Abordagens terapêuticas do Condiloma Acuminado em crianças e adolescentes / Therapeutic approaches to Condyloma Acuminatum in children and adolescents

Objetivos: A infecção pelo papiloma vírus humano dos tipos 6 e 11 pode evoluir para Condiloma Acuminado. Sua transmissão é principalmente via sexual, de forma que a presença dessas verrugas em crianças deve ser consi-derada sinal de alarme para investigação de abuso. Eventualmente, contudo, ocorre por autoinoculação ou fômites. O tratamento é desafiador, dado que apesar do extenso arsenal, a recorrência se faz comum. A presente revisão siste-mática advém a comparar taxas de sucesso das estratégias terapêuticas, objetivando fornecer substrato para escolhaacertada no tratamento da doença em crianças e adolescentes. Métodos: Foi realizada Revisão Sistemática baseada no GuidelinePreferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA), registrada na Plataforma PROSPERO sob identificação CRD42021262090. Resultados: 211 estudos foram encontrados nasdatabases con-sultadas, de forma que 30 atenderam as propostas de critérios estabelecidos na pesquisa sistematizada. Esses pas-saram extração de dados para síntese qualitativa, demonstrando eficácia de métodos não-invasivos a invasivos.Conclusões: Mediante bons resultados em resolução da doença e reduzidos efeitos adversos, a terapia mais popular entre os autores foi o Imiquimode. A pesquisa chamou atenção à necessidade de estudos mais robustos e metodo-logias mais complexas acerca das abordagens terapêuticas do Condiloma Acuminado em crianças e adolescentes. (AU)

Objectives: Infection with human papillomavirus types 6 and 11 can progress to Condyloma acuminata. Its transmission is mainly sexual, so these warts in children should be considered an alarm signal for abuse investigation. Eventually, however, it occurs by autoinoculation or fomites. Treatment is challenging, given that despite the extensive arsenal, recurrence is common. The present systematic review compares the success rates of therapeutic strategies, aiming to provide a substrate for the right choice in the treatment of the disease in children and adolescents. Methods: Asystematic review was performed based on the guideline for Preferred Report Items for Systematic Reviews and Meta-Analyses (PRISMA), registered on the PROSPERO Platform under identification CRD42021262090. Results: 211 studies were found in thedatabasesconsulted, and 30 met the proposed criteria established in the systematic research. These passed data extraction for qualitative synthesis, demonstrating the effectiveness of non-invasive to invasive methods. Conclusions: Due to good results in disease resolution and reduced adverse effects, the most popular therapy among the authors was Imiquimod. The research called attention to the need for more robust studies and more complex methodologies about the therapeutic approaches of Condyloma Acuminatum in children and adolescents. (AU)

Experiencia en cirugía de condilomas anales en mayores de 15 años / Experience in anal condyloma surgery in patients older than 15 years

Resumen Objetivo: Describir la experiencia en cirugía electiva de condilomas anales en pacientes mayores de 15 años en un hospital terciario de la Región Metropolitana. Material y Método: Estudio observacional retrospectivo y descriptivo, en el cual se analizan las intervenciones quirúrgicas electivas realizadas entre 2008 a 2021. Resultados: Dentro del período analizado se obtuvo 165 cirugías de condilomas anales, lo que corresponde a 137 pacientes en total. El 85% de los pacientes son de sexo masculino, el 68% de los pacientes son VIH positivo, un 87% de los pacientes MSM (hombres que tienen sexo con otros hombres) son VIH positivo, el 34% de los pacientes tiene antecedente de ETS, el 46% de los pacientes recibió terapia tópica como tratamiento preoperatorio o posoperatorio. Un 25% de los pacientes presenta recidiva en su historia personal, un 21% de los pacientes presenta lesiones anales intraepiteliales de alto grado, un 6% presenta carcinoma escamoso infiltrante. No hubo mortalidad descrita. Discusión: El presente estudio, describe la experiencia en cirugía de condilomas de un hospital terciario de la Región Metropolitana de Chile, cuya población corresponde a un estrato socioeconómico medio y bajo. Se logra describir a la población que es intervenida de condilomas acuminados, además de sus resultados quirúrgicos precoces y a largo plazo. Conclusión: El presente estudio, presenta una población de 137 pacientes operados de condilomas anales, a partir de los hallazgos de la cirugía. Se cumple el objetivo del estudio de caracterizar en un período de 12 años los resultados quirúrgicos de dicha serie, algo no reportado previamente en la literatura chilena.

