The use of sinecatechins (polyphenon E) ointment for treatment of external genital warts

INTRODUCTION: Sinecatechins is a standardized extract of green tea leaves, containing a mixture of catechin compounds. The 15% ointment has been approved for the topical treatment of condylomata acuminata (CA), caused by particular human papillomaviruses (HPV), mainly HPV types 6 and 11. OBJECTIVE: To update the use of sinecatechins for treatment of CA and to describe possible mechanisms involved in the mode of action. AREAS COVERED: The clearance rate of wart lesions after treatment with sinecatechins is similar to other topically applied drugs, like imiquimod and podophyllotoxin, but recurrences are seen less frequently after treatment with sinecatechins. The molecular mode of action underlying the clinical efficacy has yet not been characterized, but the following properties are likely to be involved in the regression of genital warts: activation of cellular immune reactions, induction of cell cycle arrest and apoptosis, inhibition of HPV gene expression. EXPERT OPINION: Sinecatechins is a safe and effective treatment option for CA. Due to the variety of molecular activities of catechins the product has great potential for application to other viral and tumor lesions in the future.     

A retrospective analysis of costs and patterns of treatment for external genital warts in The Netherlands

BACKGROUND: External genital warts (EGWs) are one of the most common sexually transmitted infections, but little is known about the treatment patterns or resources used in the management of this condition. OBJECTIVE: The purpose of this retrospective analysis is to examine the patterns of treatment, resource utilization, and costs for EGWs in 3 dermatology clinics in the Netherlands. METHODS: A total of 530 completed episodes of care for EGWs were analyzed to identify patterns of treatment and resources used. Costs of care were calculated based on 4 cost components for each visit: labor costs, material costs, indirect costs, and extra costs. RESULTS: Across the 3 sites, men required an average of 5.78 clinic visits to achieve a completed episode of care; women required an average of 6.52 visits. The distribution of visits is highly skewed, however, with a median of 4.56 visits for men and 5.55 for women. More than 80% of patients were initially treated with monotherapy. Podophyllin and cryotherapy were the principal choices for initial therapy. The mean cost, in euros, of completing an episode of care was 221.34 euro for men and 292.29 euro for women. The cost per completed or successful episode of care was 395.92 euro for men and 485.05 euro for women. The distribution of costs was also skewed, with a relatively small group of patients accounting for a considerable proportion of overall costs. Although only 31.4% of male patients recorded > or = 6 visits for a completed episode of care, this group accounted for 57.3% of the total costs of treatment for male patients. Among female patients, 43.4% had > or = 6 visits, which accounted for 73.9% of the total costs of care for female patients. Costs also varied markedly by therapy sequence chosen. Patients who remained on their initial monotherapy or combination therapy had the lowest costs; the extent to which patients switched therapies substantially affected overall costs. For those patients initially treated with podophyllin, the mean total costs of treatment, taking into account the proportion who required a change in therapy, were 204.84 euro for men and 386.38 euro for women. For those initially treated with cryotherapy, the mean cost of treatment was 193.60 euro for men and 169.23 euro for women. CONCLUSION: Current treatment options for EGWs do not appear to minimize resource utilization or help achieve complete episodes of care at the lowest possile cost.     

308nm准分子激光联合20％尿素软膏治疗手掌慢性湿疹临床疗效观察

目的评价308nm准分子激光治疗慢性湿疹的疗效及安全性。方法采用自身对照的方法,每例患者选取一侧手部皮损为治疗侧,采用308nm准分子激光联合20％尿素软膏进行治疗,另一侧手部皮损为对照侧,仅用20％尿素软膏治疗。2个月后进行疗效判定。结果联合治疗组有效率为88．4％,对照组为54．7％,两组疗效比较差异有统计学意义（P〈0．05）。结论308nm准分子激光治疗慢性湿疹疗效好,起效快。     

Cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix

The aim of the study was to establish the efficacy of cryotherapy in the management of histologically diagnosed subclinical human papilloma virus (HPV) infection of the cervix. Women with genital warts who had subclinical HPV infection of the cervix and no other sexually transmitted diseases were followed up at six weeks, 12 weeks, six months, 12 months and 18 months after treatment with cryotherapy. They came to the out-patient department of genito-urinary medicine (GUM) at St Luke's Hospital, an open clinic without any appointment system. Two hundred and fifty-five patients with genital warts took part in the study. They underwent clinical genital examination, along with cytology, colposcopy and colposcopically directed cervical punch biopsies. Sixty-three of them had subclinical HPV infection of the cervix only, and were considered suitable for cryosurgery. Twelve weeks after treatment only one patient developed clinical warts on the cervix, which increased to three patients (4.8%) after 12 months. No further patients developed any clinical cervical warts. In the untreated group development of clinical warts was noticed in five patients (20%) after 18 months. The difference was significant. The failure rate for the histologically diagnosed subclinical HPV infection was 38% in the treated group, whereas it persisted in 76% of the untreated group. Cryotherapy was found to be successful in the treatment of subclinical HPV infection and prevented the development of clinical disease. There were no serious side-effects and the treatment can be administered easily in an out-patient setting after histological confirmation.     

Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature

Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.     

海极星微创技术治疗外阴白色病变50例临床疗效观察

目的探讨海极星微创技术治疗外阴白色病变患者的临床价值。方法选择经本院病理检查确诊的98例外阴白色病变患者,随机分为海极星微创技术(治疗)组和苦参洗液+冰黄肤乐软膏(对照)组,观察2组患者治疗后外阴痛痒程度、外阴皮肤弹性恢复情况、外阴皮肤颜色恢复状况、外阴白斑缩小程度。结果治疗组痛痒完全消除或基本缓解47例(94%),外阴皮肤颜色恢复良好或色素减退或出现粉红色47例(94%),皮肤弹性完全恢复或基本恢复的46例(92%),白斑完全消失或部分缩小的48例(96%),与对照组相比差异有显著性特征;治疗组术中出现1例小面积皮肤破损、1例小面积溃疡。结论海极星微创技术治疗外阴白色病变疾病可靠性与安全性较高,临床疗效显著。     

Hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream versus desonide (Apolar) 0.1% ointment in the treatment of patients suffering from atopic dermatitis

A randomized, double-blind, left-right study to compare the therapeutic efficacy and the cosmetic acceptability of the new hydrocortisone 17-butyrate (Locoid) 0.1% fatty cream application form with desonide (Apolar) 0.1% ointment was performed in thirty patients suffering from moderate to severe atopic dermatitis. The medications were applied to symmetrical, bilateral skin lesions twice daily for 4 weeks. Both treatments effected highly significant reductions of the score values for the severity of all clinical skin parameters assessed. Score reductions were, however, more pronounced on Locoid-treated sides than on Apolar-treated sides both after 2 and 4 weeks of therapy. It appeared further that clinical efficacy of treatment at completion of the study was also in favour of Locoid-treated sides, indicating that Locoid fatty cream is more effective than Apolar ointment. No serious side-effects were reported during the study. The expressed patient preferences with respect to cosmetic acceptability of treatments were significantly in favour of Locoid fatty cream, indicating that patients preferred the use of this new galenic formulation over an ointment formulation. It is concluded that the new application form of Locoid, a fatty cream, is a useful and beneficial addition to topical corticosteroid therapy, which will promote patient compliance in a wide range of corticosteroid-responsive skin diseases.     

