Off-Label Treatments: Thinking Out of the Box for Skin Diseases

Dermatologist Ted Rosen says off-label therapies can be as effective, cheaper, or safer than FDA-approved options for skin diseases. Speaking at SDPA's 2026 conference, he notes that FDA approval doesn't dictate practice; many therapies are used off-label because regulatory criteria were met by others. He cites verruca vulgaris treatments like imiquimod and over-the-counter salicylic acid, and highlights additional off-label options for recalcitrant lesions, including oral zinc sulfate, adapalene, bleomycin, and the HPV vaccine. He provides study references: a 2009 trial showing 60% clearance after one month and 80% after two months for zinc; a 2011 adapalene plantar wart study; bleomycin 2021 for resistant warts; HPV vaccine intralesional vs intramuscular results.