Imiquimod cream combined with polysaccharide nucleic acid fraction of bacillus Calmette-Guerin for the prevention of recurrent condyloma acuminatum after CO2 laser surgery: an efficacy evaluation / 中华皮肤科杂志

ABSTRACT

Objective To evaluate the efficacy of imiquimod cream combined with polysaccharide nucleic acid fraction of bacillus Calmette-Guerin (BCG-PSN) for the prevention of recurrent condyloma acuminatum (CA) after CO2 laser surgery.Methods Seventy-four patients with recurrent CA were divided into two groups according to the time of admission and treatment strategiesobservation group (n =40) receiving intramuscular BCG-PSN (1.0 mg every other day for 3 months) and applying topical imiquimod cream,control group (n =34) applying topical imiquimod cream only,after CO2 laser surgery.Imiquimod cream was topically used once every other day for 4 weeks in both groups.The percentage of T lymphocyte subsets was determined in these patients before and 3 months after the beginning of treatment.Side effects were recorded during the treatment.All of the patients were followed for 6 months for the evaluation of recurrence.Data were processed with the SPSS 18.0 software,and statistical analysis was carried out by t test and chi-square test.Results After three months of treatment,the patients in the observation group showed a significant increase in the percentage of CD4+ T lymphocytes (42.19％ ± 2.79％ vs.33.56％ ± 3.72％,t =11.74,P＜ 0.05) and CD4/CD8 ratio (1.22 ± 0.21 vs.0.89 ± 0.26,t =6.24,P＜ 0.05),but a significant decrease in the percentage of CD8+T lymphocytes (32.23％ ± 3.32％ vs.39.12％ ± 3.56％,t =8.95,P ＜ 0.05) compared with those before treatment; significant differences were also observed between the observation group and control group in the percentage of CD4+ T lymphocytes (42.19％ ± 2.79％ vs.33.72％ ± 2.94％,t =2.14,P ＜ 0.05) and CD8+ T lymphocytes (32.23％ ± 3.32％ vs.38.47％ ± 3.97％,t =7.26,P ＜ 0.05) as well as CD4/CD8 ratio (1.22 ± 0.21 vs.0.92 ± 0.26,t =5.40,P ＜ 0.05).During the 6 months of follow up,the recurrence rate of CA was 5.00％ (2/40) in the observation group,compared to 47.06％ (16/34) in the control group (x2 =17.66,P ＜ 0.01).The peak of recurrence was observed in the first two months after CO2 laser surgery in both groups,with significant differences between the two groups in the recurrence rate during the first and second months (both P ＜ 0.05).No significant difference was observed in the incidence of adverse reactions between the two groups.Conclusion Imiquimod cream combined with BCG-PSN can effectively enhance immune function and reduce relapse rate in patients with CA after CO2 laser surgery.