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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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Adefemi AK, Okunowo AA, Anorlu RI. Prevalence and Epidemiological Characteristics of Anogenital Warts Among Recently Diagnosed HIV-Positive Women on Antiretroviral Therapy in Lagos, Nigeria. Cureus 2024; 16:e56251. [PMID: 38623132 PMCID: PMC11017138 DOI: 10.7759/cureus.56251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/17/2024] Open
Abstract
Background Anogenital warts (AGWs) are a prevalent condition resulting from human papillomavirus (HPV) infection, which is the most frequently encountered sexually transmitted infection (STI) on a global scale. Women who are HIV-positive experience a disproportionately high burden of AGWs compared to other populations. It is imperative to comprehend the epidemiological factors linked to the disease within this particular at-risk population. Objectives The objective of the study was to ascertain the prevalence of AGWs and its demographic and socio-biological epidemiological features among recently diagnosed HIV-positive women (HPW) in Lagos, Nigeria. Materials and methods The research was a descriptive cross-sectional study conducted among a sample of 420 recently diagnosed HPW. The study was conducted at the HIV clinic of a tertiary health institution located in Lagos, Nigeria. The participants clinically diagnosed with AGWs were classified as the study group, while individuals without AGWs were classified as the comparison group. Interviewer-administered pretested questionnaires were utilized to gather pertinent demographic and socio-biological epidemiological data from the participants involved in the study. The data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, USA). Results The prevalence of AGWs among recently diagnosed HPW was found to be 8.5% (34/402). These warts were frequently observed on the vulvar labia (35.3%, 12/34), vaginal walls (14.7%, 5/34), and perianal region (14.7%, 5/34). It is worth noting that over a third of cases (35.3%, 12/34) involved multiple areas within the anogenital region. The diagnosis of AGWs was found to have significant associations with occupation (p=0.005), marital status (p<0.001), and educational status (p=0.028). The majority of HPW diagnosed with AGWs were unemployed (32.4%, 11/34), single (47.1%, 16/34), and did not have tertiary education (94.1%, 32/34). The utilization of oral contraceptive pills (OCPs), smoking, low CD4 count, and high viral load were the significant socio-biological factors associated with the diagnosis of AGWs (p<0.001, respectively). Conclusion The study found that the prevalence of AGW among HPW was 8.5% (34/402). Several epidemiological factors, including occupation, marital status, education, CD4 count, viral load, history of OCP use, and smoking, were found to be significantly associated with the diagnosis of AGW. There is a need to conduct more comprehensive studies to thoroughly assess the impact of these epidemiological factors.
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Affiliation(s)
- Ayodeji K Adefemi
- Department of Obstetrics and Gynaecology, Lagos State University Teaching Hospital, Lagos, NGA
| | - Adeyemi A Okunowo
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, NGA
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, NGA
| | - Rose I Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos, NGA
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Lagos, NGA
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Mawardi P, Kamilah L, Fauziyyah Heryadi F, Arrosyid A. The Effectiveness of Chemical Cautery and Electrosurgery on Anogenital Wart: Systematic Review. Clin Cosmet Investig Dermatol 2023; 16:2773-2780. [PMID: 37818198 PMCID: PMC10561614 DOI: 10.2147/ccid.s426851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023]
Abstract
Introduction Anogenital warts (AGW) is one of the sexually transmitted infections (STIs) caused by human papillomavirus (HPV). Treatment modalities of AGW yield low clearance and recurrence rate, so that chemical cautery with trichloroacetic acid (TCA) and electrosurgery are widely used to remove the lesions without any severe side effects. Objective To investigate the efficacy of chemical cautery with TCA and electrosurgery in AGW based on clinical trials or case series. Methods The systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) but not registered to the International Prospective Register of Systematic Review (PROSPERO). To acquire proper and accurate information from relevant literature, two databases PubMed and the Cochrane Library were searched from January 2013 to March 2023. Results Thirteen studies were included in this systematic review, comprising seven articles on chemical cautery and six electrosurgery articles. The highest cure rate of chemical cautery with TCA was 94.1% while electrosurgery was 100%. A relatively low recurrence rate during 1 year follow-up was observed in electrosurgery with 14.6%, whereas the chemical cautery was 27.6%. Conclusion Electrosurgery for AGW treatment had higher cure rate with lower recurrence rate compared to chemical cautery with TCA. Numerous adverse effects of electrosurgery were reported include bleeding and scar formation as high risk of HPV infection.