Objective: To describe the experience in elective surgery for anal condylomas in patients over 15 years of age in a tertiary hospital in the Metropolitan Region. Materials and Method: Retrospective and descriptive observational study about elective surgical interventions performed between 2008 to 2021. Results: Within the analyzed period, 165 anal warts surgeries were obtained, corresponding to 137 patients. 85% of the patients are male, 68% are HIV positive, 87% of the MSM patients are HIV positive, 34% of the patients have a history of STDs, 46% of the patients received topical therapy as preoperative or postoperative treatment. 25% present recurrence in their personal history, 21% present high-grade anal intraepithelial lesions, 6% present infiltrating squamous carcinoma. There was no reported mortality. Discussion: The present study describes the experience in condyloma surgery in a tertiary hospital in the Metropolitan Region of Chile, whose population corresponds to a medium and low socioeconomic stratum. It is possible to describe the population that undergoes surgery for this reason, in addition to its early and long-term surgical results. Conclusion: The present study presents a population of 137 patients operated on for anal condylomas, based on the findings of the surgery. The objective of the study to characterize the surgical results of this series over a 12-year period is fulfilled, something not previously reported in the Chilean literature.

Giant perianal condyloma successfully treated with podophyllin at 25% in solid petrolatum

Purpose: Giant perianal condyloma (GPC) is a rare condition. The effective treatment is a multidisciplinary challenge; topical treatments are usually ineffective, and surgical resection has significant morbidity. Podophyllin at 25% in solid petrolatum (25%PSP) can be an effective treatment option for GPC. The aim of the present study was to assess its response and tolerability. Methods: This retrospective, single-center case series evaluated the clinical response of 14 patients with GPC treated with 25%PSP in a public hospital in Buenos Aires between December 2015 and December 2019. After obtaining a full history and performing a physical exam, the lesions were measured and photographed. Biopsies were performed to exclude malignancy, as well as exams to rule out pregnancy. Podophyllin at 25% in solid petrolatum was administered topically in cases of GPC and washed off by the patients at home after 4 hours. The patients underwent at least 4 weekly visits, which included interval history, photodocumentation of the lesions, and provider-applied 25%PSP. The response rate was assessed by comparingmeasurements and the overall decrease in volume of the GPC based on photos from the first and last sessions. Adverse outcomes were noted. Results: In total, 10 men, 3 women, and 1 transgender woman with GPC unresponsive to prior treatments and a mean age of 34.5 years were included. A total of 12 patients were immunosuppressed. All the perianal lesions were circumferential and measured between 8 cm and 20 cm. Overall, 7 patients had genital condyloma outside of the anus and perianus; the histology showed low-grade squamous intraepithelial lesions in all cases. While on treatment, 7 patients reported dermatitis, and 71% of the patients had 75% reduction in lesion size. Conclusions: Podophyllin at 25% in solid petrolatum is an effective, well-tolerated topical treatment option for GPC. (AU)

Anogenital warts in pediatric population

Abstract: The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.

Mucinosis. Presentación de caso / Mucinosis. Presentation of case

Mucinosis (REM síndrome), es una rara enfermedad cutánea, descrita hace más de 30 años por Steigleder, afectando predominantemente a mujeres de edad avanzada. Clínicamente presenta áreas con eritema persistente, pápulas que pueden confluir, formando placas con escamas. La etiología aún no está bien esclarecida, pero diversos factores como la luz ultravioleta, trastornos inmunológicos, infecciones virales, han sido relacionados o asociados con la inducción de la misma. Se presenta un reporte de caso de un paciente masculino de 20 años, con antecedentes de haber padecido de Condilomas Acuminados, además presentó otras lesiones cutáneas caracterizadas por placas alopécicas, con discreta infiltración en número de 10 en cuero cabelludo y lesiones en placas, infiltradas, de 3 a 5 centímetros de diámetro en número de 2, de bordes precisos en tercio inferior central de la espalda. Se realizó biopsia de piel, donde se corrobora el diagnóstico de Mucinosis, posteriormente el paciente ingresó en el servicio de Nefrología en el hospital de Cárdenas con diagnóstico de Insuficiencia Renal Crónica (AU).

Mucinosis (REMsyndrome), he is a rare cutaneous, described disease he does over 30 years for Steigleder, affecting predominantly women late in years. Clinically he presents areas with persistent erythema, pápulas that they can converge, forming plates with scales. The etiology not yet is very illustrious, but various factors like the ultraviolet light, immunogenic upsets, viral infections, they have been related or associated with the induction of the same. He encounters a report of case of a masculine patient of 20 years, with background to have suffered from Condylomas Acuminados, besides he presented another cutaneous injuries characterized by plates alopécicas, with discreet infiltration in number of 10 in scalp and injuries in plates, spies, of 3 a 5 cms of diameter in number of 2, of precise borders in inferior central third part of the back. The patient accomplished biopsy of skin himself, where Mucinosis's diagnosis is corroborated, at a later time he entered in Nefrología's service at Cárdenas's hospital with diagnosis of renal chronic Insuficiencia (AU).

