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High recurrence rate and adverse effects were common shortcomings in treatments for genital warts, but a number of clinical studies have found that photodynamic therapy (PDT) had some unique superiority compared to other treatments. This study aims to evaluate the efficacy and safety of PDT for genital warts in comparison to alternative treatments. Seven databases and ClinicalTrials.gov were searched and seven randomized controlled trials were finally included. There was no significant difference in clearance rate of urethral lesions between the PDT group and the CO2 laser therapy (CO2‐LT group) (Odds ratio [OR] 0.676, 95% confidence interval [CI] 0.071–6.426, P = 0.734), but the overall clearance rate of all genital warts was slightly lower for PDT (OR 0.574, CI 0.335–0.985, P = 0.044). The recurrence rate after PDT was significantly lower than after CO2‐LT (OR 0.318, CI 0.220–0.460, P < 0.001), and adverse effects were also slighter after PDT (OR 0.015, CI 0.003–0.074, P < 0.001). In addition, a modification of parameters of light irradiation provides the potential to alleviate pain. This study shows that PDT is an effective treatment for genital warts with good tolerability and safety, especially for cavitary lesions. Some modified protocols probably have the potential to reduce adverse effects, but still need further investigation. High recurrence rate and adverse effects were common shortcomings in treatments for genital warts, but a number of clinical studies have found that photodynamic therapy (PDT) had some unique superiority compared to other treatments. This study aims to evaluate the efficacy and safety of PDT for genital warts in comparison to alternative treatments. Seven databases and ClinicalTrials.gov were searched and seven randomized controlled trials were finally included. The study shows that PDT is an effective treatment for genital warts with good tolerability and safety, especially for cavitary lesions. Some modified protocols probably have the potential to reduce adverse effects, but still need further investigation. [ABSTRACT FROM AUTHOR]

Pemphigus vegetans is a rare variant of pemphigus vulgaris, characterized by vegetating lesions primarily in the flexures. A 41‐year‐old male patient presented with pemphigus vegetans highly mimicking condylomata acuminata, which led to mistreatment. Careful analysis of clinical and laboratory findings enabled us to reach a correct diagnosis and successful treatment. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic inflammatory disease with characteristic skin manifestations. Several pathogens can cause flare‐ups of psoriasis. The risks of skin infections are increased in patients receiving immunomodulators. A patient with chronic psoriasis presented with human papillomavirus infection and anogenital warts and was treated surgically with acceptable results. [ABSTRACT FROM AUTHOR]

Traditional treatment modalities for wart require long‐term treatment course and usually have high recurrence rates and unwanted side effects. In this review article, we evaluated different types of laser therapy in the treatment of warts. Published articles since 2000 up to July 2020 about laser therapy in genital and non‐genital warts were searched and assessed. Fifty articles were selected for the final review, including 22 pulsed dye laser (PDL), 10 neodymium‐yttrium‐aluminum‐garnet (Nd: YAG), 3 erbium‐doped yttrium‐aluminum‐garnet (Er: YAG), 14 carbon dioxide (CO2) laser and one systematic review. Complete response rates were different in terms of laser type used (0%‐100%, 9.1%‐100%, 83.3%‐100%, and 59.15%‐100% for PDL, Nd: YAG, Er: YAG, and CO2 laser, respectively). There was no significant difference between conventional treatment modalities and laser therapy regarding efficacy and recurrence rate. Combination of lasers with keratolytic agents, immunomodulators and photodynamic therapy can be helpful especially in immunosuppressed patients, refractory, and recurrent lesions. PDL has the lowest occurrence of adverse effects relative to other types of lasers. [ABSTRACT FROM AUTHOR]

Genital warts caused by the human papillomavirus (HPV) are the most common sexually transmitted disease and have a negative impact on quality of life. Of the more than 200 different types of HPV, low‐risk types 6 and 11 are mainly responsible for the development of condyloma acuminata. Despite a large arsenal of local therapies such as numerous topical agents, CO2 laser ablation, and surgical removal, genital warts tend to be recalcitrant. HPV vaccination is mainly used as a preventive strategy to prevent genital warts, cervical cancer, and other anogenital cancers. However, in a few cases, HPV vaccination has been shown to be a good treatment alternative for patients with recalcitrant skin warts. Here we report five cases of recalcitrant genital warts that responded well to treatment with the nonavalent HPV vaccine. HPV vaccines could be beneficial as a noninvasive treatment alternative for recalcitrant genital warts. [ABSTRACT FROM AUTHOR]