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Affiliation(s)
- Prasetyadi Mawardi
- Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University/Dr Moewardi General Hospital, Surakarta, Indonesia
| | - Lian Kamilah
- Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University/Dr Moewardi General Hospital, Surakarta, Indonesia
| | - Fanny Fauziyyah Heryadi
- Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University/Dr Moewardi General Hospital, Surakarta, Indonesia
| | - Azhar Arrosyid
- Department of Dermatology and Venereology, Faculty of Medicine, Sebelas Maret University/Dr Moewardi General Hospital, Surakarta, Indonesia
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Prayogo SA, Andrew H, Cong S, Intaran KDA. Photodynamic therapy in the treatment of condyloma acuminata: A systematic review of clinical trials. Int J STD AIDS 2023; 34:76-86. [PMID: 36420589 DOI: 10.1177/09564624221138351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Condylomata acuminata (CA) is a sexually transmitted infection with a high prevalence associated with psychosexual morbidity in both men and women of various age. Up to now, treatment modalities yield low clearance and recurrence rate (RR) and are also deemed low quality evidence-wise. Photodynamic therapy (PDT) is a novel and promising therapy to effectively cure and prevent CA recurrence. METHOD This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and registered to the International Prospective Register of Systematic Review (PROSPERO) (CRD42022332760). RESULTS Ten studies were included in this systematic review. A significant value of complete response (CR) ranging from 63-100% in patients with genital warts after receiving several sessions of PDT. A relatively low recurrence rate was seen in all 10 studies, with an RR of less than 17%. Quality assessment of included studies reported mostly high-quality research. CONCLUSIONS PDT therapy resulted in a higher CR with significantly lower RR compared to other therapies. Thus, PDT can be an alternative treatment of CA with low RR and minimal side effects. Additional research, especially randomized clinical trials in various countries, is needed to further substantiate this treatment and formulate definitive protocols.
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Affiliation(s)
| | - Hubert Andrew
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta Pusat, Indonesia
| | - Stefanny Cong
- Faculty of Medicine, 64733Universitas Indonesia, Jakarta Pusat, Indonesia
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Paasch U, Zidane M, Baron JM, Bund T, Cappius HJ, Drosner M, Feise K, Fischer T, Gauglitz G, Gerber PA, Grunewald S, Herberger K, Jung A, Karsai S, Kautz G, Philipp C, Schädel D, Seitz AT, Nast A. S2k guideline: Laser therapy of the skin. J Dtsch Dermatol Ges 2022; 20:1248-1267. [PMID: 36098675 DOI: 10.1111/ddg.14879] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This guideline aims to improve the efficiency and safety of lasers and optical radiation sources with similar effects (especially IPL). Laser therapy of skin lesions with an increased amount of melanocytes should be performed with caution. Laser treatment of pigmented melanocytic nevi is not recommended. The guideline contains recommendations regarding the treatment of lentigines and café-au-lait spots, non-pigmented dermal nevi, Becker nevus, nevus of Ota/Hori/Ito and melasma. Further recommendations focus on the treatment of skin lesions without an increased amount of melanocytes (ephelides, postinflammatory hyperpigmentation including berloque dermatitis, seborrheic keratoses, traumatic/decorative tattoos and metallic deposits), hypopigmentation (vitiligo), benign non-pigmented neoplasms (fibrous papule of the nose, nevus sebaceus, epidermal nevus, neurofibroma, sebaceous gland hyperplasia, syringoma, xanthelasma palpebrarum), inflammatory dermatoses (acne papulopustulosa/conglobata, acne inversa, granuloma faciale, lichen sclerosus, lupus erythematosus, psoriasis vulgaris, rosacea, rhinophyma), wrinkles/dermatochalasis/striae, hypertrichosis, scars (atrophic, hypertrophic; keloids, burn/scald scars), laser-assisted skin healing, onychomycosis, precancerous lesions and malignant tumors (actinic keratoses/field cancerization, cheilitis actinica, basal cell carcinoma), vascular skin lesions (angiokeratoma, angioma, hemangioma, malformation, spider veins, granuloma telangiectaticum (pyogenic granuloma), rubeosis (erythrosis interfollicularis colli, ulerythema ophryogenes), nevus flammeus, telangiectasias and Osler's disease (hereditary hemorrhagic telangiectasia) and viral skin lesions (condylomata acuminata, mollusca contagiosa, verrucae planae juveniles/vulgares/ verrucae palmares et plantares).
