Condyloma acuminatum

Condyloma acuminatum Intralesional 0.05 ml (250,000 international units) per wart twice a week up to 8 wk. Maximum dose/treatment session 0.5 ml (2.5 million international units). Do not repeat for 3 mo after initial 8-wk course unless warts enlarge or new warts appear. 

Podophyllum resin, an alcoholic extract of Podophyllum palatum is used in the treatment of condyloma acuminatum and other verrucae. 

Imiquimod is an immune response modifier shown to be effective in the topical treatment of external genital and perianal warts (ie, condyloma acuminatum see Chapter 61). The 5% cream is applied three times weekly and washed off 6-10 hours after each application. Recurrences appear to be less common than after ablative therapies. Imiquimod is also effective against actinic keratoses, and possibly, molluscum contagiosum. Local skin reactions are the most common side effect these tend to resolve within weeks after therapy. However, pigmentary skin changes may persist. Systemic adverse effects such as fatigue and influenza-like syndrome have occasionally been reported. 

Podophyllum resin, an alcoholic extract of Podophyllum peltatum, commonly known as mandrake root or May apple, is used in the treatment of condyloma acuminatum and other verrucae. It is a mixture of podophyllotoxin, and peltatin, desoxypodophyllotoxin, dehydropodophyllotoxin, and other compounds. It is soluble in alcohol, ether, chloroform, and compound tincture of benzoin. 

Pirog, E. C., Chen, Y.-T., and Isacson, C. 2000. MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum. Am. J. Surg. Pathol. 24 1393-1399. Pizzolo, G., Vincenzi, C., Nadali, G., Veneri, D., Vinante, F., Chilosi, M., Basano, G., Connelly, M. 

Alfa-2 b (Intron A] Hairy cell leukemia Kaposi sarcoma (AIDS related] chronic hepatitis B condyloma acuminatum malignant melanoma... 

Beta Beta-IA (Avonex] Multiple sclerosis condyloma acuminatum... 

Podophyllotoxin and its derivatives are active cytotoxic agents with specific affinity for the microtubule protein of the mitotic spindle. Normal assembly of the spindle is prevented, and epidermal mitoses are arrested in metaphase. A 25% concentration of podophyllum resin in compound tincture of benzoin is recommended for the treatment of condyloma acuminatum. Application should be restricted to wart tissue only, to limit the total amount of medication used and to prevent severe erosive changes in adjacent tissue. In treating cases of large condylomas, it is advisable to limit application to sections of the affected area to minimize systemic absorption. The patient is instructed to wash off the preparation 2-3 hours after the initial application, since the irritant reaction is variable. Depending on the individual patient s reaction, this period can be extended to 6-8 hours on subsequent applications. If three to five applications have not resulted in significant resolution, other methods of treatment should be considered. 

Pirog EC, Chen YT, Isacson C. MIB-1 immunostaining is a beneficial adjunct test for accurate diagnosis of vulvar condyloma acuminatum. Am J Surg Pathol. 2000 24 1393-1399. 

Interferon alfa-n3 is an immnnomodnlator. These small proteins bind to specific cell membranes and initiate complex seqnences, intracellnlar events, inclnding induction of certain enzymes that prodnce antiproliferative action against tumor cells and inhibit viral replication in virus-infected cells. They are used in the treatment of condyloma acuminatum. 

Recombinant, natural, and pegylated IFNs currently are approved in the United States, depending on the specific IFN type, for treatment of condyloma acuminatum, chronic HCV infection, chronic HBV infection, Kaposi s sarcoma in HIV-infected patients, other malignancies, and multiple sclerosis. 

Viral infections of the skin are very common and include verrucae (human paprUomavims [HPV]), herpes simplex (HSV), condyloma acuminatum (HPV), moUuscum contagiosum (poxvirus), and chicken pox (variceUa-zoster vims [VZV]). Acyclovir (ZOVIRAK), famciclovir (famvir), and vala-cyclovir (VALTREX) frequently are used systemicaUy to treat herpes simplex and varicella infections... 

Frank et al. [63] published in 1996 the results of the treatment of seven genital condyloma acuminatum lesions. There had been 20% ALA applied topically 14 h before light exposure of an argon dye laser with a dose of 100 J cm" at an intensity of 75 or 150 mW cm. After three months four lesions showed a complete response. 

Fehr et al. [64] in 1996 proved, in a group of 24 patients, the selective fluorescence of condyloma acuminatum after an unselective topical 5-aminolevulinic acid application. Furthermore the fluorescence Ih after application was higher with 2.5% ALA than with 20% ALA. The conclusion was that studies evaluating selective photodynamic destruction of condylomas are Justified. 

M.K. Fehr, C.F. Chapman, T. Krasieva, B.J. Tromberg, J.L. McCullough, M.W. Bems, Y. Tadir (1996). Selective photosensitizer distribution in vulvar condyloma acuminatum after topical application of 5-aminolevulinic acid. Am. J. Obstet. Gynecol, 174(3), 951-957. 

Tran YP, Yao L, MaUa P, Song Y, li SS. Successful treatment of giant condyloma acuminatum with combination retinoid and interferon-gamma therapy. Inter J STD AIDS 2012 23(6) 445-7. 

Podophyllin is used in treating venereal warts (condyloma acuminatum) and other papillomas, most commonly as a dispersion in Compound Benzoin Tincture or as a solution in alcohol. It is also rather extensively used in laxative preparations, usually along with other cathartic agents. 

Regulatory Status. The once widespread use of podophyllum resins in OTC laxative preparations has been disallowed. Subject of a German therapeutic monograph external preparations for condyloma acuminatum. ... 

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