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Nugent D, Apoola A, Coleman H, Gilmour C, Lawton MD, Nori A, D C Ross J, Whitlock G, Yeend-Curd-Trimble H. British association for sexual health and HIV national guideline for the management of anogenital warts in adults (2024). Int J STD AIDS 2024; 35:498-509. [PMID: 38456387 DOI: 10.1177/09564624241233338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
This guideline offers recommendations on the diagnosis, treatment and health promotion principles needed for the effective management of human papillomavirus (HPV)-related warts at anogenital sites including the external genitals, vagina, cervix, urethra, perianus and anal canal. The guideline is aimed primarily at patients aged 16 years or older presenting to healthcare professionals working in level 3 sexual health services in the United Kingdom. However, the principles of the recommendations may be applied in other care settings, including in primary care, using locally adapted care pathways where appropriate. The management of HPV-related anogenital dysplasia or warts at other extragenital sites is outside the scope of this guideline.
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Affiliation(s)
- Diarmuid Nugent
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | - Ade Apoola
- Derbyshire Community Health Services NHS Foundation Trust, Derby, UK
| | - Harry Coleman
- Central & North West London NHS Foundation Trust, London, UK
| | - Cindy Gilmour
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
| | | | - Achyuta Nori
- Guy's & St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D C Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gary Whitlock
- Chelsea & Westminster Hospitals NHS Foundation Trust, London, UK
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Gustafsson L, Wilson A, Bergvall K. Efficient Topical Treatment of Canine Nodular Sebaceous Hyperplasia with a Nitric Acid and Zinc Complex Solution. Animals (Basel) 2024; 14:570. [PMID: 38396537 PMCID: PMC10885944 DOI: 10.3390/ani14040570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Nodular sebaceous gland hyperplasia in the often middle-aged to old dog is a common, benign proliferation that results in exophytic, pink to yellow, alopecic, and often multilobulated nodules. Removal is usually carried out by surgical excision. As many old dogs have comorbidities that increase the risk of anesthesia, a topical treatment is warranted. We hypothesized that the application of a solution containing nitric acid, zinc, copper, and organic acids (Verrutop®), would be a safe and efficient way to treat these nodules. Eleven dogs with a total of 29 nodules, grossly compatible with nodular sebaceous gland hyperplasia, were included in the study. Eighteen of the nodules were treated; 11 were left untreated. No anesthesia or sedation was needed. Four weeks after one application, 17/18 treated nodules had decreased by 100% in volume. There was a statistically significant difference in percentual volume change between the treated and untreated nodules from day 0 to day 28 (p < 0.0001). No serious side effects were noted. Sebaceous hyperplasia cannot always be distinguished grossly from sebaceous tumors. Cytological evaluation can be helpful, and in cases of deviant macroscopic features, local recurrence, or more aggressive behavior, the appropriate intervention would be to biopsy or excise the nodule for histopathology. Topical application of Verrutop® is an easy, low-cost, and efficient way to remove canine sebaceous gland hyperplasia with minimal side effects in cases where surgery and anesthesia are not desired.
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Affiliation(s)
- Lina Gustafsson
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
| | - Alison Wilson
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
| | - Kerstin Bergvall
- Evidensia Södra Djursjukhuset, Månskärsvägen 13, 141 75 Huddinge, Sweden; (A.W.); or (K.B.)
- Swedish University of Agricultural Sciences, Faculty of Veterinary Medicine and Animal Science, P.O. Box 7084, 750 07 Uppsala, Sweden
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García-Oreja S, Álvaro-Afonso FJ, García-Madrid M, López-Moral M, García-Álvarez Y, Lázaro-Martínez JL. Cryotherapy versus topical nitric-zinc complex solution for the treatment of plantar warts: A randomized controlled trial. J Med Virol 2023; 95:e29212. [PMID: 37930111 DOI: 10.1002/jmv.29212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
Cryotherapy is commonly regarded as the primary treatment method for plantar warts. A new medical device called nitric-zinc complex solution (NZCS) has also emerged as a potential alternative for wart treatment. The main aim of this study was to analyze and compare the effectiveness of cryotherapy using liquid nitrogen and NZCS in treating plantar warts. We conducted a randomized and controlled clinical trial involving patients with plantar warts. A total of 62 patients were enrolled in the study and monitored for 12 weeks or until their warts were completely resolved. The patients received either cryotherapy or NZCS, with a maximum of six treatment applications. The cure rate was 65.5% in the group treated with cryotherapy and 56.6% in the group treated with NZCS. The average number of treatment applications required for curing warts was significantly lower in the cured group (3.28 ± 1.63) than in the group with unresolved warts (5.5 ± 1.27) (p < 0.01). Moreover, the average number of applications was lower in the cryotherapy group (3.6 ± 1.8) than in the NZCS group (4.8 ± 1.8) (p < 0.01). Based on the findings, NZCS could be considered a favorable first-line treatment option for plantar warts.