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Affiliation(s)
- Uwe Paasch
- Hautaerzte Paasch, Practice Prof. Paasch, Jesewitz OT Gotha, Germany, University Hospital Leipzig, Department and Clinic for Dermatology, Venereology and Allergology, Leipzig
| | - Miriam Zidane
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Berlin
| | - Jens Malte Baron
- University Hospital Aachen, Department for Dermatology and Allergology - Skin Medicine, Aachen
| | - Thorsten Bund
- Department for Plastic, Esthetic, and Reconstructive Microsurgery, Hand Surgery at Ernst von Bergmann Hospital, Potsdam
| | | | - Michael Drosner
- Skin & Laser Schwerin, Skin & Laser Rostock, Schwerin and Rostock
| | | | - Tanja Fischer
- Skin & Laser Center Berlin-Potsdam, Berlin and Potsdam
| | - Gerd Gauglitz
- Skin and Laser Center Glockenbach Quarter, Munich, Department for Dermatology and Allergology, Ludwig-Maximilians University, Munich
| | - Peter Arne Gerber
- Dermatology at Luegplatz, Düsseldorf, Department for Dermatology, Medical Faculty, Heinrich-Heine University, Düsseldorf
| | - Sonja Grunewald
- University Hospital Leipzig, Department and Clinic for Dermatology, Venereology and Allergology, Leipzig
| | - Katharina Herberger
- University Hospital Hamburg-Eppendorf (UKE), Department for Dermatology and Venereology, Hamburg
| | - Anja Jung
- Center for Proctology, Evangelisches Elisabeth Hospital, Berlin, Deutschland
| | | | - Gerd Kautz
- Skin and Laser Hospital Dres. Gerd and Ingrid Kautz, Konz
| | - Carsten Philipp
- Center Laser Medicine, Evangelisches Elisabeth Hospital, Berlin
| | | | - Anna-Theresa Seitz
- University Hospital Leipzig, Department and Clinic for Dermatology, Venereology and Allergology, Leipzig
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM), Berlin
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Zhu P, Qi R, Yang Y, Huo W, Zhang Y, He L, Wang G, Xu J, Zhang F, Yang R, Tu P, Ma L, Liu Q, Li Y, Gu H, Cheng B, Chen X, Chen A, Xiao S, Jin H, Zhang J, Li S, Yao Z, Pan W, Yang H, Shen Z, Cheng H, Song P, Fu L, Chen H, Geng S, Zeng K, Wang J, Tao J, Chen Y, Wang X, Gao X. Clinical guideline for the diagnosis and treatment of cutaneous warts (2022). J Evid Based Med 2022; 15:284-301. [PMID: 36117295 PMCID: PMC9825897 DOI: 10.1111/jebm.12494] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
AIM Cutaneous warts caused by human papillomavirus are benign proliferative lesions that occur at any ages in human lives. Updated, comprehensive and systematic evidence-based guidelines to guide clinical practice are urgently needed. METHODS We collaborated with multidisciplinary experts to formulate this guideline based on evidences of already published literature, focusing on 13 clinical questions elected by a panel of experts. We adopted Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to form classification of recommendations as well as the improved Delphi method to retain respective recommendations with a consensus degree of over 80%. RESULTS Our guideline covered aspects of the diagnosis and treatment of cutaneous warts such as diagnostic gold standard, transmission routes, laboratory tests, treatment principle, clinical cure criterion, definitions, and treatments of common warts, flat warts, plantar warts, condyloma acuminatum, and epidermodysplasia verruciformis. Recommendations about special population such as children and pregnant women are also listed. In total, 49 recommendations have been obtained. CONCLUSIONS It is a comprehensive and systematic evidence-based guideline and we hope this guideline could systematically and effectively guide the clinical practice of cutaneous warts and improve the overall levels of medical services.
