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PubMed1990

Vulvar condylomas and squamous vestibular micropapilloma. Differences in appearance and response to treatment.

A study of 37 women with typical condylomas and so-called squamous micropapilloma was undertaken to determine their response to systemic interferon and/or podophyllin treatment. Thirty lesions were classified as condylomas and 9 as squamous micropapillomas; two women had both lesions. Twenty-six (87%) of 30 condylomas responded, whereas only 1 (11%) of the 9 cases of micropapillomatosis showed a partial response (P less than .001) to podophyllin and/or interferon. Twenty-six biopsies from condylomas in which sufficient DNA was available for analysis contained human papillomavirus (HPV) DNA sequences that hybridized to an HPV 6 + 16 probe mix under nonstringent conditions. In contrast, HPV DNA sequences could not be detected in any of the nine cases of micropapillomatosis. Immunoperoxidase studies performed on these lesions failed to demonstrate viral capsid antigen. Thus, despite certain similarities in the clinical presentation and microscopic features of condylomas and squamous micropapillomas, it is not clear at present whether micropapillomas are HPV-related lesions.

Condylomata Acuminata↗

PubMed1994

Anogenital warts in patients attending the sexually transmitted diseases clinic in Ibadan, Nigeria.

One hundred and forty-eight cases of anogenital warts comprising 98 males and 50 females were seen at the Special Treatment Clinic, University College Hospital, Ibadan between May 1977 and 1984. The ages of the patients ranged from 11 months to 49 years. Ten cases occurred in children under 9 years. The peak incidence was in the 20-24 years age group. Local applications with podophyllin was the most frequently recommended therapy as the first line of treatment and produced a cure rate of 38.8% in those treated for three weeks. Thirty-three percent of the patients treated with podophyllin showed marked improvement before they were lost to follow up. Cryotherapy gave a cure rate of 85% but was recommended only for 20 patients. The clinical implication of these findings as well as the limitations encountered in the management of anogenital warts in a developing country are discussed.

Adolescent↗

PubMed2002

A retrospective analysis of costs and patterns of treatment for external genital warts in The Netherlands.

BACKGROUND: External genital warts (EGWs) are one of the most common sexually transmitted infections, but little is known about the treatment patterns or resources used in the management of this condition. OBJECTIVE: The purpose of this retrospective analysis is to examine the patterns of treatment, resource utilization, and costs for EGWs in 3 dermatology clinics in the Netherlands. METHODS: A total of 530 completed episodes of care for EGWs were analyzed to identify patterns of treatment and resources used. Costs of care were calculated based on 4 cost components for each visit: labor costs, material costs, indirect costs, and extra costs. RESULTS: Across the 3 sites, men required an average of 5.78 clinic visits to achieve a completed episode of care; women required an average of 6.52 visits. The distribution of visits is highly skewed, however, with a median of 4.56 visits for men and 5.55 for women. More than 80% of patients were initially treated with monotherapy. Podophyllin and cryotherapy were the principal choices for initial therapy. The mean cost, in euros, of completing an episode of care was 221.34 euro for men and 292.29 euro for women. The cost per completed or successful episode of care was 395.92 euro for men and 485.05 euro for women. The distribution of costs was also skewed, with a relatively small group of patients accounting for a considerable proportion of overall costs. Although only 31.4% of male patients recorded > or = 6 visits for a completed episode of care, this group accounted for 57.3% of the total costs of treatment for male patients. Among female patients, 43.4% had > or = 6 visits, which accounted for 73.9% of the total costs of care for female patients. Costs also varied markedly by therapy sequence chosen. Patients who remained on their initial monotherapy or combination therapy had the lowest costs; the extent to which patients switched therapies substantially affected overall costs. For those patients initially treated with podophyllin, the mean total costs of treatment, taking into account the proportion who required a change in therapy, were 204.84 euro for men and 386.38 euro for women. For those initially treated with cryotherapy, the mean cost of treatment was 193.60 euro for men and 169.23 euro for women. CONCLUSION: Current treatment options for EGWs do not appear to minimize resource utilization or help achieve complete episodes of care at the lowest possile cost.

Adult↗

PubMed1987

Cutaneous pathology following etoposide therapy.

