Vircin .... for stubborn warts - is it *** all that *** (or just 'that')

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I am exited to read about Pedicis: the champion of Vircin to provide a superior treatment option for those recalcitrant warts that other treatments cannot bust. In a clinical study, VIRCIN, cleared plantar warts in 88% of patients, says Pedicis' research website blurb. Readers interested in the study are provided with a link to the study published in Podiatry Management. The link doesn't work, I searched but failed to find the article.

So, how does Vircin work. The therapeutic delivery of three ingredients can provide the knock out punch. The website has several testimonials from happy doctors who confirm the efficacy of the claim.

How does Vircin succeed where other treatments fail?

The three ingredients listed are:

1. Salicylic Acid - a keratolytic agent, found in many wart treatments
2. Povidone-Iodine - claimed to be anti-viral
3. An IDO inhibitor (IDO is an enzyme made by the warts virus to protect itself from the body's immune response) Tumor cells also make the IDO enzyme.

Sounds like powerful stuff ... always a little curious about marketing claims, I had to go fact checking.
So, let's poke around a little.

Povidone Iodine is anti-viral?

Well, maybe. The marketing literature cites the work of Kawana et al (1997, J Dermatology). I found a little abstract that listed a bunch of viruses inactivated by povidone-iodine. A couple of caveats: firstly, this was demonstrated in-vitro but not in-vivo. Secondly the HPV virus was not tested. Uhm ....
OK, let's move on.

IDO inhibitors

What about the IDO inhibitor, that sounds exiting. There is no information in the marketing blurb to know just what this might be. Never mind, ask the people who sell and make the stuff. Because they must know.
Here's a problem: they won't tell .... it's proprietary so *hushhhhhh*

I am getting a little irritated when those good folk hide behind the 'proprietary' excuse. What are you hiding? How does it look to the inquiring patient who asks to know, when the doctor prescribing the medication can offer a shoulder shrug and, and maybe look back at them, in a mystical fashion.
I checked out Vircin on the 'Medicationdaily' website. That only adds to the puzzle. The ONLY active ingredient listed here is salicylic acid.

Is Vircin 'all that' or just 'that' .......

 

Never heard of it, so went and looked. It may or may not be any good, but too many red flags:
- promoted by testimonials - the FDA and FTC have rules on that; not sure if what they are doing is compliant; but testimonials are always a red flag anyway
- I found the "clinical study" in Podiatry Management (http://www.pedicis.com/vircin-pm.pdf ) ... it was not a clinical study, but just some uncontrolled case reports.
- Where did you find that list of ingredients; I can't find that info anywhere else (I assume you can request it: http://www.pedicis.com/request-product-info.html)
- they state it contains 3 active ingredients "employs an immuno-modulator along with salicylic acid and an anti-viral to provide a one-two-three punch in combating plantar warts", but nowhere is there any info on the "immuno-modulator " and "anti-viral"
- one of the most comprehensive and authoritative online drug databases is drugs.com (though they are prone to occasional error) lists salicylic acid as the only active ingredient; no sign of the "immuno-modulator " and "anti-viral" - they do state the inactive ingredients as "BHT, Ethyl Pyruvate, Glycerin, Povidone Iodine, Propylene Glycol, Transcutol, Triethanolamine" (and that appears to be taken from the label on the product)

As it is an OTC, it doesn't need FDA approval, but it still does need to comply with FDA rules - I don't know enough to know if they are ... but the lack of information on ingredients, the reliance on testimonials and an uncontrolled case series means they very close to the edge or over it.

 

on further investigation, they have a patent pending. found the application here:
https://patents.google.com/patent/WO2016134130A1
in which they list the active ingredients as:
"99 1 parts of a keratolytic; 99 1 parts ethyl pyruvate; and 99 1 parts povidone iodine"

Do not understand why the ethyl pyruvate and povidone iodine are listed on the label of the product as inactive ingredients.

povidone iodine must be the antiviral, but its a pretty weak one
ethyl pyruvate is an antiinflammatory agent, so must be the claimed "immune modulator" ... that is a bit of a stretch

 

Hmm. I tend to agree with my colleagues scepticism. Immonomodulating meds which are licensed for both benign and malignant skin tumours (such as Imiquimod) INCREASE cytokine activity with the aim of achieving a heightened immune response via a cell-mediated adaptive response to eradicate the fast growing cells and provide long-term immunity. So, I fail to see how an immunomodulating med which is ANTI-INFLAMMATORY could achieve the same, or "superior" results.

I'm not at home at the moment, so will take a closer look at this product tomorrow.