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Affiliation(s)
- Peiyao Zhu
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Rui‐Qun Qi
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Yang Yang
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Wei Huo
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
| | - Yuqing Zhang
- Department of Clinical Epidemiology and Evidence‐Based MedicineThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
| | - Li He
- Department of DermatologyFirst Affiliated Hospital of Kunming Medical UniversityKunmingP.R. China
| | - Gang Wang
- Department of DermatologyXijing HospitalFourth Military Medical UniversityXi'an, ShaanxiP. R. China
| | - Jinhua Xu
- Department of DermatologyHuashan HospitalFudan UniversityShanghaiP.R. China
| | - Furen Zhang
- Shandong Provincial Hospital for Skin Diseases & Shandong Provincial Institute of Dermatology and VenereologyShandong First Medical University & Shandong Academy of Medical SciencesJinanP.R. China
| | - Rongya Yang
- Department of DermatologyGeneral Hospital of Beijing Military Command of PLADongcheng DistrictBeijingP.R. China
| | - Ping Tu
- Department of Dermatology and VenerologyPeking University First HospitalBeijingP.R. China
| | - Lin Ma
- Department of DermatologyBeijing Children's HospitalCapital Medical UniversityNational Center for Children's HealthBeijingP.R. China
| | - Quanzhong Liu
- Department of DermatologyTianjin Medical University General HospitalTianjinP.R. China
| | - Yuzhen Li
- Department of DermatologySecond Affiliated Hospital of Harbin Medical UniversityHarbinP.R. China
| | - Heng Gu
- Institute of DermatologyChinese Academy of Medical Sciences and Peking Union Medical CollegeNanjingP.R. China
| | - Bo Cheng
- Department of DermatologyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouP.R. China
| | - Xiang Chen
- Department of DermatologyXiangya HospitalCentral South UniversityChangshaP.R. China
| | - Aijun Chen
- Department of DermatologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingP.R. China
| | - Shengxiang Xiao
- Department of DermatologyThe Second Affiliated HospitalSchool of MedicineXi'an Jiaotong UniversityXi'anP.R. China
| | - Hongzhong Jin
- Department of DermatologyPeking Union Medical College HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeDongcheng DistrictBeijingP.R. China
| | - Junling Zhang
- Department of DermatologyTianjin Academy of Traditional Chinese Medicine Affiliated HospitalTianjinP.R. China
| | - Shanshan Li
- Department of DermatologyThe First Hospital of Jilin UniversityChangchunJilin ProvinceP.R. China
| | - Zhirong Yao
- Department of DermatologyXinhua HospitalShanghai Jiao Tong University School of MedicineShanghaiP.R. China
| | - Weihua Pan
- Department of DermatologyShanghai Key Laboratory of Molecular Medical MycologySecond Affiliated Hospital of Naval Medical UniversityShanghaiP.R. China
| | - Huilan Yang
- Department of DermatologyGeneral Hospital of Southern Theatre Command of PLAGuangzhouP.R. China
| | - Zhu Shen
- Department of DermatologyInstitute of Dermatology and VenereologySichuan Academy of Medical Sciences and Sichuan Provincial People's HospitalChengduP.R. China
| | - Hao Cheng
- Department of Dermatology and VenereologySir Run Run Shaw HospitalSchool of MedicineZhejiang UniversityHangzhouP.R. China
| | - Ping Song
- Department of DermatologyGuang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingP.R. China
| | - Lingyu Fu
- Department of Clinical Epidemiology and Evidence‐Based MedicineThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
| | - Hongxiang Chen
- Department of DermatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Songmei Geng
- Department of DermatologyThe Second Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxiP.R. China
| | - Kang Zeng
- Department of DermatologyNanfang HospitalSouthern Medical UniversityGuangzhouP.R. China
| | - Jianjian Wang
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouP.R. China
| | - Juan Tao
- Department of DermatologyUnion HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhanP.R. China