Etoposide (VP-16) is a semisynthetic podophyllotoxin derivative that is active against a number of solid and hematologic malignancies. Previously reported cutaneous complications include Stevens-Johnson syndrome and radiation recall. We report 4 cases of cutaneous eruptions with distinctive histopathologic changes following etoposide therapy. Diffuse erythematous macules and papules developed 5-9 days after initiation of etoposide therapy and resolved spontaneously within 3 weeks. Histologic examination revealed epidermal maturation disturbances with scattered markedly enlarged individual keratinocytes. These cells had pale cytoplasms and fragmented, haphazardly dispersed nuclear chromatin in a starburst pattern ("starburst cells"). Many keratinocytes showed notable nuclear enlargement with multiple prominent nucleoli. In addition, numerous dyskeratotic cells and basilar mitotic figures in metaphase were present. Some of these changes have been described in condylomata acuminata treated with topical applications of podophyllin, a compound structurally related to etoposide. Starburst cells have not been reported in cutaneous eruptions produced by other chemotherapeutic agents. These cells may represent abnormal mitotic arrest secondary to podophyllin and its related compounds.

Adult↗

PubMedDate not supplied

An open, comparative, study of the efficacy of 0.5% podophyllotoxin lotion and 25% podophyllotoxin solution in the treatment of condylomata acuminata in males and females.

The efficacy and safety of topical treatment for external condylomata acuminata with either self-applied 0.5% podophyllotoxin (PT) or hospital-applied 25% podophyllin (PODO) solution was compared in 138 males and 67 females in an open multicentre study. After one week of treatment, wart clearance was observed in 53% of males and 37% of females in the PT group as compared with 19% of males and 19% of females in the PODO group (P < 0.001 in males; P = 0.13 in females). At 5 weeks after commencing treatment, clearance of warts had been achieved in 86% males and 72% females in the PT group as compared with 78% of males and 62% females in the PODO group (P = 0.08 in males; P = 0.14 in females). Treatment had cleared 81% of 180 treated sites in all PT recipients as compared with 61% of 95 treated sites in all PODO recipients (P < 0.001). The increased speed of action of PT was associated with an increased incidence of symptoms and signs of inflammation at treatment sites in both males and females (P < 0.001). These were generally mild, did not interfere with continuing treatment, and were more frequent in those patients whose warts were eradicated most rapidly. Home-based treatment with 0.5% podophyllotoxin lotion in appropriately instructed patients of either sex is superior in efficacy to outpatient applied 25% podophyllin and has the potential to reduce the number of hospital attendances required in genital wart eradication.

Administration, Topical↗

PubMed1987

Optimum treatment of genital warts.

Genital warts (condylomata acuminata) must be treated and controlled carefully because of their frequent relapses and the risk of malignancy. Treatment is by destruction of the lesions. The most frequently used treatment for external warts is podophyllin 20% in ethanol which is applied to the affected area and then carefully washed off after 4 to 6 hours. The effectiveness of this method of treatment varies between 20 and 98%, with the warts generally disappearing in 3 to 4 days. If podophyllin is ineffective or is contraindicated (e.g. in pregnancy), other measures such as surgical removal, electrocautery, cryo-surgery or laser treatment can be used independently or in combination. Other treatments that have been used include topical application of 5-fluorouracil and intralesional or systemic use of interferons. Patients and their sexual partners should be followed for several months after treatment. A Papanicolaou smear should be obtained from women prior to treatment because of the association of human papilloma virus infection with cervical invasive neoplasia.

Condylomata Acuminata↗

PubMed1999

[Giant condyloma of the penis. Clinical case].

OBJECTIVE: To report an uncommon case of giant penile condyloma. METHODS/RESULTS: The patient was treated surgically by denudation and fulguration due to the extent of the penile lesion before treatment with topical podophyllin. The histopathological study was determinant in the diagnosis and the postoperative results were excellent. Papillomavirus infection and B. Lowenstein tumor are discussed. CONCLUSIONS: It is recommended to start treatment with topical podophyllin. If the lesion does not improve, resection and fulguration of the condyloma should be performed. The patient should be followed closely for recurrence.

Condylomata Acuminata↗

PubMed1992

Mechanisms of action of teniposide (VM-26) and comparison with etoposide (VP-16).

