Potential human papillomavirus reactivation following topical corticosteroid therapy of genital lichen sclerosus and erosive lichen planus.
Using a highly sensitive polymerase chain reaction (PCR) technique, based on general GP5+/GP6+ PCR primers covering 34 different human papillomavirus (HPV) types, the presence of HPV DNA was studied in paraffin-embedded penile biopsies from 20 men treated topically with corticosteroids. Clobetasol propionate was applied for 2-16 (mean 7) weeks by 19 men (age 18-73; mean 40) with lichen sclerosus. High-risk HPV was detected prior to therapy in three patients (16%) who lacked clinical or histopathological signs of HPV infection. Following therapy high-risk HPV was detected in biopsies from four men (21%), of whom three also exhibited clinical and/or light microscopic signs of HPV infection. Low-risk HPV DNA was not detected in any of these samples. Four biopsies were collected during a 5-year period from a 51-year-old man who was treated repeatedly with topical mild-moderate potent corticosteroids at intervals of up to 10 weeks for penile erosive lichen planus, followed by nine clinical outbreaks of typical condylomas that consistently showed the presence of low-risk HPV DNA only. These observations indicate that long-lasting topical corticosteroid therapy occasionally may be associated with opportunistic reactivation of a latent high- and low-risk mucosotrophic HPV type infection. The importance of clinical follow-up is underlined.
von Krogh
G
G
Department of Dermatovenereology, Karolinska Hospital, Stockholm, Sweden. Geo.von.Krogh@ood.ki.se
Dahlman-Ghozlan
K
K
Syrjänen
S
S
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D002990:Clobetasol / Q000008:administration & dosage / Q000009:adverse effects* / Q000031:analogs & derivatives*; D003218:Condylomata Acuminata / Q000175:diagnosis* / Q000209:etiology; D046508:Culture Techniques; D004279:DNA, Viral / Q000032:analysis*; D006801:Humans; D008010:Lichen Planus / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D018459:Lichen Sclerosus et Atrophicus / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D027383:Papillomaviridae / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000175:diagnosis* / Q000209:etiology; D010409:Penile Diseases / Q000473:pathology / Q000821:virology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment
D004279:DNA, Viral; D002990:Clobetasol