| | - Yaolong Chen
- Evidence‐Based Medicine CenterSchool of Basic Medical SciencesLanzhou UniversityLanzhouP.R. China
- World Health Organization Collaborating Center for Guideline Implementation and Knowledge TranslationLanzhouP.R. China
- GIN AsiaLanzhouP.R. China
| | - Xiuli Wang
- Institute of PhotomedicineShanghai Skin Disease HospitalSchool of MedicineTongji UniversityShanghaiP.R. China
| | - Xing‐Hua Gao
- Department of DermatologyThe First Hospital of China Medical UniversityHeping DistrictShenyangP.R. China
- NHC Key Laboratory of Immunodermatology, China Medical UniversityHeping DistrictShenyangP.R. China
- Key Laboratory of Immunodermatology, China Medical UniversityMinistry of EducationHeping DistrictShenyangP.R. China
- National and Local Joint Engineering Research Center of Immunodermatological TheranosticsHeping DistrictShenyangP.R. China
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Paasch U, Zidane M, Baron JM, Bund T, Cappius HJ, Drosner M, Feise K, Fischer T, Gauglitz G, Gerber PA, Grunewald S, Herberger K, Jung A, Karsai S, Kautz G, Philipp C, Schädel D, Seitz AT, Nast A. S2k-Leitlinie: Lasertherapie der Haut. J Dtsch Dermatol Ges 2022; 20:1248-1270. [PMID: 36162017 DOI: 10.1111/ddg.14879_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Uwe Paasch
- Hautärzte Paasch, Praxis Prof. Paasch, Jesewitz OT Gotha, Deutschland, Universitätsklinikum Leipzig, Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Leipzig
| | - Miriam Zidane
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Berlin
| | - Jens Malte Baron
- Universitätsklinikum Aachen, Klinik für Dermatologie und Allergologie - Hautklinik, Aachen
| | - Thorsten Bund
- Klinik für Plastische, Ästhetische und Rekonstruktive Mikrochirurgie, Handchirurgie am Klinikum Ernst von Bergmann, Potsdam
| | | | - Michael Drosner
- Haut & Laser Schwerin, Haut & Laser Rostock, Schwerin und Rostock
| | | | - Tanja Fischer
- Haut- & Lasercentrum Berlin-Potsdam, Berlin und Potsdam
| | - Gerd Gauglitz
- Haut- und Laserzentrum im Glockenbachviertel, München, Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, München
| | - Peter Arne Gerber
- Dermatologie am Luegplatz, Düsseldorf, Klinik für Dermatologie, Medizinische Fakultät, Heinrich-Heine-Universität, Düsseldorf
| | - Sonja Grunewald
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Leipzig
| | - Katharina Herberger
- Universitätsklinikum Hamburg-Eppendorf (UKE), Klinik für Dermatologie und Venerologie, Hamburg
| | - Anja Jung
- Zentrum Proktologie, Evangelische Elisabeth Klinik, Berlin, Deutschland
| | | | - Gerd Kautz
- Haut- und Laserklinik Dres. Gerd und Ingrid Kautz, Konz
| | | | | | - Anna-Theresa Seitz
- Universitätsklinikum Leipzig, Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Leipzig
| | - Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM), Berlin
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8
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Sindhuja T, Bhari N, Gupta S. Asian guidelines for condyloma acuminatum. J Infect Chemother 2022; 28:845-852. [PMID: 35341674 DOI: 10.1016/j.jiac.2022.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
The present guidelines aim to provide comprehensive information on genital condyloma acuminata, including the epidemiology, clinical features, diagnosis and management. The guidelines provide evidence-based recommendations on the diagnosis, prevention and treatment of genital condyloma acuminata in adults in Asia, including patients with HIV co-infection. METHODOLOGY A PubMed search was performed, using the keywords "condyloma acuminata", "anal wart", "anogenital wart", "genital wart" and "genital HPV". A total of 3031 results were found in publications during last six years. A careful review of the titles and abstracts was done to find all the studies pertaining to epidemiology, clinical features, diagnosis, treatment and prevention of condyloma acuminata. DIAGNOSIS Various diagnostic procedures described are: 1. PCR (LE: 2b). 2. Serology (LE: 2b). 