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Affiliation(s)
- Sara García-Oreja
- Facultad de Enfermería, Fisioterapia y Podología, University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Marta García-Madrid
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Mateo López-Moral
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
| | - José Luís Lázaro-Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), University Podiatric Clinic, Complutense University of Madrid, Madrid, Spain
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Zou P, Du Y, Yang C, Cao Y. Trace element zinc and skin disorders. Front Med (Lausanne) 2023; 9:1093868. [PMID: 36733937 PMCID: PMC9887131 DOI: 10.3389/fmed.2022.1093868] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Zinc is a necessary trace element and an important constituent of proteins and other biological molecules. It has many biological functions, including antioxidant, skin and mucous membrane integrity maintenance, and the promotion of various enzymatic and transcriptional responses. The skin contains the third most zinc in the organism. Zinc deficiency can lead to a range of skin diseases. Except for acrodermatitis enteropathic, a rare genetic zinc deficiency, it has also been reported in other diseases. In recent years, zinc supplementation has been widely used for various skin conditions, including infectious diseases (viral warts, genital herpes, cutaneous leishmaniasis, leprosy), inflammatory diseases (hidradenitis suppurativa, acne vulgaris, rosacea, eczematous dermatitis, seborrheic dermatitis, psoriasis, Behcet's disease, oral lichen planus), pigmentary diseases (vitiligo, melasma), tumor-associated diseases (basal cell carcinoma), endocrine and metabolic diseases (necrolytic migratory erythema, necrolytic acral erythema), hair diseases (alopecia), and so on. We reviewed the literature on zinc application in dermatology to provide references for better use.
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Affiliation(s)
- Pan Zou
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuxin Du
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Chunguang Yang ✉
| | - Yuchun Cao
- Department of Dermatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Yuchun Cao ✉
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Gaspari V, Cinotti E, Puviani M, Trovato E, Campoli M, Milani M. Assessment of sinecatechins 10% ointment used as proactive sequential therapy in recurrence rate of genital warts lesions after cryotherapy. The PACT-II Trial (postablation immunomodulator treatment of condylomata with sinecatechins): a prospective assessor-blinded, multicenter, pilot trial. Ital J Dermatol Venerol 2022; 157:72-77. [PMID: 35176844 DOI: 10.23736/s2784-8671.21.06894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cryotherapy is commonly used as ablative treatment of external genital warts (EGW). However, after cryotherapy recurrence of lesions affects on average 45% (42-70%) of subjects in the 6 months after the treatment. Sinecatechins 10% are an effective topical treatment of EGW. A low recurrence rate (<6%) was observed in pivotal phase 3 trials conducted with this product. Topical sinecatechins have demonstrated to significantly reduce the recurrence rate of EGW in subjects treated with laser therapy (The PACT-I trial). So far, no prospective data are available regarding the efficacy of sinecathechins as immunomodulator sequential therapy after cryotherapy in EGW subjects. The purpose of this study was to assess the rate of recurrence lesions after the use of topical sinecatechins 10%, as sequential proactive immunomodulation treatment after cryotherapy in subjects with EGW (The PACT-II Trial: the postablation immunomodulator treatment of condylomata with sinecatechins trial) (Trial Registration number: ISRCTN44037479). METHODS In a prospective, assessor-blinded, multicenter trial a total of 55 subjects with a diagnosis of multiple EGW (36 men and 19 women, mean age 47±10 years) and a mean lesion number of 9±7, after their informed consent, were enrolled in the study. All subjects were treated with cryotherapy (an average of 2 sessions). After the ablative treatment, all subjects were instructed to apply sinecatechin 10% ointment 3 times daily for 4 consecutive months. The primary study endpoint was the evaluation (assessor-blinded) of