Argon plasma versus electrofulguration in the treatment of anal and perianal condylomata acuminata in patients with acquired immunodeficiency virus

Abstract Purpose: To compare the effectiveness of anal and perianal condylomata treatment using argon plasma and electrofulguration. Methods: From January 2013 to April 2014, 37 patients with anal and perianal condylomata, who had been diagnosed through proctological examination, oncotic cytology, polymerase chain reaction (PCR) and histology, underwent treatment with argon plasma and electrofulguration. The perianal and anal regions were divided into two semicircles. Each semicircle was treated using one of the methods by means of simple randomization. Therapeutic sessions were repeated until all clinical signs of infection by HPV were eliminated. The patients were evaluated according to several variables like the genotype of HPV, HIV infection, oncological potential per genotype, oncotic cytology and histology. Results: Among all the variables studied, only immunosuppression due to HIV influenced the results, specifically when the fulguration method was used. There was no significant difference in effectiveness between argon and fulguration based on lesion relapse (p > 0.05). However, among HIV-positive patients, fulguration presented worse results, with a significant difference (p = 0.01). Conclusion: Regarding treatment of anal and perianal condylomata acuminata, comparison between applying fulguration and argon demonstrated that these methods were equivalent, but use of fulguration presented more relapses among HIV-positive patients.

Tratamiento de las verrugas genitales: una actualización / Genital wart treatment: an update

La infección por el Virus del Papiloma Humano es una afección altamente prevalente a nivel mundial y una de sus consecuencias es la verruga genital externa o condiloma genital. El tratamiento de estas lesiones ha sido tradicionalmente difícil, debido a la alta recurrencia de las lesiones. Se revisan los aspectos más novedosos del tratamiento de las verrugas genitales. Las sinecatequinas y una nueva formulación de Imiquimod al 3,75% resaltan como las terapéuticas más novedosas, mientras que la terapia fotodinámica carece de evidencia científica adecuada como para recomendar su uso rutinario. Las vacunas profilácticas y terapéuticas parecen poseer un gran potencial pero aún se encuentran en fases iniciales de investigación. Es deseable estudios con un mayor número de pacientes y un seguimiento más prolongado, que permita una comparación directa de la efectividad entre las diferentes técnicas terapéuticas a corto y largo plazo.

Human Papillomavirus infection is a highly prevalent condition worldwide whose frequent consequence is the external genital wart or genital condyloma. The treatment for this condition has been traditionally difficult due to the recurrence of the lesions. The most innovative aspects of the treatment of genital wart, are reviewed. The sinecatechins and a new formulation of Imiquimod 3.75% stand out as the most innovative therapeutic, while photodynamic therapy lacks adequate scientific evidence to recommend its routine use. The prophylactic and therapeutic vaccines seem to have great potential but are still in early stages of research. Studies should be conducted with larger patient samples and longer follow-ups to allow comparison of the effectiveness among the different therapeutic techniques in the short and long term.

Caracterización clínica, epidemiológica y terapéutica de pacientes con condiloma acuminado / Clinical, epidemiological and therapeutics characteristics of patients with condyloma acuminatum

OBJETIVO. Caracterizar desde el punto de vista epidemiológico, clínico y de respuesta terapéutica a los pacientes con condiloma acuminado (CA) en la consulta protocolizada del Hospital Clínico Quirúrgico Hermanos Ameijeiras (HCQHA) PACIENTES y MÉTODO. Estudio descriptivo, longitudinal, ambispectivo, en 2/9 pacientes con CA del Servicio de Dermatología del HCQHA en el período 2009-2013, para su caracterización clínico, epidemiológica y de los tratamientos recibidos. Se determinaron variables epidemiológicas (edad, sexo, color de la piel, estado civil, grado escolaridad, ocupación, hábitos tóxicos, orientación y conducta sexual), características clínicas de las lesiones y tratamientos y respuesta a estos. RESULTADOS. Predominaron los pacientes menores de 20 años, trabajadores, solteros, heterosexuales, del sexo masculino, piel blanca, de nivel escolar preuniversitario, con conducta sexual muy promiscua y prolongado tiempo de evolución de la enfermedad asociado a gran área de afectación y a elevado número y tamaño de las lesiones. Los tratamientos utilizados fueron radiocirugía, podofilina al 25 %, ácido tricloroacético al 80 %, 5-fluorouracilo (crema), criocirugía, interferón-a2b humano recombinante (3 x 10 UI) por vía intramuscular e interferón-a2b humano recombinante (3 x 10 Ul) por vía subcutánea más criocirugía. Significativa mayor respuesta y significativo menor porcentaje de recidivas (p < 0,001) se observó en los pacientes tratados con el interferón asociado a la criocirugía. CONCLUSIONES. El CA predominó en adolescentes y adultos jóvenes, solteros, heterosexuales, del sexo masculino, nivel escolar, preuniversitario, con conducta sexual promiscua. Los mayores porcentajes de respuesta al tratamiento y los menores porcentajes de recidiva se lograron con el interferón alfa adyuvante a la criocirugía.