Abstract: To date, epidermoid cysts associated with human papillomavirus (HPV) infection have been described mainly in palmoplantar locations, and have involved HPV types 60 and 57. In contrast, HPV‐6/11 is a major cause of condyloma acuminatum. Here, we report the case of a healthy 31‐year‐old man who presented to our clinic with a 1‐month history of a 1‐cm, reddish‐brown, cystic scrotal tumor with a punctum. The lesion was studied histologically, immunohistochemically and by DNA–DNAin situ hybridization. Histology revealed an epidermoid cyst with vacuolated keratinocytes with shrunken nuclei (koilocytes) in the cyst wall. Immunostaining was positive for HPV antigens and in situ hybridization revealed HPV‐6/11 DNA in the koilocytes. This is the first report of an HPV‐6/11‐associated epidermoid cyst in the anogenital skin of an immunocompetent individual. [ABSTRACT FROM AUTHOR]

The anal region is an unusual site of Hailey–Hailey disease. It manifests with lichenoid lesions with crusted erosions around the anus. It should be differentiated from condylomata acuminata, extramammary Paget disease, and bowenoid papulosis. [ABSTRACT FROM AUTHOR]

Abstract: Recently, it has been reported that ingenol mebutate (IM) is an effective treatment option for anogenital warts (AGW), inducing fast wart necrosis within 24 hours in vivo. With regard to its mode of action, IM is thought to act both as an inducer of direct cytotoxic effects and immunologic mechanisms. To distinguish whether the wart necrosis is mainly caused by cytotoxic effects, or whether immune mechanisms are leading, we used time‐lapse imaging to analyse IM‐treated warts ex vivo over 24 hours. Ex vivo IM‐treated warts, which have been detached from the immune system, did not show destructive necrosis, pointing towards a primarily immune‐driven mode of action of IM in the treatment of AGW. [ABSTRACT FROM AUTHOR]

Objective This meta-analysis was designed to assess the efficacy of topical 5-aminolaevulinic acid ( ALA) photodynamic therapy ( PDT) in Chinese patients with condylomata acuminata ( CA). Methods Electronic literature databases ( Medline, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang database) were searched for relevant randomized controlled trials ( RCTs) published prior to October 2012. Only RCTs that compared ALA-PDT to non- ALA- PDT for patients with genital condylomata were selected. The outcomes included the recurrence rate and adverse events. The risk ratios ( RRs) and 95% confidence intervals ( CIs) were calculated as the ALA-PDT vs. without ALA-PDT. Results Twenty RCTs composed of 1903 patients ( ALA-PDT, n = 1106; non- ALA- PDT, n = 797) were included in the meta-analysis. ALA-PDT decreased the recurrence rate within 12 week after treatment (vs. without ALA-PDT, RR: 0.28, 95% CI: 0.22-0.35) and 24 week after treatment (vs. without ALA-PDT, RR: 0.24, 95% CI: 0.17-0.34) in a fixed-effect model. The common adverse events related ALA-PDT included a mild burning and/or stinging sensation, erythema, mild edema, erosion, and hyperpigmentation. Conclusion Local application of ALA-PDT reduced recurrence rate vs. without ALA-PDT. The use of ALA- PDT should be considered as a feasible therapy for the treatment of CA. [ABSTRACT FROM AUTHOR]

Background: Cryotherapy cannot destroy subclinical human papillomavirus-infected cells of condylomata acuminata (CA). The topical application of aminolevulinic acid (ALA) results in a shallow penetration depth in CA lesions (1). Objectives: To compare the efficacy and safety of cryotherapy plus ALA-photodynamic therapy (PDT) with cryotherapy in the treatment of multiple CA. Methods: Eighty patients with multiple CA received cryotherapy plus ALA-PDT (n= 40) or cryotherapy plus placebo-PDT (n= 40). After cryotherapy, a 20% ALA or a placebo solution was applied to the CA area 3 h before illumination with red light (635 nm, 100mW/cm², 100 J/cm²). The treatment was repeated 7 days after the first treatment if the lesions were not completely resolved. The complete response rate, recurrence rate and adverse effects in the two groups were analyzed. Results: After two treatments, the complete response rates in the combined group (cryotherapy plus ALA-PDT) and cryotherapy group were 32.4% (36/111) and 32.6% (43/132) in the anal area (P>0.05), 100% (32/32) and 54.5% (18/33) in the urethral meatus (P<0.05), and 94.2% (129/137) and 50.5% (56/111) in the external genitals (P<0.05), respectively. The recurrence rates in the combined group and cryotherapy group were 24.3% (27/111) and 31.1% (41/132) in the anal area (P>0.05), 9.4% (3/32) and 39.4% (13/33) in the urethral meatus (P<0.05), and 3.6% (5/137) and 31.5% (35/111) in the external genitals (P<0.05), respectively. The adverse effects in each group included mild to moderate pain, edema, erosion and hypopigmentation, without any infection, ulcers, scarring or urethral malformations. Conclusion: Cryotherapy plus ALA-PDT is a more effective regimen for the treatment of multiple CA compared with cryotherapy alone. [ABSTRACT FROM AUTHOR]

