Condylomas

Secondary syphilis Without appropriate treatment, primary syphilis will advance to secondary syphilis, a stage usually apparent from its clinical symptomatology. Symptoms include fatigue, diffuse rash, fever, lymphadenopathy, and genital or perineal condyloma latum. Also, the skin is most often affected and a rash may present as macular, macropapular, or pustular lesions, or involve skin surfaces including the palms of the hands and soles of the feet. 

Diagnosis is generally made from the clinical presentation and may be classified into several categories classic condyloma acuminata, which are pointed or cauliform keratotic warts with a thick, horny surface resembling common skin warts and flat warts, frequently observed on the surface. 

Mycosis fungoidesb Condyloma acuminata0 Chronic hepatitis B Hepatitis C Chronic hepatitis D... 

The presence of human papilloma virus (HPV) is associated with female genital tract diseases such as condyloma, Bowenoid papulosis, and cervical, vaginal, and vulvar intraepithelial neoplasia and carcinoma. A general concern is the association of HPV with cervical cancer (Gl). The HPV consists of an icosahedral viral particle (virion) containing 8000 base pairs, a circular, double-stranded piece of DNA surrounded by a protein capsid. Viral replication takes place within the nuclei of infected squamous epithelial cells (H5). Following infection of epithelial cells, the viral DNA penetrates throughout the entire thickness of the epithelium, but intact viruses are found only in the upper layers of tissue. 

Actinic keratosis For the topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Genital and perianal warts Treatment of external genital and perianal warts/condyloma acuminata in patients 12 years of age and older. 

Gardasil was approved by the FDA in 2006. It is a quadrivalent recombinant vaccine against the human papilloma vims (HPV), more specifically against types 6, 11, 16 and 18. It is able to reduce pre-cancerous cervical, vaginal and vulvar lesions, associated with HPV types 16 and 18, as well as condylomas associated with HPV types 6 and 11. With the approval of the first HPV vaccine, cervical cancer now has a primary prevention tool. 

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. 

Alpha interferon is also effective in the treatment of hairy cell leukaemia, condyloma acuminata (caused by papilloma virus), chronic myelogenous leukaemia and AIDS related Kaposi s sarcoma. 

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. 

Percutaneous absorption of podophyllum resin occurs, particularly in intertriginous areas and from applications to large moist condylomas. It is soluble in lipids and therefore is distributed widely throughout the body, including the central nervous system. 

Pure podophyllotoxin (podofilox) is approved for use as a 0.5% podophyllotoxin preparation (Condylox) for application by the patient in the treatment of genital condylomas. The low concentration of podofilox significantly reduces the potential for systemic toxicity. Most men with penile warts may be treated with less than 70 n-L per application. At this dose, podofilox is not routinely detected in the serum. Treatment is self administered in treatment cycles of twice-daily application for 3 consecutive days followed by a 4-day drug-free period. Local adverse effects include inflammation, erosions, burning pain, and itching. 

Dysosma pleiantha (Hance) Woodson Pa Jiao Lian (rhizome) Podophyllotoxin, astragalin, peltatin, etoposide, hyperin, deoxypodophyllotoxin.33 Treat condyloma acuminata, exophytic warts. 

Pre-existing condyloma acuminata have been stated to increase during oral contraception, with regression after withdrawal (244). 

Mariotti F, Ruocco V. Oral contraceptives and sharpened condylomas. Riforma Med 1971 85 429. 

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. 

Dysosma pleianthum (bajiaolian), a species of May apple, is a traditional Chinese herbal medicine rich in podo-phyUotoxin. It has been widely used in China for thousands of years as a general remedy and for the treatment of snake bite, weakness, condyloma accuminata, lymphadenopathy, and tumors. 

Interferon alfa-2b is a broad-spectnim agent. It is indicated for hairy cell leukemia, condyloma acuminata (geniiil or venereal warts). AIDS-rclatcd Kaptrsi s sarconia. and chronic hepatitis B and C infections. 

Genital/anal warts Human papillomavirus Multiple lesions ranging in size from small papular warts to large exophytic condylomas... 

KS CML melanoma hairy cell leukemia renal cell carcinoma NHL multiple myeloma Hepatitis B and C condyloma acuminata... 

Butor et al. (1997) were able to detect and map Human Papilloma Virus (HPV) infected cells labelled by means of FISH in cervical condyloma biopsies using a cDNA probe conjugated with biotin and subsequent detection with FITC conjugated avidin. 

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