RESUMO
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.
Assuntos
Anti-Infecciosos Locais/administração & dosagem , Catequina/uso terapêutico , Condiloma Acuminado/tratamento farmacológico , Criocirurgia , Imunomodulação , Papillomaviridae , Podofilina/administração & dosagem , Administração Cutânea , Adolescente , Adulto , Idoso , Anti-Infecciosos Locais/uso terapêutico , Catequina/administração & dosagem , Catequina/efeitos adversos , Terapia Combinada , Condiloma Acuminado/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pomadas , Extratos Vegetais/administração & dosagem , Estudos Retrospectivos , Resultado do Tratamento , Adulto JovemRESUMO
Cutaneous angiomyxomas are myofibroblastic neoplasms with locally aggressive behaviour and a high risk of recurrence. We describe a case of a solitary cutaneous angiomyxoma presenting on the nasal dorsum of a 28-year-old man, excised with Mohs surgery using permanent section control and repaired with an advancement flap. Histology showed myxoid nests of bland CD34-positive and vimentin-positive stellate and spindled cells in the deep dermis and abundant thin-walled blood vessels. An echocardiogram, performed to rule out the possibility of a cardiac myxoma with cutaneous embolisation, was normal.