recurrent lesions after 6 months (2 month of follow-up after the conclusion of topical treatment). The secondary study endpoints were the appearance of new EGW lesions (lesions affecting area not treated by cryotherapy) and the local tolerability. RESULTS At baseline, the mean number of EGW lesions were 9±7. After cryotherapy, the mean lesions number were reduced to 1.6±1.8. At month 4, EGW mean lesion number were 0.2±0.4 (P=0.0001 vs. after cryotherapy). At month 6, recurrence of lesions was detected in 10 subjects (18%; 95% CI: 9-30%) with an average of 1.4 lesions. Of these recurrent lesions, 6 occurred in completely healed lesions site after cryotherapy and 8 in partially healed ones. New lesions (outside the cryotherapy treated area) were observed in 10 subjects. The product was very well tolerated. No serious side effects were reported. Three subjects reported moderate skin irritation on the application site. CONCLUSIONS The PACT-II Trial has shown that the recurrence rate of EGW lesions after successful cryotherapy using sinecatechins as immunomodulator sequential therapy is lower in comparison with the percentage documented in the literature without sequential therapy (20 vs. 45%). These results are in line with already published data evaluating the role of sinecatechins after laser therapy (PACT-I trial). Future comparative, double-blind controlled trials assessing the efficacy of different proactive strategies are warranted.
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Affiliation(s)
- Valeria Gaspari
- Clinic of Dermatology, Sant'Orsola Hospital, University of Bologna, Bologna, Italy
| | - Elisa Cinotti
- Department of Medical, Surgical and Neuroscience, University of Siena, Siena, Italy
| | - Mario Puviani
- Clinic of Dermatology, Medica Plus Modena, Modena, Italy
| | - Emanuele Trovato
- Department of Medical, Surgical and Neuroscience, University of Siena, Siena, Italy
| | - Marco Campoli
- Department of Medical, Surgical and Neuroscience, University of Siena, Siena, Italy
| | - Massimo Milani
- Department of Medicine, Cantabria Labs Difa Cooper, Caronno Pertusella, Varese, Italy -
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Shahidi-Dadras M, Gholizadeh N, Dadkhahfar S, Gheisari M, Heydarifakher P, Moslemi Haghighi S, Mozafari N. A comparative study of intralesional bleomycin versus cryotherapy in the treatment of condyloma accuminata. Int J STD AIDS 2021; 32:1347-1353. [PMID: 34546119 DOI: 10.1177/09564624211041467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Bleomycin is an antineoplastic agent, which is used off label for various dermatologic conditions. There are numerous reports on the use of intralesional bleomycin (ILB) for the treatment of common warts. However, reports on the efficacy of bleomycin in the treatment of anogenital warts (AGWs) are still limited. The aim is to compare the efficacy/tolerability and recurrence rates of AGW treatment with ILB versus cryotherapy. In this prospective study, 50 patients with AGWs were assigned either to receive triple freeze-thaw cycle of cryotherapy or to receive 1.5 mg/mL ILB for a maximum of four sessions with 3-week intervals. Clinical efficacy was determined by the percentage of the patients with complete clearance. The patients with complete clearance were visited by passing 3 months from the last treatment session to evaluate any recurrence. Of 44 patients completing the study, 16 of 21 (76.19%) patients in the ILB group and 15 of 23 (65.22%) patients in the cryotherapy group showed complete resolution (p value = .425). Moreover, recurrence occurred after 3 months in 18.75% and 46.66% of the ILB and the cryotherapy groups' patients, respectively (p value = .096). The most common local adverse events in both treatment groups were pain, dyspigmentation, and ulceration/erosion, while the delayed ulceration and secondary infection were only observed in the bleomycin group. Intralesional bleomycin is as effective as cryotherapy in the treatment of AGWs, but it is more invasive and associated with post-treatment pain, the delayed ulceration, and cutaneous infection. Intralesional bleomycin is not accompanied with the major risk of necrosis or fibrosis, so the use of ILB in the anogenital area is likely to be safe.This clinical trial was registered in Iranian Registry of Clinical Trials site with code: IRCT20190519043631N1.
