Abstract
OBJECTIVES: Imiquimod is an immune response modifier that has demonstrated a good efficacy and relatively low recurrence rates in comparison to other genital wart treatment modalities. The primary objective of this open-label study was to evaluate the effect on sustained clearance of treated lesions and the safety of patient-applied topical imiquimod after laser therapy of external anogenital warts. METHODS: After laser treatment of visible external anogenital warts the ablated region(s) were treated with imiquimod 5% cream three times/week over 12 weeks beginning when the wound healing process was completed, followed by a six-month treatment-free observation period for the assessment of sustained clearance of treated lesions. RESULTS: A total of 211 male and female patients was enrolled in the study. After 12 weeks of treatment, 65.4% of all patients showed sustained clearance. During the treatment period, 15 patients (7.1% of 211 patients) presented with recurrent warts in the treated areas, and 58 (27.5%) patients were excluded for other reasons. During the six-month follow-up period, ten additional patients (7.3% of 138 patients) developed wart recurrences. The application of imiquimod 5% cream was well tolerated. The number of patients with adverse events related to study medication declined from the first month of treatment until the end of the third month. Most frequently, mild to moderate itching, burning, pain and erythema were reported. CONCLUSIONS: After laser therapy and sufficient wound healing, administration of imiquimod 5% cream three times/week appears to be safe and to reduce the incidence of wart recurrences.
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Selected References
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- Boyce D. E., Jones W. D., Ruge F., Harding K. G., Moore K. The role of lymphocytes in human dermal wound healing. Br J Dermatol. 2000 Jul;143(1):59–65. doi: 10.1046/j.1365-2133.2000.03591.x. [DOI] [PubMed] [Google Scholar]
- Carpiniello V. L., Zderic S. A., Malloy T. R., Sedlacek T. Carbon dioxide laser therapy of subclinical condyloma found by magnified penile surface scanning. Urology. 1987 Jun;29(6):608–610. doi: 10.1016/0090-4295(87)90101-4. [DOI] [PubMed] [Google Scholar]
- Coleman N., Birley H. D., Renton A. M., Hanna N. F., Ryait B. K., Byrne M., Taylor-Robinson D., Stanley M. A. Immunological events in regressing genital warts. Am J Clin Pathol. 1994 Dec;102(6):768–774. doi: 10.1093/ajcp/102.6.768. [DOI] [PubMed] [Google Scholar]
- Czelusta A. J., Evans T., Arany I., Tyring S. K. A guide to immunotherapy of genital warts: focus on interferon and imiquimod. BioDrugs. 1999 May;11(5):319–332. doi: 10.2165/00063030-199911050-00004. [DOI] [PubMed] [Google Scholar]
- Edwards L., Ferenczy A., Eron L., Baker D., Owens M. L., Fox T. L., Hougham A. J., Schmitt K. A. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. Arch Dermatol. 1998 Jan;134(1):25–30. doi: 10.1001/archderm.134.1.25. [DOI] [PubMed] [Google Scholar]
- Ferenczy A., Mitao M., Nagai N., Silverstein S. J., Crum C. P. Latent papillomavirus and recurring genital warts. N Engl J Med. 1985 Sep 26;313(13):784–788. doi: 10.1056/NEJM198509263131304. [DOI] [PubMed] [Google Scholar]
- Gollnick H., Barasso R., Jappe U., Ward K., Eul A., Carey-Yard M., Milde K. Safety and efficacy of imiquimod 5% cream in the treatment of penile genital warts in uncircumcised men when applied three times weekly or once per day. Int J STD AIDS. 2001 Jan;12(1):22–28. [PubMed] [Google Scholar]
- Holzheimer R. G., Steinmetz W. Local and systemic concentrations of pro- and anti-inflammatory cytokines in human wounds. Eur J Med Res. 2000 Aug 18;5(8):347–355. [PubMed] [Google Scholar]
- Kawakami M., Kaneko N., Anada H., Terai C., Okada Y. Measurement of interleukin-6, interleukin-10, and tumor necrosis factor-alpha levels in tissues and plasma after thermal injury in mice. Surgery. 1997 Apr;121(4):440–448. doi: 10.1016/s0039-6060(97)90315-9. [DOI] [PubMed] [Google Scholar]
- Koutsky L. Epidemiology of genital human papillomavirus infection. Am J Med. 1997 May 5;102(5A):3–8. doi: 10.1016/s0002-9343(97)00177-0. [DOI] [PubMed] [Google Scholar]
- Miller R. L., Gerster J. F., Owens M. L., Slade H. B., Tomai M. A. Imiquimod applied topically: a novel immune response modifier and new class of drug. Int J Immunopharmacol. 1999 Jan;21(1):1–14. doi: 10.1016/s0192-0561(98)00068-x. [DOI] [PubMed] [Google Scholar]
- Ravage Z. B., Gomez H. F., Czermak B. J., Watkins S. A., Till G. O. Mediators of microvascular injury in dermal burn wounds. Inflammation. 1998 Dec;22(6):619–629. doi: 10.1023/a:1022366514847. [DOI] [PubMed] [Google Scholar]
- Riva J. M., Sedlacek T. V., Cunnane M. F., Mangan C. E. Extended carbon dioxide laser vaporization in the treatment of subclinical papillomavirus infection of the lower genital tract. Obstet Gynecol. 1989 Jan;73(1):25–30. [PubMed] [Google Scholar]
- Tyring S. K., Arany I., Stanley M. A., Tomai M. A., Miller R. L., Smith M. H., McDermott D. J., Slade H. B. A randomized, controlled, molecular study of condylomata acuminata clearance during treatment with imiquimod. J Infect Dis. 1998 Aug;178(2):551–555. doi: 10.1086/517472. [DOI] [PubMed] [Google Scholar]
- von Krogh G., Lacey C. J., Gross G., Barrasso R., Schneider A. European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts. Sex Transm Infect. 2000 Jun;76(3):162–168. doi: 10.1136/sti.76.3.162. [DOI] [PMC free article] [PubMed] [Google Scholar]