Teniposide is the result of extensive, long-term efforts to refine and improve on the cytotoxic activity of naturally occurring compounds extracted from podophyllin resins and purified. Isolation of an extremely potent though minor component of one of the early podophyllin derivatives led in turn to the synthesis and evaluation of several aldehyde condensation products. Two of these, teniposide and etoposide, were further investigated when their considerable antitumor activity in animals became apparent. Recognition of transient DNA breaks induced by teniposide, etoposide, and other podophyllotoxin analogues established not only that their site of activity was DNA but also that their cytotoxic effect was dose-dependent. Extensive investigation has further indicated that a primary mechanism of action of these agents involves inhibition of the catalytic activity of eukaryote topoisomerase II and, more important, the consequent stabilization of the normally transient covalent intermediate formed between the DNA substrate and the enzyme. As a result of elevated enzyme levels or enzyme activity, or both, in transformed cells, topoisomerase II inhibitors are highly selective for cancer cells versus normal cells. Although teniposide is not substantially more potent than etoposide in terms of catalytic inhibition or stabilization of the DNA-enzyme intermediate, it is more readily taken up by cells, which results in greater teniposide accumulation within the cells and, thus, a greater capacity for cytotoxicity.

Antineoplastic Agents↗

PubMed1996

[The CO2 laser treatment of extensive skin changes to the vulva caused by the human papillomavirus (HPV) and refractory to other types of therapy].

The authors describe three cases of large vulvar lesions caused by HPV. One patient has condylomata covering entirely the labia majora and minora, the clitoris, the perineum and the perianal area. The lesions made the structures of the vulva hard to distinguish. She was treated with podophyllin, Solcoderm and diathermy without effect. After 2 applications of Laser vaporisation 40 days apart she was completely cured. The other patient had two big squamous papillomata 3.5 by 3.5 cm and 0.5 cm thick situated on both sides of commissura posterior. She was also treated unsuccessfully with Podophyllin, Solcoderm and surgical excision. She was completely cured by a single-stage CO2-laser treatment. The third patient had condylomata acuminata of the labia minora and majora, fossa navicularis, the perineum and the perianal area. No other treatment had been attempted before. After two sessions of laser vaporisation she was cured, too.

Adolescent↗

PubMed1982

Giant and recurrent condyloma acuminatum: appraisal of immunotherapy.

Eighty-four cases of condyloma acuminatum were presented, with conventional treatment, e.g., surgical excision and fulguration with or without Podophyllin application. Recurrence rate was 28 per cent to 65 per cent, depending on the number and duration of treatments. Immunotherapy was used on 17 patients with recurrent and giant condyloma acuminatum. Condylomata were successfully eradicated in 94.1 per cent of patients, which indicates that immunotherapy is a very effective alternative in the treatment of recurrent and giant condyloma acuminatum.

Adolescent↗

PubMed1999

Resolution of recalcitrant hand warts in an HIV-infected patient treated with potent antiretroviral therapy.

Human papilloma virus (HPV)-related cutaneous manifestations occur with increased frequency and severity among HIV-infected persons. In this report, we describe an HIV-infected man with persistent, severe cutaneous hand warts that did not respond to multiple therapies, including liquid nitrogen cryotherapy, topical dinitrochlorobenzene, topical podophyllin, and intralesional interferon-alfa injections. Approximately 1 year after starting a potent protease inhibitor-containing antiretroviral regimen, the patient's recalcitrant cutaneous warts markedly diminished in size, even though the patient did not receive any specific therapy for the warts after starting aggressive antiretroviral therapy. The patient continued on a potent protease inhibitor-containing antiretroviral regimen and, approximately 2 years later, the warts completely resolved. Our patient's dramatic clinical improvement of cutaneous HPV infection that followed protease inhibitor-containing antiretroviral therapy provides a clear-cut example that protease inhibitor-containing combination antiretroviral therapy can produce significant clinical benefit.

AIDS-Related Opportunistic Infections↗

PubMed1995

Human papillomavirus infection and genital warts: update on epidemiology and treatment.

The treatment of genital warts remains frustrating since it is often painful, expensive, and unsuccessful. Moreover, little is known about the infectivity and natural history of exophytic genital warts or subclinical genital infection with human papillomavirus. The traditional goals of therapy for sexually transmitted diseases--eradication of infection, elimination of symptoms, prevention of long-term sequelae, and interruption of transmission--are currently not attainable for or applicable to genital warts. The medical literature from January 1988 to August 1993 was reviewed for recent studies on the treatment of exophytic warts. The following treatments were included in the reviewed studies: podofilox (which was recently approved by the Food and Drug Administration), podophyllin, cryotherapy, topical 5-fluorouracil, intralesional interferon, systemic interferon, and laser surgery. No single treatment modality was superior to another, and recurrence rates associated with all modalities were high. Treatment of genital warts should be guided by preferences of the patient, and a specific therapeutic regimen should be chosen with consideration of expense, efficacy, convenience, and potential for adverse effects.

Condylomata Acuminata↗

PubMed1978

Systemic reactions to topically applied drugs.

