New treatments for human papillomavirus infection

Topical Mucoadhesive Alginate-Based Hydrogel Loading Ketorolac for Pain Management after Pharmacotherapy, Ablation, or Surgical Removal in Condyloma Acuminata

Condyloma acuminata is an infectious disease caused by the human papilloma virus (HPV) and one of the most common sexually transmitted infections. It is manifested as warts that frequently cause pain, pruritus, burning, and occasional bleeding. Treatment (physical, chemical, or surgical) can result in erosion, scars, or ulcers, implying inflammatory processes causing pain. In this work, a biocompatible topical hydrogel containing 2% ketorolac tromethamine was developed to manage the painful inflammatory processes occurring upon the removal of anogenital condylomas. The hydrogel was physically, mechanically, and morphologically characterized: it showed adequate characteristics for a topical formulation. Up to 73% of ketorolac in the gel can be released following a one-phase exponential model. Upon application on human skin and vaginal mucosa, ketorolac can permeate through both of these and it can be retained within both tissues, particularly on vaginal mucosa. Another advantage is that no systemic side effects should be expected after application of the gel. The hydrogel showed itself to be well tolerated in vivo when applied on humans, and it did not cause any visible irritation. Finally, ketorolac hydrogel showed 53% anti-inflammatory activity, suggesting that it is a stable and suitable formulation for the treatment of inflammatory processes, such as those occurring upon chemical or surgical removal of anogenital warts.

Efficacy of AV2-Salicylic acid combination therapy for cutaneous warts: Study protocol for a single-center randomized controlled trial

Cutaneous warts comprise an extremely common condition caused by infection with the human papillomavirus (HPV). Although most verrucae will disappear spontaneously, many patients do seek treatment. Current wart treatments do not target the cause of the lesion directly, resulting in variable treatment efficacies and high wart recurrence rates. AV2 is a broad-spectrum antiviral drug, that is capable of deactivating HPV. It is however not able to destruct the already infected cells, which raises the need for an additional ablative treatment i.e. salicylic acid (SA). Implementation of AV2-Salicylic acid (AV2-SA) combination therapy would ensure permanent lesion clearance by on the one hand inactivation of HPV by AV2, and on the other hand elimination of the lesion by SA treatment. The primary aim of this study is to assess the efficacy of AV2-SA treatment versus standard SA treatment, by comparing cure and recurrence rates of cutaneous warts between the two treatment groups (at 12 weeks and six months after randomization). The second aim is to assess the safety and tolerability of AV2-SA therapy. The third aim is to identify subgroups of cutaneous warts that have favorable response to treatment, by comparing cure rates in an HPV genotype-specific manner. This randomized controlled trial will enroll 260 participants with cutaneous warts who will either receive the AV2-SA combination therapy or SA control treatment. Real time monitoring will be possible by daily photographs sent via WhatsApp™ (a messaging application) as well as online follow-up questionnaires administered on several occasions. HPV genotyping will be performed on swab self-samples.

Treatment of Warts in Children: An Update

Warts are among the most common skin infections in children. Although numerous treatment options are available, none are completely effective in a single session. Treatment is particularly complicated in children, not only because certain treatments are poorly tolerated, but also because parents frequently have unrealistic expectations. In this article, we offer an update on the treatments available for warts, focusing specifically on pediatric patients. We do not discuss treatments for oral and anogenital warts.

Focal epithelial hyperplasia by human papillomavirus (HPV)-32 misdiagnosed as HPV-16 and treated with combination of retinoids, imiquimod and quadrivalent HPV vaccine

Focal epithelial hyperplasia (FEH) or Heck's disease is a rare, benign and asymptomatic mucosal proliferation associated with human papillomavirus (HPV) infection, mainly with genotypes 13 and 32. We report a florid case of FEH in an 11-year-old Haitian girl with systemic lupus erythematosus receiving immunosuppressive therapy. Cryotherapy was previously performed on numerous occasions with no results. We decided to prescribe a non-invasive and more comfortable treatment. A combination of topical retinoid and imiquimod cream was well tolerated and led to an important improvement. The evidence of infection by HPV-16 detected by polymerase chain reaction (PCR) technique, prompted us to prescribe the quadrivalent HPV vaccine (types 6, 11,16 and 18). Subsequent PCR sequencing with generic primers GP5-GP6 and further BLAST comparative analysis confirmed that genomic viral sequence in our case truly corresponded with HPV-32. This molecular misdiagnosis can be explained by the similarity between genomic sequences of both HPV-16 and -32 genotypes. At the 1-year follow up, we observed total clinical improvement and no recurrences of the disease. Complete healing in this case may correspond to a potential action of topical retinoid, imiquimod and the cross-protection mechanism of the quadrivalent HPV vaccine.

