title: Combined treatment of anogenital HPV infection with cryodestruction, podophyllin 25% and post-ablation immunomodulation with sinecatechins 15% ointment - a retrospective analysis.
abstract: External genital warts, caused by human papillomavirus, have a significant clinical, epidemiological, and financial impact, including the risk for malignant transformation. Treatment modalities include: (a) destructive (ablative); (b) cytotoxic (proapoptotic) and (c) immunomodulatory, with success and recurrence rates varying from 23% to 94% and from 4.1% to 77%, respectively. Most studies evaluated only single modality therapy, with few reports examining a combined approach for external genital warts management. The introduction of sinecatechins ointment in recent years has resulted in very low recurrence rates of 4.1-10.6%, despite lower initial clearance rates than ablative methods. We present a retrospective review of 27 patients who underwent combined therapy for external genital warts by using one or two sessions of cryodestruction combined with 25% podophyllin as the cytotoxic agent, and post-ablation immunomodulation with topical sinecatechins 15% ointment. This approach resulted in an excellent initial clearance rate of 96.3% with a recurrence rate of 7.4% after a total period of six months of follow-up. We suggest the importance of the combined approach in external genital warts management including post-ablative immunomodulation to augment the immune response and combat the residual latent infection. We hope to encourage trials examining the combined approach to the treatment of external genital warts.
authors.affiliation: College of Medicine, University of Illinois, IL, USA mark.e.juhl@gmail.com.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Juhl
authors.affiliation: Innovative Dermatology, Chicago, IL, USA.
authors.forename: Vernes
authors.initials: V
authors.lastname: Seferovic
authors.affiliation: Innovative Dermatology, Chicago, IL, USA.
authors.forename: Sasha
authors.initials: S
authors.lastname: Antonijevic
authors.affiliation: Innovative Dermatology, Chicago, IL, USA Department of Dermatology, Northwestern University, Chicago, IL, USA.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Krunic
mesh_terms: D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000627:therapeutic use; D002392:Catechin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003218:Condylomata Acuminata / Q000188:drug therapy* / Q000821:virology; D003452:Cryosurgery; D005260:Female; D006801:Humans; D056747:Immunomodulation; D008297:Male; D008875:Middle Aged; D009824:Ointments; D027383:Papillomaviridae; D010936:Plant Extracts / Q000008:administration & dosage; D011033:Podophyllin / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000891:Anti-Infective Agents, Local; D009824:Ointments; D010936:Plant Extracts; C018371:Preparation K; D002392:Catechin; D011033:Podophyllin
keywords: HPV; cryodestruction; genital warts; immunomodulation; sinecatechins; treatment