External anogenital warts (EGWs) are non-malignant skin tumours caused by human papillomavirus. They are one of the fastest growing sexually transmitted diseases. Current treatments are unsatisfactory. Green tea sinecatechin Polyphenon E ointment is a botanical extract from green tea leaves exhibiting anti-oxidant, anti-viral and anti-tumour properties. The aim of this study was to integrate valid information and provide basis for rational decision making regarding efficacy and safety of green tea extracts in the treatment of EGWs. A systematic search in electronic databases was conducted using specific key terms. Main search was performed independently by two reviewers. The accumulated relevant literature was subsequently systematically reviewed and a meta-analysis was conducted. Three randomized, double-blind, placebo-controlled studies evaluating efficacy and safety of Polyphenon E 15% and 10% in the treatment of warts were included in the systematic review and meta-analysis. A total of 660 men and 587 women were enrolled. Regarding primary outcome, both Polyphenon E 15% and 10% demonstrated significantly higher likelihood of complete clearance of baseline and baseline and new warts compared with controls. No significant heterogeneity was detected. Recurrence rates were very low. Commonest local skin sign was erythema and local skin symptom was itching. Efficacy of Polyphenon 15% and 10%, at least for the primary endpoint, is clearly indicated. Polyphenon E treatment exhibits very low recurrence rates and appears to have a rather favourable safety and tolerability profile. Recommendations for future studies should include evaluation of the efficacy of green tea catechins in the treatment of internal anogenital warts and direct comparison with its principal comparator, imiquimod. [ABSTRACT FROM AUTHOR]

Aim Human papillomavirus is the most common cause of sexually transmitted disease. It is associated with immunosuppression and shows a marked tendency to recur. We investigated a natural immunostimulant aimed to reduce recurrence. Method A randomized controlled study was carried out including 261 patients allocated to surgical excision alone (control group; n = 122) and surgical excision plus postoperative immunostimulation for 30 days with a natural product (STET; study group; n = 139). Patients with HIV positivity were excluded. All patients gave fully informed consent. Results The patients were followed for 6 months after surgery. Recurrence occurred in 7.2% (10/139) in the study group and in 27.1% (33/122) in the control group ( P < 0.0001). There were no significant differences in the sex, sexual orientation, number of lesions, time to diagnosis and treatment or localization of lesions in the two groups. Conclusions Immunostimulation using a natural product significantly reduced the incidence of recurrence of anal condylomata in patients undergoing surgical excision. [ABSTRACT FROM AUTHOR]

Objectives: To determine the safety and efficacy of photodynamic therapy (PDT) with topical application of 20% wt/vol aminolevulinic acid hydrochloride (ALA) in the treatment of condylomata acuminata (CA). Study design: Patients with CA were randomly allocated into the ALA-PDT group and the CO2 laser group in an allocation ratio of 3 : 1. The treatment was repeated weekly if necessary, but no more than 3 times. The primary efficacy endpoint was the wart clearance rate 1 week after the last treatment. The recurrence rate was evaluated at weeks 4, 8 and 12 after the treatment ended. The clinical response to therapy and adverse effects were recorded. Results: A total of 91 patients with CA were enrolled in the clinical trial. Of these 90 (98.9%) patients completed the trial (67 in the ALA-PDT group, and 23 in CO2 laser group). By 1 week after the last treatment, the complete clearance rate was 95.93% in the ALA-PDT group and 100% in CO2 laser group ( P>0.05). The clearance rate of CA at male urethral orifice was100% in the ALA-PDT group and 100% in the CO2 laser group ( P>0.05). The overall recurrence rate calculated by the end of the entire follow-up period was significantly lower in the ALA-PDT group than that in the CO2 laser group (9.38% vs 17.39%, P<0.05). Moreover, there was no systemic adverse event in either group. The proportion of patients with adverse effects in the ALA-PDT group (8.82%) was also significantly lower than that in the CO2 laser group (100%, P<0.05). The side-effects in patients treated with ALA-PDT mainly included mild burning and/or stinging restricted to the illuminated area. Conclusion: The results confirmed that topical application of ALA-PDT is a simpler and as effective therapy with a lower incidence of adverse effects in the treatment of CA compared with conventional CO2 laser therapy. [ABSTRACT FROM AUTHOR]