Advancements in Pharmacotherapy for Noncancerous Manifestations of HPV

Human papillomavirus (HPV) is the most common sexually transmitted disease. Via infection of the basal epithelial cells, HPV causes numerous malignancies and noncancerous cutaneous manifestations. Noncancerous cutaneous manifestations of HPV, including common, plantar, plane, and anogenital warts, are among the most common reasons for an office visit. Although there are various therapies available, they are notoriously difficult to treat. HPV treatments can be grouped into destructive (cantharidin, salicylic acid), virucidal (cidofovir, interferon-α), antimitotic (bleomycin, podophyllotoxin, 5-fluorouracil), immunotherapy (Candida antigen, contact allergen immunotherapy, imiquimod) or miscellaneous (trichloroacetic acid, polyphenon E). The mechanism of action, recent efficacy data, safety profile and recommended regimen for each of these treatment modalities is discussed.

Efficacy of Myrtus communis L. and Descurainia sophia L. Versus Salicylic Acid for Wart Treatment

Background:

Wart is a skin disease with circular appendages, which is called “suloul” in Iranian traditional medicine (ITM). According to ITM literature, warts have different types and causes. The most important mechanism is excretion of materials (Khelt) from body to skin and mucus; its causative material is often phlegm, black bile or a combination of them. To treat warts, it is necessary to consider the patient’s life style, modify his dietary intake and moisturize his temperament.

Objectives:

This study aimed to compare Myrtus communis L. and Descurainia sophia L. as a method of ITM, versus salicylic acid in treatment of wart.

Patients and Methods:

In this study, conducted in Yazd, Iran, 100 patients were selected and randomly divided into four groups. Group 1) salicylic acid, group 2) salicylic acid and D. sophia L. group 3) M. communis L. group 4) M. communis L. and D. sophia L. Numbers, sizes of lesions and symptoms, on days 0, 20, 40 and 90 were examined and analyzed. The relapse rate was investigated three months after. Changes of sizes and numbers of warts in each period of time in each group, compared to baseline, were assessed by Wilcoxon Signed Rank test. To compare these changes between the groups, Kruskal Wallis test was used.

Results:

In this study 100 patients participated, 69% of which were female. Compared to baseline, mean ± SD of changes for the number of warts in day 40 were 1.12 ± 4.2, 0.96 ± 2.5, 1.32 ± 5.1 and 0.04 ± 0.2 respectively in the four groups (P = 0.02). Mean ± SD of changes for the number of warts in day 90 were 1.84 ± 4.5, 1.56 ± 2.8, 1.24 ± 5.1 and 0.04 ± 0.6 respectively in the four groups (P = 0.03). In addition mean ± SD of changes for the size of warts in day 40 were 0.96 ± 1.8, 1.03 ± 2.4, 2.47 ± 3.0 and 0.45 ± 1.7 respectively in the four groups (P < 0.001). Mean ± SD of changes for the size of warts in day 90 were 1.24 ± 2.1, 1.3 ± 2.3, 2.45 ± 3.1 and 0.45 ± 1.7 respectively in the four groups (P < 0.001). Relapse was not seen in any groups after three months. The frequency of side effects was similar after three months.

Conclusions:

M. communis L. can be used as a topical treatment for warts. It not only shows more rapid response than salicylic acid, but also has fewer side effects. It seems that D. sophia L. can modify the digestion process and patients can excrete large amounts of the substance that causes warts. Therefore, it is better to use it more than 40 days. According to our investigation, in ITM, considering the cause and mechanism of disease generation and the causing materials of the disease, different treatments should be applied for each patient. Although applying an appropriate treatment is necessary, a unique treatment for all the patients cannot be available.