Topical drugs can be absorbed percutaneously in sufficient amounts to cause untoward systemic effects. Generally speaking, infants and young children appears to be more vulnerable than adults. It has been shown that the prolonged and extensive use of topical corticosteroids can induce iatrogenic hypercorticism and that they may also impair the patients ability to cope with stress. Furthermore, the relatively limited use, areawise and timewise, of agents such as phenol, resorcinol, salicylic acid, hexachlorophene, boric acid, mercurials, and podophyllin may suffice to elicit dire systemic reactions.

Administration, Topical↗

PubMed1996

The cost of treating genital warts.

BACKGROUND: Genital warts is a common sexually transmitted disease treated by a variety of medical specialists. Standard therapies offer symptomatic relief but cannot ensure lasting remission. Using the clinical literature, claims databases, and a panel of experienced practitioners, the relative efficacy, cost, and cost effectiveness of five common treatments for genital warts were assessed in this study. METHODS: We reviewed the clinical literature for the following genital wart therapies: podofilox, podophyllin, trichloroacetic acid, cryotherapy, and laser therapy, focusing on their relative efficacy. Physicians experienced in treating genital warts defined standard treatment protocols for men and women patients with moderate wart burdens. Using national claims data and protocols developed by physicians, we derived three economic models based on provider charges, third-party payments, and a resource-based relative value scale, respectively. RESULTS: The literature review demonstrated highly variable success and recurrence rates among treatment methods and failed to show that one treatment provides consistently superior efficacy. In the economic models, treating women generally proved more costly than treating men per episode of care. This was due to the need for more extensive follow-up visits in the treatment of women. Total costs were highest for cryotherapy and lowest for a patient-applied therapy that reduced the need for follow-up visits. CONCLUSIONS: Clinicians should consider both clinical and cost issues when choosing the appropriate treatment for patients with genital warts.

Clinical Protocols↗

PubMed1977

Buschke-Löwenstein's tumour presenting with urinary fistula.

A case of Buschke-Löwenstein's tumour presenting with urinary fistula is described. The large lesion in the subpreputial sac occluded the preputial opening and infiltrated beneath the skin of the shaft of the penis resulting in a fungating growth encasing the fistulous tract. The lesion responded well to 25% podophyllin, which is reportedly unusual.

Adult↗

PubMed1985

Condylomata acuminata in children: report of four cases.

Four cases of condylomata acuminata in children (two boys, two girls) are reported. Three children had perianal warts and one vulvar warts. One of the four children had been sexually assaulted, but a history of sexual contact was absent in the other three. Surgical excision was undertaken in one case and the others responded well to the local application of 25% podophyllin in benzoin tincture compound. In the absence of sexual contact, a non-coital mode of transmission of infection could be a possibility.

Child↗

PubMed1988

Immunotherapy of genital warts with inosine pranobex and conventional treatment: double blind placebo controlled study.

In a multicentre, prospective, randomised, placebo controlled study of 55 patients with histories of genital warts for at least one year, a four week course of inosine pranobex 3 g a day improved the clinical response to conventional treatment (primarily podophyllin or trichloroacetic (now called trichlorethanoic) acid). Although more patients given inosine pranobex improved than those given placebo, the difference in general response between the two groups was not significant. When other variables (numbers of warts and extent of lesions) were considered, however, the patients given inosine pranobex fared significantly better. These results suggest that inosine pranobex may be worth considering as adjunct to treatment of patients with refractory genital warts.

Adult↗

PubMed2003

Successful treatment of bowenoid papulosis in a 9-year-old girl with vertically acquired human immunodeficiency virus.

A 9-year-old black girl with vertically acquired human immunodeficiency virus (HIV) and no history of condyloma acuminata presented with a 4-year history of enlarging and spreading dark brown flat papules in the perineum. Some of the lesions were confluent and extended from the clitoris to the labia majora and posteriorly to the buttocks and perianal region. A biopsy of one of the lesions showed bowenoid features. Our patient had a normal Pap smear, but vaginal and cervical biopsy specimens revealed human papillomavirus type 16. Therapy with topical imiquimod cream every other day was started, but little improvement was noted after 2 months. Application of 25% podophyllin every 4 to 8 weeks was added, and improvement was noted within 1 month. After 1 year of treatment, the patient had complete resolution of all lesions, and she has had no further appearance of lesions. Our case emphasizes the need for increased awareness of the potential for development of bowenoid papulosis in HIV-positive children as well as the successful treatment of our patient with topical therapy alone.

Acquired Immunodeficiency Syndrome↗