3. In-situ hybridization (LE: 3). PREVENTION 1. Vaccination (LE: 1a): Quadrivalent vaccine reduced the frequency of anogenital warts in both vaccinated and unvaccinated contacts. According to the update Advisory Committee on Immunization Practices (ACIP) recommendations, the following protocol is recommended: (a). HPV vaccination at age 11 or 12 years for both males and females. (b). Catch-up vaccination for all persons through age 26 years. (c). Shared clinical decision-making regarding potential HPV vaccination for persons aged 27-45 years, who are at risk of new HPV infection. 2. Male circumcision (LE: 2a): conflicting evidence. HIV AND CONDYLOMA ACUMINATA In HIV-affected individuals, the course of HPV is more aggressive, with a greater risk of treatment resistance, increased chances of intraepithelial neoplasia as well as cancers. TREATMENT Physician administered. 1. Photodynamic therapy (LE: 1a). 2. Laser (LE: 2b). 3. Surgery (LE: 1a). 4. Electrosurgery (LE: 2c). 5. Cryotherapy (LE: 1b). 6. Immunotherapy (LE: 1b). 7. Podophyllin (LE: 1b). Provider administered. 1. Imiquimod 5%(LE: 1a). 2. Podophyllotoxin (LE: 1b). 3. Sinecatechins (LE: 1a). 4. Cidofovir (LE: 3). 5. 5- Fluorouracil (LE: 1a). 6. Interferon (LE: 1a).
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Affiliation(s)
- Tekumalla Sindhuja
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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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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Pontini P, Mastorino L, Gaspari V, Granger C, Ramoni S, Delmonte S, Evangelista V, Cusini M. A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc ® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts. Dermatol Ther (Heidelb) 2020; 10:1063-1073. [PMID: 32734366 PMCID: PMC7477018 DOI: 10.1007/s13555-020-00430-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Anogenital warts (AGW) are a relevant clinical issue in the field of sexually transmitted disease, and to date no treatment provides a satisfactory clearance rate. Treatment can be both medical and surgical, and be provided by a healthcare provider or by the patient. Cryotherapy (CRYO) is among the most common treatments for AGW. Nitrizinc® Complex solution (NZCS) is a solution containing organic acids, nitric acid and zinc and copper salts that is applied topically to warts, producing mummification of the damaged tissue. It is considered to be an effective and well-tolerated treatment for genital and common warts. The aim of our study was to compare NZCS to CRYO in the treatment of AGW. METHODS We performed a prospective, multicentre, single-blind, randomised, superiority clinical study involving 120 patients, aged 18-55 years, diagnosed with a first episode of AGW, with each patient having from three to ten AGW. The patients were treated either with NZCS or CRYO for a maximum of four treatments. Primary endpoints were: (1) comparison of the clinical efficacy of CRYO and NZCS, based on response to treatment (clearance of AGW) within four treatment sessions; and (2) tolerability, assessed via a short questionnaire at the end of each treatment session. Secondary endpoints were: (1) number of treatments needed for clearance; and (2) recurrence at 1 and 3e months after confirmed clearance. The results were analysed on an intention-to-treat basis. RESULTS A complete response was achieved in 89.7% of the NZCS group and in 75.4% of the CRYO group (p = 0.0443). NZCS was found to be better tolerated. There was no difference between the NZCS and CRYO treatment arms in the number of sessions needed to clear the lesions. Recurrence occurred after 1 month in 18.4% of the NZCS group and 38.1% of the CRYO group (p = 0.0356), and after 3 months in 25 and 40.6% of these groups, respectively (p = 0.1479). CONCLUSIONS Nitrizinc® Complex solution can be considered to be as effective as CRYO for the treatment of small (< 5 mm) external AGW, with a better tolerability profile and lower rate of recurrence. TRIAL REGISTRATION ISRCTN identifier, ISRCTN36102369.