BACKGROUND. A literature review revealed few studies witli clinical, epidemiological and therapeutics characteristics of patients witli condyloma acuminate. PATlENTS AND METHOD. We performed a descriptive, ambispective study in 219 with condyloma acuminate, attended in the dermatology department of the Hermanos Ameijeiras Hospital between January 2009 and December 2013. The aim was to obtain the patients' clinical and epidemiological characteristics and to know the received treatment and their therapeutic efficacy. Were determined different epidemiological variables, such as: age, sex, skin color, civil state, schooling, occupation, toxic habits, behavior and orientation sexual; the clinical characteristics of the lesions; and were evaluated the received treatments and their response. RESULTS. The most frequents clinical and epidemiological characteristics of patients were masculine, single, workers, white skin color, younger than 20 years old, heterosexual orientation and promiscuous behavior with very large evolution s time of the illness associated to big affected area and high number and site of the lesions. The received treatments were: radiosurgery, 25 % podophyllin resin, 80 % trichloroacetic acid, topical 5-fluorouracil (5 % cream], cryosurgery, intramuscular interferon-a2b (3 x 10 lU) and subcutaneous application of interferon-a2b (3 x 10 lU) three times a week plus fortnightly application of cryosurgery. Statistically significant better response and lower relapse rates (p<0,001) were found in the patients who received subcutaneous application of interferon- a2b (3x10 IU) 3 three times a week the therapeutic efficacy and the patientsÆ clinical, epidemiological characteristics allow improved patient management.

Local control of human papillomavirus infection after anal condylomata acuminata eradication / Controle local da infecção perianal pelo papilomavirus humano após a erradicação dos condilomas acuminados

OBJECTIVE: To verify whether the eradication of anal condylomata acuminata was effective for local control of HPV infection using anal colposcopy and anal brush cytology. METHODS: We evaluated 147 patients treated for anal margin and/or anal canal condyloma, with 108 HIV-positive and 39 HIV-negative individuals. The average age for males was 40 years for HIV-positive and 27.5 for HIV-negative. In females, the mean age was 37.5 years for HIV-positive and 31.5 for HIV-negative. RESULTS: Twenty-four patients (16.3%) had normal cytology and anal colposcopy, 16 (10.9%) normal cytology and altered anal colposcopy, 52 (35.4%) normal anal colposcopy and altered cytology, and 55 (37.4%) had altered cytology and anal colposcopy. CONCLUSION: the eradication of clinical lesions failed to locally control HPV infection. .

OBJETIVO: verificar se a erradicação dos condilomas acuminados perianais foi efetiva no controle local da infecção pelo HPV, utilizando a colposcopia anal e a citologia anal com escova. MÉTODOS: avaliamos 147 pacientes tratados de condiloma da margem e/ou canal anal, sendo 108 HIV-positivos e 39 HIV-negativos. A média etária no sexo masculino foi 40 anos para os HIV-positivos e 27,5 anos para os HIV-negativos. No sexo feminino, a média etária foi 37,5 anos para os HIV positivos e 31,5 anos HIV-negativos. RESULTADOS: vinte e quatro pacientes (16,3%) apresentavam citologia e colposcopia normais, 16 (10,9%) citologia normal e colposcopia alterada, 52 (35,4%) citologia alterada e colposcopia normal e 55 (37,4%) citologia e colposcopia alteradas. CONCLUSÃO: a erradicação das lesões clínicas não controlou localmente a infecção pelo HPV. .

