The toxicity of topically applied podophyllin in a 16 yr old girl is presented. Coma requiring respiratory support and major neurologic complications as well as hematologic and hepatic toxicity was observed. Therapy with a new modality, charcoal hemoperfusion, resulted in resolution of the acute toxicity, leaving a peripheral neuropathy which had not completely resolved after 4 mo. The pharmacology and suggested treatment measures for the toxicity of this rarely reported agent are reviewed.