris) are enigmatic in therapy. The
high rate of spontaneous resolution prohibits the use of
aggressive therapy, particularly in the preschool-aged
child who is unlikely to sit still for painful therapeutic
procedures such as liquid nitrogen. Anecdotally, many
of my patients from the West Indies had reported the use
of raw garlic cloves in their country. Reports on the use of
garlic for warts have appeared in the Chinese literature
(1). Garlic extracts (Allium sativum) have recently been
reported to be useful as antiviral agents in the therapy of
cytomegalovirus and herpes simplex virus infections
(2,3).
I treated five children with verruca vulgaris, using
garlic cloves in the following protocol. Their parents
were told to purchase raw garlic, unpressed, and to
cleave a clove in half on a nightly basis and rub the
flat edge of the clove onto each of their child’s warts,
carefully cleansing the surrounding skin so as not to
spread any garlic juices. The areas were covered
overnight with Band-Aids or waterproof tape and
washed off in the morning. All five children were 5
years of age—three girls and two boys with an average
of 2.2 warts, all on the hands. These children were
otherwise healthy, except that three had a history of
atopic dermatitis. None of the warts were very
hyperkeratotic and most were palmar. The patients
were examined every 3 weeks and their parents were
told not to use any other medications for their child’s
warts.
Each of the patients cleared with garlic usage. The
average time to onset of improvement was 3.2 weeks
(range 2–4 weeks) and 9 weeks to clear (range 7–12
weeks). One patient reported itching, and all the patients
mentioned that the agent had a strong aroma. The cost of
the therapy was roughly $1.00 per week.
Garlic cloves appear to be a useful therapy in young
children with hand warts. It is painless and well tolerated.
The mechanism of activity is unknown, but it is felt that
there may be reduced cellular proliferation in virally
infected cells (4) and the induction of an increase in local
nitric oxide by endothelial cells (5). However, garlic can
induce irritation and blistering contact dermatitis, and
mechanical removal of warts may still be the route of
greatest efficacy (6). Patients must be careful to avoid
normal skin and to cover the areas so as not to induce a
blistering contact dermatitis. Although the mechanism of
action is not clear, garlic would seem to be a good
therapeutic option in children with hand warts who
cannot tolerate liquid nitrogen and have failed over-the-
counter salicylic acid therapies.
REFERENCES
1. Zhang S, Zhang M, Xing Y, Zhao L, Wang J. Treatment of
119 cases of verruca vulgaris and verruca plana by external
application of pulvis pepper alba. J Trad Chin Med
1996;16:127–128.
2. Guo NL, Lu D-P, Woods GL, et al. Demonstration of the
anti-viral activity of garlic extract against human cytomeg-
alovirus in vitro. Chin Med J 1993;106:93–96.
3. Tsai Y, Cole LL, Davis LE, Lockwood SJ, Simmons V,
Wild GC. Antiviral properties of garlic: in vitro effects on
influenza B, herpes simplex and coxsackie viruses. Planta
Med 1985;5:460–461.
4. Seki T, Tsuji K, Moritomo T, Ariga T. Garlic and onion oils
inhibit proliferation and induce differentiation of HL-60
cells. Cancer Lett 2000;160:29–35.
5. Kim K, Chun S, Choi W, et al. Differential regulation of
NO availability from macrophages and endothelial cells by
the garlic component S-allyl cysteine. Free Radic Biol Med
2001;30:747–756.
6. Raffat M, Leung AK. Garlic burns. Pediatr Dermatol
2000;17:475–476.
NANETTE B. SILVERBERG, M.D.
New York, NY
LIPOID PROTEINOSIS:
A FOLLOW-UP COMMENT
To the Editor:
In reference to our article, ‘‘Lipoid Proteinosis:
Report of Four Siblings and Brief Review of the
Literature,’’ that appeared in Pediatric Dermatology (1)
recent observations made in the family deserve mention.
During earlier examination of the cases, the parents
denied any consanguinity in their marriage. Recently we
were able to document consanguinity in the parents by
tracing the family pedigree up to six generations (Fig. 1).
Recently the mother delivered a sixth child, a boy
(present age 8 months). The examination of the infant
was within normal limits.
Lipoid proteinosis affects both males and females
equally, and parental consanguinity has been described
in many earlier reports (2–5). Our report includes two
male and two female siblings born to consanguineous
parents and further supports the hypothesis of autos-
omal recessive inheritance. It is suspected to be a
disorder of abnormal collagen production (6). How-
ever, an underlying gene defect still remains to be
identified.
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