A prospective, open, comparative study of 5% potassium hydroxide solution versus cryotherapy in the treatment of genital warts in men

BACKGROUND: Genital warts are caused by human papillomavirus infection and represent one of the most common sexually transmitted diseases. Many infections are transient but the virus may recur, persist, or become latent. To date, there is no effective antiviral treatment to eliminate HPV infection and most therapies are aimed at the destruction of visible lesions. Potassium hydroxide is a strong alkali that has been shown to be safe and effective for the treatment of genital warts and molluscum contagiosum. Cryotherapy is considered one of the most established treatments for genital warts. No comparative trials have been reported to date on the use of potassium hydroxide for genital warts. OBJECTIVE: A prospective, open-label, randomized clinical trial was conducted to compare topical potassium hydroxide versus cryotherapy in the treatment of genital warts affecting immunocompetent, sexually active men. METHODS: Over a period of 10 months, 48 patients were enrolled. They were randomly divided into two groups and selected on an alternative basis for either potassium hydroxide therapy or cryotherapy. While response to therapy did not differ substantially between both treatment modalities, side effects such as local pain and post-treatment hypopigmentation were considerably more prevalent in the groups treated using cryotherapy. Result: In our study, potassium hydroxide therapy proved to be at least as effective as cryotherapy and offered the benefit of a better safety profile. CONCLUSION: Topical 5% potassium hydroxide presents an effective, safe, and low-cost treatment modality for genital warts in men and should be included in the spectrum of therapies for genital warts. .

Condiloma acuminado gigante (tumor de Buschke-Lowenstein): presentación de un caso / Giant acuminated condiloma (Bushke-Lowenstein tumor): case report

El condiloma gigante del pene o tumor de Buschke-Lowenstein, es un tumor epitelial benigno de origen viral y sexualmente transmisible, que en raros casos puede malignizar. Su histología se caracteriza por papilomatosis y acantosis endo y exofítica. Existen diferentes tratamientos del tumor, pero el más efectivo es la resección quirúrgica radical para evitar recidivas y malignización. Describir y documentar un caso de un condiloma acuminado gigante o tumor de Buschke-Lowenstein. Revisaremos la bibliografía existente sobre este tipo de tumor. Paciente masculino de 51 años de edad con lesiones vegetantes de 6 años de evolución, que se extienden desde la región perianal a perineal y ambas regiones inguinales, escroto y base de pene, a quien se le realizó resección quirúrgica amplia de la lesión. El estudio anatomopatológico reporta condiloma acuminado gigante, con inflamación crónica severa sobre agregada, el paciente mantiene resultados funcionales y estéticos muy satisfactorios después de la cirugía. El tumor de Buschke-Lowenstein es un condiloma acuminado gigante que se presenta con más frecuencia en hombres, benigno, cuyas lesiones clínicas son mayores de 10 cm, por lo que el tratamiento de elección debe ser siempre quirúrgico.

The giant condyloma of the penis or denominated Buschke-Lowenstein tumor is a benign epithelial tumor of viral origin and its sexually transmissible, in rare cases can become transformation to malignant. Histology is characterized by papillomatosis and acanthosis endophytic and exophytic. There are different treatments of the tumor, but the most effective of them is the radical surgical resection to prevent recurrences and the malignant transformation of the lesion. To describe and document a case view of us in our institution of giant condyloma acuminatum or Buschke-Lowenstein tumor. We will review the existent literature on this type of tumor. Male patient 51 years old with vegetative lesions of 6 years of evolution, extending from the perineal and per anal region to groins, the scrotum and the penis base, who underwent extensive surgical resection treatment. The pathology reports giant condyloma acuminatum with severe chronic inflammation, actually the patient maintains satisfactory functional and aesthetic results after the surgery. The Buschke-Lowenstein tumor is a giant condyloma acuminated it´s occurs more often in men, benign clinical lesions which are greater than 10 cm, so the treatment of choice should always be the surgical.

Infecções anais pelo papilomavírus humano, crioterapia e crioimunologia / Anal infections by human papillomavirus, criotherapy, and cryoimunology

As verrugas genitais causadas pelo papilomavírus humano (HPV) são problemas comuns na prática clínica do coloproctologista. As opções terapêuticas são numerosas, não havendo padrão-ouro para o tratamento dos condilomas. Dentre elas, é possível destacar a crioterapia, que é eficaz, apesar de pouco utilizada. O efeito destrutivo da crioterapia ocorre por lesão celular direta, causada pelo frio, e por anóxia tecidual, consequente às alterações microcirculatórias. Dentre as vantagens do método, cita-se a segurança; a simplicidade de aplicação; o uso dentro e fora do canal anal, inclusive durante a gestação; e o desconforto local leve, dispensando anestesia. Os agentes criogênicos mais utilizados são o nitrogênio líquido e, mais recentemente, o dimetiléter-propano. Uma vantagem adicional é observada no tratamento das lesões neoplásicas e seus precursores. Postula-se que seu congelamento induziria à resposta imune antitumoral, consequente ao mecanismo de lesão tecidual, que expõe grande quantidade de antígenos intracelulares aos macrófagos e às células dendríticas. Entretanto, a literatura médica ainda carece de estudos abordando especificamente o tema, sobretudo na área da coloproctologia. De qualquer forma, podemos afirmar que a crioterapia é método eficaz, seguro, confortável e prático para o tratamento das verrugas anogenitais induzidas pelo HPV.