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Affiliation(s)
| | - Nasim Gholizadeh
- School of Medicine, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sahar Dadkhahfar
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Gheisari
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parsa Heydarifakher
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Nikoo Mozafari
- Skin Research Center, 48486Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Dermatology, 48486Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Song D, Pan L, Zhang M, Wang S. Clinical use of zinc in viral warts: a systematic review of the clinical trials. J DERMATOL TREAT 2021; 33:1878-1887. [PMID: 34132162 DOI: 10.1080/09546634.2021.1942420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Zinc has shown promise in the treatment of patients with viral warts in a number of clinical trials, but there is no consensus on its effectiveness. OBJECTIVE To investigate the efficacy of various formulations of zinc on cutaneous warts. DATA SOURCES We searched the Cochrane Central Register of Controlled Trials, EMBASE, PUBMED and Web of Science without publishing-time restriction. Trials examining zinc in the treatment of warts were collected. RESULTS Out of 265 articles, a total of 16 met inclusion criteria. 6 clinical trials investigated clinical effectiveness of oral zinc supplementation alone in treating viral warts, 2 trials evaluated the efficacy of oral zinc in combination with other therapy, 5 trials investigated the efficacy of intralesional zinc sulphate, and 3 trials investigated topical zinc treatment efficacy. Zinc therapy was found to be beneficial in 13 of 16 studies evaluating its effects on warts. CONCLUSIONS The use of zinc is a simple, safe and cost-effective treatment in viral warts based on some preliminary evidence. However, more well-designed studies need to be performed to further evaluate the effect of zinc for warts.
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Affiliation(s)
- Deyu Song
- Department of dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Linxin Pan
- Department of dermatology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Ming Zhang
- Department of dermatology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Sheng Wang
- Department of dermatology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tyros G, Papageorgiou C, Kanelleas A, Kotsafti O, Spyridonos E, Gregoriou S, Tagka A, Stratigos A, Nicolaidou E. The effect of anxiety, psychopathological symptoms and personality traits on response to treatment in male patients with anogenital warts: a prospective study. J Eur Acad Dermatol Venereol 2021; 35:1859-1864. [PMID: 33914981 DOI: 10.1111/jdv.17324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/13/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In the era of precision medicine, identification of possible predictive factors of clinical response to treatment is fundamental. This need is particularly strong for anogenital warts (AGW), because there are several treatment modalities with different clearance and recurrence rates. However, data regarding the effect of mental health parameters on response to treatment in patients with AGW are lacking. OBJECTIVES The purpose of the present study was to evaluate the association between patients' mental health parameters and AGW treatment outcomes. METHODS This was a single-centre, prospective study that included newly diagnosed male patients with AGW. At their initial visit, all patients completed the State-Trait Anxiety Inventory (STAI), the Symptom Checklist-90-Revised (SCL-90-R) and the Eysenck Personality Questionnaire (EPQ) questionnaires, which evaluate anxiety, psychopathological manifestations and personality traits, respectively. All patients received cryotherapy until clearance of lesions and were followed up for 18 months for detection of recurrences. RESULTS The study included 167 male patients. The mean number of days for AGW clearance was 89 ± 65. During the 18-month follow-up, 28% of participants showed a recurrence, after a mean number of 150 ± 132 days. No statistically significant association was detected between questionnaires scores and (a) time needed for AGW clearance, (b) time until 1st recurrence and (c) number of recurrences. CONCLUSION If confirmed, our findings indicate that we may not need to modify our AGW treatment plan according to a patient's mental health profile.
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Affiliation(s)
- G Tyros
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - C Papageorgiou
- 1st Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginitio Hospital, Athens, Greece
| | - A Kanelleas
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - O Kotsafti
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - E Spyridonos
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - S Gregoriou
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - A Tagka
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - A Stratigos
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
| | - E Nicolaidou
- 1st Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, "A. Sygros" Hospital for Skin and Venereal Diseases, Athens, Greece
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Letter to the Editor Regarding 'A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts'. Dermatol Ther (Heidelb) 2020; 10:1435-1437. [PMID: 33057983 PMCID: PMC7649168 DOI: 10.1007/s13555-020-00449-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Indexed: 11/20/2022] Open
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