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Affiliation(s)
- Paolo Pontini
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy.
| | - Luca Mastorino
- Dermatology Clinic, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza-University of Turin, Turin, Italy
| | - Valeria Gaspari
- Unit of Dermatology, Head and Neck Department, Sant'Orsola Malpighi University Hospital, Bologna, Italy
| | | | - Stefano Ramoni
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
| | - Sergio Delmonte
- Dermatology Clinic, Department of Medical Sciences, Azienda Ospedaliera Universitaria Città della Salute e della Scienza-University of Turin, Turin, Italy
| | - Valeria Evangelista
- Unit of Dermatology, Head and Neck Department, Sant'Orsola Malpighi University Hospital, Bologna, Italy
| | - Marco Cusini
- Unit of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy
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Miyoshi N, Tanabe H, Suzuki T, Saeki K, Hara Y. Applications of a Standardized Green Tea Catechin Preparation for Viral Warts and Human Papilloma Virus-Related and Unrelated Cancers. Molecules 2020; 25:molecules25112588. [PMID: 32498451 PMCID: PMC7321293 DOI: 10.3390/molecules25112588] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/21/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Most cell-based and animal experiments have shown that green tea catechins (GTC) exhibit various health benefits. In human experimental and epidemiological studies, there are conflicting results, and more precise investigations are required. One of the most effective ways to prove beneficial health effects in humans might be clinical intervention studies. Polyphenon®E was developed as a standardized GTC preparation, which was approved by Food and Drug Administration of US in 2006 as a medication to treat genital warts (Veregen® or sinecatechins). Positive efficacy of Polyphenon®E/sinecatechins/Veregen® (PSV) on anogenital warts has been demonstrated in several epidemiological studies and there have been several case reports to show the clinical effectiveness of PSV. In addition, several studies have provided evidence to suggest that PSV is effective in other human papillomavirus (HPV)-related diseases, although some studies failed to show such effects. Since (−)-epigallocatechin gallate (EGCG) is the major component of PSV, the mechanism of the action of PSV might be deduced from that of EGCG. The microarray analysis of the biopsy samples from the patients suggested that apoptosis induction and the downregulation of inflammation are involved in the mechanism of the action of PSV in the clearance of anogenital warts. Cell-based and animal experiments using PSV also demonstrated effects similar to those elicited by EGCG, explaining how PSV works to induce apoptosis and exert anti-inflammatory actions in HPV-related diseases. Future studies would clarify what kinds of diseases respond effectively to PSV, showing health benefits of GTC and EGCG in humans.