Genital warts caused by human papillomavirus (HPV) are a common problem in clinical practice of colorectal surgeons. There are several therapeutic options, although, there is not a gold standard for the treatment of condilomas. Among them, we could mention cryotherapy, which is an effective method, despite having little use. The destructive effect of cryotherapy is through direct cellular injury, which is provoked by cold, and tissue anoxia, due microcirculatory changes. Among the method advantages, we could relate safety; simplicity of application; use inside and outside the anal canal, and during pregnancy; and mild local discomfort, not requiring anesthesia for its application. The most commonly used cryogenic agents are liquid nitrogen and more recently dimethylether-propane. An additional advantage is observed in the treatment of neoplasias and its precursors. It is postulated that freezing would induce an anti-tumor immune response, consequent to the mechanism of tissue injury, exposing a large amount of intracellular antigens to macrophages and dendritic cells. However, the literature still lacks studies specifically addressing this issue, especially in coloproctology. Anyway, we could say that cryotherapy is an effective, safe, comfortable, and practical method to treat anogenital warts induced by the HPV.

Série de casos de verruga anogenital em crianças tratadas com imiquimodes / Case series of anogenital warts in children treated with imiquimod

Apresentamos três casos de verrugas anogenitais em crianças, entre julho de 2009 e julho de 2010, tratadas com imiquimode creme a 5%. Esse estudo salienta a possibilidade do uso de uma droga imunomoduladora, evitando a realização de tratamentos tradicionais, tais como a excisão cirúrgica, os métodos físicos e químicos que, além de dolorosos, requerem internação e anestesia, podendo deixar cicatrizes com extensão proporcional ao tamanho da lesão.

We present three cases of anogenital warts in children, between July 2009 and July 2010, treated with imiquimod 5% cream. This study highlights the possibility of using an immunomodulatory drug, avoiding the need of traditional treatments such as surgical excision, physical and chemical methods, which are not only painful, but also require hospitalization and anesthesia, and can leave scars with extension proportional to the size of the injury.

Eficacia terapéutica comparativa entre la podofilina y el allium sativum en el condiloma acuminado / Comparative therapeutic eficiency between podophylline and allium savitum in verruga acuminata

Se realizó un estudio abierto, controlado, para comparar la eficacia de podofilina 25 por ciento y Allium sativum en el tratamiento del Condiloma Acuminado. Se incluyeron al azar 30 pacientes: 15, en el grupo A y 15, en el grupo B, en la consulta dermatológica del Hospital Universitario Celia Sánchez Manduley (2006-2007); aplicando al grupo A podofilina 25 por ciento, 2 veces a la semana, y el grupo B Allium sativum, 2 veces por semana. Ambos productos tópicamente por 6 semanas. La eficacia terapéutica fue evaluada una semana después de culminar el tratamiento comparando el estado inicial y final de las lesiones. A los pacientes curados, se les realizó seguimiento trimestral durante un año para detectar posibles recidivas. La eficacia terapéutica fue mejor en el grupo B (73,3 por ciento) con menos recidivas (9,1 por ciento), aunque estadísticamente la diferencia fue poco significativa. El resultado empezó a verse generalmente entre la 3-4 semana del tratamiento. Se demostró la eficacia del Allium sativum en esta dermatosisAU)

An opened and controlled study was carried-out, to compare the efficiency of Podophylline 25 percent and Allium sativum in the treatement of verruca acuminata. 30 patients were taken at random: 15 in group A and 15 in group B in the Dermatology consultation of Celia Sánchez M. Universitary Hospital in the year 2006-2007; applaying to group A, Podophylline 25 percent twice per week and Allium savitum to group B twice per week. Both products per six weeks. The therapeutic efficiency was evaluated a week after finishing the treatment comparing the initial state and final lesion. To the cured patients a tracking every three months was carried out during the whole year to detect possible relapses. The therapeutic efficiency was better in group B (73,3 percent) with less relapses (9,1 percent), although statistically the difference was less significant. The results started to be seen between the three-four weeks of treatment. The eficiency of Allium sativum was proved in this dermatoid lesions(AU)

Condiloma anal gigante: relato de caso / Giant condyloma acuminatum: a case report

O tumor de Buschke-Löwenstein é uma variedade pouco frequente da infecção pelo HPV. O tumor possui comportamento invasivo, embora seja histologicamente benigno. Pode estar associado a condições de imunossupressão e a recorrência após o tratamento é frequente. Objetivo: descrever um caso de um portador de aids e demonstrar que a imunossupressão é fator contribuinte, e que a cirurgia é o tratamento mais eficaz. Métodos: descrição do caso clínico, com referências na literatura. Resultados: foi realizada a cirurgia com ressecção ampliada e evolução satisfatória no pós-operatório.Conclusão: a cirurgia é o tratamento recomendado pela maioria dos autores e a biópsia é procedimento indicado para excluir malignidade.