Human papillomaviruses (HPV) are non-enveloped tumor viruses with a double stranded DNA approximately 8 kilobases in length. The viral genome is enclosed by a spherical capsid with icosahedral symmetry and a diameter of about 55 nm. More than 100 HPV types have been identified. They infect the squamous epithelia of skin and mucosa and usually cause benign papillomas or warts. Persistent infection with high-risk oncogenic HPV causes all cervical cancers, most anal cancers, and a subset of vulvar, vaginal, penile and oropha-ryngeal cancers. In recent years cutaneous beta-HPV types have been associated with the pathogenesis of non-melanoma skin cancers. Two prophylactic HPV vaccines based on virus-like particles (VLP) are licensed. These are up to 100% effective in preventing HPV 16 and HPV 18 infections and associated genital lesions in women, who have not been previously infected with these types. One vaccine also prevents genital warts caused by HPV 6 and HPV 11. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of determination of human papillomavirus (HPV) subtype on the success of imiquimod therapy in women with vulvar condylomata acuminata.Methods: A total of 132 women with biopsy-proven vulvar condylomata acuminata were enrolled in this prospective study. HPV DNA detection and determination of genotype were made through polymerase chain reaction (PCR) technique. The women were treated with imiquimod cream 5% in the area of the visible lesions, three times a week at night for 16 weeks.Results: Twelve of the 132 women (9.1%) failed to detect any improvement with this therapy during the 16-week period. However, 80 women (60.6%) experienced total clearance of the lesions, and 20 women (15.2%) observed a partial response. The complete response rates were 76.2% for HPV-6, 66.7% for HPV-11, 35% for HPV-6 plus 11, and 6.3% for unclassified HPV subtypes (other HPV subtypes than HPV 6 and -11).Conclusions: Topical imiquimod 5% cream is an appropriate treatment modality for HPV-6 or -11 positive vulvar warts. [ABSTRACT FROM AUTHOR]

Background Condylomata acuminata of the anal canal, a common sexually transmitted disease, are difficult-to-treat lesions with a high recurrence rate after initial successful treatment. Objective Our aim was to evaluate by anoscopy the efficacy of podophyllotoxin 0.5% solution topically applied for the treatment of anal warts. Methods We prospectively studied consecutive patients with condylomata acuminata of the anal canal that spared the rectum. They were treated with 0.5% podophyllotoxin solution topically applied on the warts, by anoscopy. Podophyllotoxin solution was administered on days 1, 2 and 3 every week (a treatment cycle) for a maximum of 4 weeks. Patients whose warts were not completely eradicated were classified as failures. Follow-up anoscopy was performed monthly for the first 6 months and every 6 months thereafter. Those who relapsed during the follow-up period were retreated. Results Twenty-two immunocompetent patients entered the study. The primary clearance rate was 22.7, 54.5, 68.1 and 86.3% after 1, 2, 3 and 4 treatment cycles, respectively. During the follow-up period (46, 12–60 months), seven patients (36.8%) relapsed. Four of them were successfully retreated. Thus, a complete cure was achieved in 16 out of 22 patients (72.7%). Adverse side-effects were mild. They included proctalgia in six (27.2%), bleeding in four (17.2%), and both proctalgia and bleeding in two (9%) patients. Conclusions Endoscopic topical application of 0.5% podophyllotoxin solution is an effective and well-tolerated method for the treatment of condylomata acuminata of the anal canal. [ABSTRACT FROM AUTHOR]

Background: Candylomata acuminata is one of the commonest sexually transmitted diseases. The urethra is involved in up to 30% of cases. Case report: A case of intraurethral condylomata acuminata is presented as an illustration of diagnosis and therapy. Comment: Mealoscopy allows direct visualisation of meatal condylomata. Ascending urethrogram or contrast voiding cysturethrography can show tilling defects suspicious of condylomata acuminata: urethroscopy is diagnostic. In the author's opinion, Laser therapy is the treatment of choice. [ABSTRACT FROM AUTHOR]