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Affiliation(s)
- Noriyuki Miyoshi
- Graduate School of Integrated Pharmaceutical and Nutritional Sciences, University of Shizuoka, Shizuoka 422-8526, Japan
- Correspondence: (N.M.); (Y.H.); Tel.: +81-54-264-5531 (N.M.); Tel.: +81-3-3209-0129 (Y.H.)
| | - Hiroki Tanabe
- Faculty of Health and Welfare Science, Nayoro City University, Nayoro, Hokkaido 096-8641, Japan;
| | - Takuji Suzuki
- Faculty of Agriculture, Yamagata University, Yamagata 990-8560, Japan;
| | - Koichi Saeki
- Regenerative Medicine iPS Gateway Center Co., Ltd., Tokyo 150-0012, Japan;
| | - Yukihiko Hara
- Tea Solutions, Hara Office Inc., Tokyo 130-0012, Japan
- Correspondence: (N.M.); (Y.H.); Tel.: +81-54-264-5531 (N.M.); Tel.: +81-3-3209-0129 (Y.H.)
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12
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Doiron P. Topical condyloma treatment: comparative evidence for a common problem. Br J Dermatol 2020; 183:5-6. [PMID: 32390160 DOI: 10.1111/bjd.19044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- P Doiron
- Division of Dermatology, Department of Medicine, Women's College Hospital, Toronto, ON, M5S 1B2, Canada
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13
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Bertolotti A, Ferdynus C, Milpied B, Dupin N, Huiart L, Derancourt C. Local Management of Anogenital Warts in Non-Immunocompromised Adults: A Network Meta-Analysis of Randomized Controlled Trials. Dermatol Ther (Heidelb) 2020; 10:249-262. [PMID: 32030564 PMCID: PMC7090115 DOI: 10.1007/s13555-020-00357-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION No hierarchy of first-line treatments for anogenital warts (AGWs) is provided in international guidelines. This study aimed to determine the efficacy of topical treatments and ablative procedures for the management of AGWs. METHODS Twelve electronic databases were systematically searched from inception to August 2018. All randomized controlled trials (RCTs) comparing immunocompetent adults with AGWs who received at least 1 provider-administered or patient-administered treatment in at least 1 parallel group were included. Risk of bias assessment followed the Cochrane Handbook. The study endpoint was complete lesion response after clearance and recurrence assessment. A network meta-analysis was performed. RESULTS A network geometry was constructed based on 49 of the 70 RCTs included in our systematic review. All but 4 RCTs had a high risk of bias. The most efficacious treatments compared to placebo were surgery (RR 10.54; CI 95% 4.53-24.52), ablative therapy + imiquimod (RR 7.52; CI 95% 4.53-24.52), and electrosurgery (RR 7.10; CI 95% 3.47-14.53). SUCRA values confirmed the superiority of surgery (90.9%), ablative therapy + imiquimod (79.8%), and electrosurgery (77.1%). The most efficacious patient-administered treatments were podophyllotoxin 0.5% solution (63.5%) and podophyllotoxin 0.5% cream (62.2%). CONCLUSIONS With low-level evidence of most included RCTs, surgery and electrosurgery were superior to other treatments after clearance and recurrence assessment. Podophyllotoxin 0.5% was the most efficacious patient-administered treatment. Combined therapies should be evaluated in future RCTs in view of their identified effectiveness. The results of future RCTs should systematically include clinical type, number and location of AGWs, and sex of the patient, to refine therapeutic indications. PROTOCOL REGISTRATION PROSPERO-CRD42015025827.
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Affiliation(s)
- Antoine Bertolotti
- Department of Infectious Disease, Saint-Pierre Hospital, Reunion Island, France.
- EA 4537, Antilles-Guyane University, Martinique, France.
- INSERM CICEC 1410, Reunion Island, France.
| | | | - Brigitte Milpied
- Department of Dermatology and Pediatric Dermatology, National Center for Rare Skin Disorders, Saint-André and Pellegrin Hospitals, Bordeaux, France
| | - Nicolas Dupin
- Department of Dermatology, Cochin Hospital, Paris Descartes University, Paris, France
| | - Laetitia Huiart
- Department of Population Health, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Christian Derancourt
- EA 4537, Antilles-Guyane University, Martinique, France
- Department of Dermatology, Hôpital de Briançon, Briançon, France
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