Buschke-Löwenstein tumor is an uncommon variety of HPV infection. Being histologically benign, the tumor has invasive behavior. It maybe associated with conditions of immunosupression, and recurrence after treatment is frequent. Objective: to describe a case in a patient with AIDS, to show that immunosupression is a contributing factor, and that surgery is the most effective treatment. Methods: a case description, with references in the literature. Results: extended resection surgery with satisfactory outcome in the postoperative period. Conclusion: surgery is the treatment recommended by most authors and biopsy is an indicative procedure to exclude malignancy.

Uso de imiquimode tópico no tratamento da infecção anal pelo papilomavírus humano / The use of topic imiquimod in the treatment of the anal infection by human papillomavirus

Dos diversos tratamentos da infecção anal pelo papilomavírus humano, uma opção é o imunomodulador imiquimode. Derivado da família imidazoquinolina, o imiquimode é quimioterápico e imuno-estimulante com atividade antitumoral e antiviral. A medicação é aplicada em esquema domiciliar, três vezes por semana em noites alternadas, por oito a 16 semanas. Os efeitos adversos locais são comuns, mas bem tolerados. A droga atinge remissão de 74 a 84 por cento, sendo completa entre 25 e 77 por cento dos doentes, com menor taxa de remissão completa e maior índice de recidiva em imunodeprimidos. Aguardamos estudos com grandes casuísticas para avaliar melhor a eficácia dessa medicação, incluindo a incidência de recidivas e o tempo livre de novas lesões.

Considering several kinds of treatments for human papillomavirus anal infection, the topical immune response modifier imiquimod is an option. An imidazoquinoline derivate, imiquimod is a chemotherapic drug and an immune stimulator with antitumoral and antiviral action. The medication is used at home, by patients, three times a week, in alternated nights, for eight to 16 weeks. Side-effects are common, but well tolerated. This drug reaches from 74 to 84 percent of remission, although from 25 to 77 percent are complete. There are lower complete remission and higher recurrence in immune compromised patients. Studies with more patients for better evaluation of this medication efficiency are needed, including those about recurrences and time free from new lesions.

La quimiopuntura, nueva estrategia de tratamiento del paciente con condiloma acuminado recidivante / Chemopuncture, new strategy to treat patients with recidivant acuminated condyloma

El tratamiento de afecciones médicas basado en la inyección en ciertos puntos acupunturales con productos químicos, mediante la cual la absorción del producto es mucho mayor, se conoce con el nombre de Quimiopuntura o Farmacopuntura. Teniendo en cuenta la alta incidencia de pacientes con condilomas acuminados recidivantes en nuestra consulta y la ausencia de tratamientos que controlen las tasas de recidivas, decidimos evaluar la eficacia de la Quimiopuntura con el empleo de la vitamina B 12 subcutáneo en puntos inmunoestimulantes en Clínica MININT provincial, ya que se conoce la relación de las recidivas de esta afección con el estado inmune de los pacientes afectados. Usando el método de aleatorización simple sin reemplazo, distribuimos a nuestros pacientes con diagnóstico clínico de condilomas acuminados recidivantes en dos grupos (n= 30 para cada grupo). El Grupo A (control) se trató con crioterapia (inmunomodulador tópico) y el Grupo B (experimental) con quimiopuntura. Los pacientes fueron evaluados quincenalmente durante los tratamientos y mensualmente post-tratamiento durante 6 meses. Con esta investigación se demuestra que la quimiopuntura con vitamina B12 es eficaz en el control de la recidiva de los condilomas acuminados.