Background: In contrast to adults, only limited data are available on the human papillomavirus (HPV)-type spectrum in anogenital warts (AGW) of children., Objective: This study aimed to evaluate the HPV-type spectrum in AGW of prepubertal children., Materials & Methods: In a retrospective German multicentre study, HPV genotyping was performed in AGW biopsies of 55 1- to 12-year-old children using HPV group-specific PCRs followed by hybridization with type-specific probes or sequence analysis., Results: Human papillomavirus-DNA was found in 53 of the 55 AGW. In 58.5% (31/53) of the HPV-positive AGW, mucosal HPV types were detected. HPV6 (27/53, 50.9%) was the predominant type. 43.4% (23/53) of the lesions were induced by cutaneous HPV types (HPV2, HPV27, HPV57). Mucosal HPV types were significantly more common in children under 5 years of age than in children 5 years of age and older (22/25, 88.0% [95% CI: 70.0-95.8] vs. 9/28, 32.1% [95% CI: 17.9-50.7], P < 0.001). In contrast, cutaneous HPV types were significantly more prevalent in the 5- to 12-year age group (4/25, 16.0% [95% CI 6.4-34.7] vs. 19/28, 67.9% [95% CI 49.3-82.1], P < 0.001)., Conclusion: Anogenital warts in 5- to 12-year-old children are frequently associated with cutaneous HPV types, possibly due to horizontal transmission. HPV typing, in addition to comprehensive clinical and psychosocial evaluation, can potentially help in the assessment of these cases., (© 2021 The Authors. Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.)

Applied topically, imiquimod induces the production of interferon-α plus other cytokines. Because intralesional interferon is effective in the treatment of condylomata acuminata (genital warts), topical imiquimod has also been investigated as a potential therapy for this condition. The dosing regimen found to best balance efficacy, side-effects and practicality is 5% imiquimod cream applied overnight by the patient three times weekly until warts clear, for up to 16 weeks. The largest double-blind trial to examine this protocol involved 311 patients with external anogenital warts who were randomized to use imiquimod 5% cream, imiquimod 1% cream or vehicle cream. Evaluation of all patients given medication at any time showed that 50% of those who received 5% imiquimod experienced clearing of all baseline warts, as compared to 21% of those who used 1% imiquimod and 11% of those treated with vehicle. Overall, 5% imiquimod treatment was significantly more effective than vehicle (P< 0.0001). Excluding patients who discontinued medication for reasons unrelated to therapy (such as moving out of town or poor compliance), 56% of those who received 5% imiquimod experienced complete clearing of baseline warts. Clearing also occurred in 27% of those who received imiquimod 1%. Recurrence of baseline warts occurred in 13% of patients whose warts cleared with 5% imiquimod. When applied overnight at home three times each week, topical imiquimod 5% cream is an effective therapy with acceptable side-effects. The recurrence rate is low and further studies to specifically compare recurrence rates are warranted. [ABSTRACT FROM AUTHOR]

Imiquimod is 1-(2-methylpropyl)-1H-imidazo[4,5-c]quinolin-4-amine and has a molecular formula of C14H16N4. It was discovered by researchers at 3M Pharmaceuticals (St Paul, MN, USA) and is the newest in a class of drugs known as immune response modifiers. Imiquimod 5% cream has been formulated for the treatment of external genital and perianal warts (condylomata acuminata) in male and female patients. Each gram of 5% cream contains 50mg of imiquimod. In preclinical studies, imiquimod induced the production of cytokines, the principal one for antiviral activity being interferon-α. Imiquimod does not induce direct antiviral activity, nor does it cause direct, non-specific cytolytic destruction. Preclinical studies suggest that its antiviral action results from in vivo cytokine-induced activation of the immune system. A double-blind, placebo-controlled study designed to evaluate this hypothesis has been previously presented. The results of the study showed that wart regression after treatment with imiquimod is strongly correlated with a decrease in virally infected cells and with increases in the expression of a spectrum of cytokines. This supports the hypothesis that stimulation of local cytokines by imiquimod leads to a reduction of human papilomavirus load and wart regression, without evidence of scarring. [ABSTRACT FROM AUTHOR]