 

Craig,

Several colleagues here seem to like the stuff, which prompted the detective work. Problem with those pesky warts; we all know too well, they do like to entertain with spontaneous remission, as and when there is a productive innate immune response. And whatever treatment / podiatrist last saw to that foot gets to have all the praise & glory. Explains why the wart might , among many other claimed cures, answer to the kiss of the Blarney Stone .... it's not unusual (common practice) for products and treatments in the US to get the marketing make-over, the nature of the beast in the commerce driven health-care market. And I don't care, as long as the reality can meet the hype .... at least half way.

http://www.medicationdaily.com/vircin-advanced-wart-treatment/ingredients

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764803/

An Armamentarium of Wart Treatments, Michelle M. Lipke, MPAS, PA-C

A Smorgasburg of options that omits the IDO inhibitor which might not be on the radar 10 years ago. (Alternatively the IDO never was on the radar)

I am delighted there is the old duct tape option cited here, which outperformed cryo on a head-to-head .... ah, nostalgia

After consulting with The University of Wikipedia, I can state with confidence that ethyl pyruvate does not feature as a potential candidate for that IDO inhibitor. The good people at Pedicin have a lot of explaining to do. Is that why the mystical IDO ingredient remains a hidden proprietary compound?

 

Yeah, it`s all a bit cloak `n dagger, but I reckon the patent pending will be claiming that BHT (butylated hydroxytoluene) is the anti-viral for two reasons;

1) It is listed first in the "inactive" ingredients,
2) There is some weak evidence that as an `antioxidant` - gotta work then as the equivalent of a `superfood` ie, a `super anti-viral`- it MIGHT have some virustatic effect. On some virus particles. However, this is doubtful in the case of HPV as the virus is safely encompassed in an immune-response defying (with down regulated cell-surface markers) keratinocyte for protection against the more effective antimicrobials brought about by an innate response than BHT.

Here is a link to that piece of `evidence` - written in 1975 (we`ve progressed a tad in HPV evasion of host immunity understanding since then) - that BHT may be anti-viral; https://jhu.pure.elsevier.com/en/pu...oluene-inactivates-lipid-containing-viruses-3


Next.

 

The role of IDO inhibitors as adjuvants in HPV treatment are discussed in one of my favourite papers, but doubt this is actually what Pedicis are utilising...https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3856406/

 

Taken from the `clinical trial` http://www.pedicis.com/vircin-pm.pdf; "Of the 12 patients treated with VIRCIN in our practice, all warts resolved, with most in 2-6weeks".

"All warts"? Really? Anyone who claims a 100% success rate is sus. Yes, they have provided before and after pics for their best two participants for this trial. Do the post-op pics appear to be resolved lesions, ie the return of normal dermatoglyphcs? Nope. Moreover, anyone who claims to resolve a lesion associated with HPV within 2 weeks, do not posses appreciation for basic skin turn-over times....

 

Shall I go on?....No.

 

yes, go on .... I'm enjoying this

Also, Belinda what might be plausible candidates for the IDO inhibitor? Are there any anti-viral topical compounds on the market containing such an agent?

 

Since this stuff costs $40 for a .5 oz tube, it looks like just another expensive concoction to foist on an unsuspecting public. Good old Wartstick is 40% Salicylic Acid and costs under ten bucks for .4 oz. 8 oz of Povidine Iodine costs around five bucks. Ethyl pyruvate goes for around $30 for 50 grams.

That the company has a link to a "clinical trial" in Podiatry Management makes the whole thing rather suspect. One podiatry practice following 12 patients? Really? That's the best that they could come-up with? And, I'm not terribly impressed with the before and after pictures either.

I wouldn't even be following this thread if it weren't for the fact that I decided after 10 years of not having plantar warts that it was safe to go back into the water. Well, if the water is in a swimming pool, that was a bad assumption. Now I'm back to fighting to get rid of the damned things again.

And, until there's some actual clinical trials supporting the manufacturer's claims, Vircin doesn't look like it's worth the bother.

 

Well, I can understand the cynicism .... I approached Pedicis about a patient with stubborn plantar warts (5 years, already tried the gamut of treatments elsewhere) . I asked if they can agree to provide free treatment to trial it out. To my surprise, Pedicis agreed. The patient will return tomorrow when I can offer her two options. If she elects Vircin I will be very interested to follow up, with clinical pictures. As for your conundrum, why not try Falknor's Needling method.

 

As the head of the lab at the Lankenau Institute for Medical Research (LIMR) that discovered the IDO inhibitor used in Vircin - ethyl pyruvate (EP) - I am delighted to read of the positive experience of podiatrists with this product. The original report on the IDO inhibitory activity of ethyl pyruvate was published in Muller et al. (2010) Cancer Research 70, 1845. This compound is widely used as a keratinolytic (skin penetrant) but its immunomodulatory properties were not recognized until our publication. IDO inhibitors are being developed for use in cancer treatment, but there is a scientific basis for interest in IDO inhibitors to treat chronic infections, e.g. HPV infections in squamous epithelia (Mittal et al. (2013) J Invest Dermatol 133: 2686-94).

Pedicis Research learned of the discovery via personal contact with the Lankenau Institute, which provided the first formulation to podiatrists (termed SAEP for salicylate/EP) before Pedicis elected to go out with the product on their own, adding iodine as a variant formulation. As noted above, a valid clinical trial has yet to be completed for either formulation. There is interest at LIMR in collaborating with podiatrists who may like to participate in randomized controlled trials, including for an additional experimental product developed in our labs to eradicate nail fungus (EPIC). Experience in research studies is necessary; please contact us if potential interest in participating in trials of either of these experimental agents.

George Prendergast, PhD, LIMR