The treatment of medical affections based on the injections in certain acupunctural points with chemical products, through which the absorption of the products is higher, is known by the name of chemopuncture or pharmacopuncture. Taking into account the high incidence of patients with recidivant acuminated condylomas in our consultation and the lack of treatments controlling the recidivant rate, we decided to evaluate the efficacy of chemopuncture using subcutaneous B 12 vitamin in immunostimulant points at the provincial INTMIN clinic, because it is known the relationship of this affection recidivants with the immune status of the affected patients. Using the simple randomized method without replacement, we divided our patients with a clinic diagnosis of recidivant acuminated condylomas in two groups (n= 30 for each group). The Group A (control) patients were treated with cryotherapy (topic immunomodulator) and the Group B (experimental) patients with chemopuncture. Patients were evaluated fortnightly during the treatment and monthly during six months after the treatment. This investigation showed that chemopuncture with B 12 vitamin is efficacious in controlling the recidivism of the acuminated condylomas.

Criocirugía en el tratamiento del condiloma acuminado / Cryosurgery in the management of condyloma acuminatum

ANTECEDENTES: La criocirugía es una técnica rápida, barata, sencilla y limpia, que permitetratar múltiples lesiones de condiloma acuminado en un solo acto quirúrgico, generalmente sin necesidad de anestesia, no ocasiona sangramiento, ni vaporización de los tejidos, conexcelente resultado estético y postoperatorio no doloroso. OBJETIVO: Determinar la eficacia terapéutica de la criocirugía en el condiloma acuminado.PACIENTES Y MÉTODO: Estudio cuasiexperimental. Se incluyeron los primeros 40 pacientes adultos con condiloma acuminado que acudieron a la consulta del policlínico docente: ôJoaquínAlbarránõ entre noviembre 2005 y enero 2006. Se realizó criocirugía quincenal a las lesiones, con nitrógeno liquido (-196Co), durante 6 semanas. La eficacia terapéutica fue evaluada dossemanas después de culminar el tratamiento, comparando el estado inicial y final de las lesiones. A los pacientes con respuesta total se les realizó seguimiento trimestral durante 1 año para detectar recidivas. RESULTADO: El análisis pareado inicio-final demostró respuesta significativa al tratamiento, en cuanto a: diámetro mayor, diámetro menor, número de lesiones y respuesta fundida (respuestatotal y parcial). La tasa de recidiva fue elevada. Los principales eventos adversos observados fueron: ardor, dolor, tumefacción y vesiculación; de intensidad leve y de desaparición espontánea. CONCLUSIÓN: La criocirugía es eficaz en el tratamiento tópico del condiloma acuminadopero tiene alta tasa de recidiva. Las reacciones adversas fueron locales y de leve intensidad.

Background: Cryosurgery has been used in the management of condyloma acuminatum (many lesions in only one visit). It requires: little time, fits easily into the physicianÆs office, minimalwound care, no expensive supplies or injectable anesthesia, no produce bleeding. In addition, the cosmetic results are excellent. Aim: Determinate the therapeutical effectivenesscryosurgery in the topical treatment of the condyloma acuminata Patients and methods: A prospective, open, controlled study was carried out. The first 40 adult patients at random with this diagnosis were included and attended at the Joaquín Albarrán teaching polyclinic, in the time period comprised between november 2005 and january 2006. Thepatients received a fortnightly application of cryosurgery with Liquid nitrogen (at -196°C), for six weeks. The therapeutical effectiveness wasassessed a couple of weeks after completing the treatment, comparing the initial and final state of lesions. The patients who responded totally were followed up quarterly during a year inorder to spot possible relapses. Results: The start-end comparative analysisshowed an outstanding response to thetreatment, in relation to: larger diameter, smaller diameter, number of lesions and fusible response (total and partial). The relapse rates were high.The major adverse events observed were: burning, pain, swelling and vesicles. Comment: The therapeutical effectiveness of cryosurgery in the topical treatment of the condyloma acuminate was demonstrated but therelapse rates were high. The adverse events were local and of mild intensity.

Condiloma acuminado - resposta terapêutica com imiquimode e cirurgia / Genital wart - therapeutic response with immiquimod and surgery

O condiloma acuminado é uma das manifestações do papilomavírus humano (HPV) na área genital. Relata-se o caso de uma paciente do sexo feminino, 27 anos com extensa lesão condilomatosa na região vulvar. O tratamento foi realizado com exérese cirúrgica das lesões maiores, seguido da aplicação de imiquimode nas lesões menores e recidivas, com resolução clínica completa em 8 semanas. Foram abordadas as diferentes formas de tratamento com enfoque na terapêutica com imiquimode.

Condylomata acuminata is one of the genital manifestations of the Human papillomavírus (HPV) infection in the genital area. This is a case report of a 27 years-old female patient with extensive genital warts in the vulvar. The treatment was performed with surgical ressection of the biggest warts and local application of immiquimod in the others lesions and relapses. The complete clinical resolution was observed in 8 weeks. We will review the different forms of treatment emphasing immiquimod treatment.