苍耳子软膏治疗单纯疱疹的临床观察

目的：观察苍耳子软膏治疗单纯疱疹的临床疗效。方法I夕h用苍耳子软膏治疗由单纯疱疹病毒所致单纯疱疹60例,并与阿昔洛韦软膏治疗62例进行疗效比较。结果：苍耳子软膏组总有效率91．67％,阿昔洛韦软膏组总有效率91．94％,两组疗效比较差异无显著性（P〉0．05）。结论：苍耳子软膏可用于治疗单纯疱疹,其疗效与阿昔洛韦软膏相当。     

Human papillomavirus E6/E7 mRNA testing as a predictive marker for cervical carcinoma

Human papillomavirus (HPV) is necessary for the development of cervical carcinoma, and incorporation of molecular testing for HPV in screening and patient management has been proposed. Sufficient scientific evidence exists to recommend HPV DNA testing in the triage of women with equivocal cytology and in follow-up after the treatment of precursor lesions. However, due to a low clinical specificity and positive predictive value, HPV DNA testing has so far not been recommended as primary screening in Europe. In general, diagnostic HPV tests have to demonstrate accuracy, reproducibility and clinical utility before they can be used in patient management and implemented in cervical cancer screening programmes. In this article we give an overview of RNA-based HPV diagnostics and the role of E6/E7 mRNA detection as a predictive marker for the development of cervical carcinoma. HPV E6/E7 mRNA testing for high-risk types seems to correlate better with the severity of the lesion compared with HPV DNA testing, and is a potential marker for the identification of women at risk of developing cervical carcinoma. Commercial assays for simultaneous genotyping and detection of E6/E7 mRNA from the five most common high-risk HPV types are now available and require further evaluation for primary screening, triage and follow-up after treatment.     

Comparison of povidone-iodine solution and soft white paraffin ointment in the management of skeletal pin-sites: A pilot study

Povidone-iodine solution is currently employed for pin-site care in many institutions. There are concerns that this agent reacts with the metal pins and can impede healing. This study compared two different treatment protocols for the care of the skin surrounding skeletal pin-sites.This practical clinical trial, employing stratified sampling, compared 10% cutaneous povidone-iodine solution with soft white paraffin ointment for the treatment of skeletal pin-sites. The end points of the study were the presence of clinical signs of pin-site inflammation and/or infection and pin removed as treatment was completed. Data were analysed on 116 pin-sites from 18 patients. Seventy-two pins (62%) were treated with povidone-iodine and 44 (37.9%) with paraffin ointment. The group treated with soft white paraffin ointment more frequently developed clinical signs of infection (n = 15; 34.1%) than the povidone-iodine treatment group (n = 13; 18.1%) (χ² (df) = 3.8(1); p = 0.05). Also, 43.8% of pin-sites on the medial aspect of the lower leg displayed inflammation/infection compared with 16.7% of other lower limb pin-sites (χ² (df) = 9.28(1); p = 0.002).The use of an antibacterial agent in the management of skeletal pin-sites reduces the likelihood of infection. Further studies are needed to determine whether anatomical position of the pin-site is a risk factor for the development of pin-site infection and whether intervention could reduce inflammation/infection at medial lower limb pin-sites.     

Methylprednisolone aceponate in eczema and other inflammatory skin disorders -- a clinical update

Methylprednisolone aceponate (MPA) has been shown to provide rapid, reliable and highly effective treatment of eczematous disorders, with an efficacy comparable to that of most reference topical corticosteroids. It also has excellent local and systemic tolerability. MPA is effective in the treatment of facial and scalp eczema and sunburn and has shown promising results in the treatment of psoriasis. Its rapid efficacy and lack of undesirable local and/or systemic side effects make MPA particularly suitable for use in children and infants. The wide range of formulations (0.1%) of MPA, including cream, ointment, fatty ointment, milk and solution, enable treatment to be tailored to the individual patient. In addition, MPA has the advantage of once-daily application compared with twice-daily treatment for other topical corticosteroids, thereby improving patient safety and promoting patient compliance but without compromising efficacy.     

Update on the diagnosis and treatment of human papillomavirus infection

Human papillomaviruses (HPVs) are associated with a spectrum of diseases, ranging from common warts to invasive carcinoma of the genital tract. The clinical manifestations of HPV infection depend on the viral subtype, the immune status of the patient, and environmental co-carcinogens. Infection with HPV is often asymptomatic, which makes viral detection challenging. Current therapies do not reliably eradicate HPV infection, and benign genital warts and genital tract intraepithelial neoplasia often recur after treatment. We discuss the pathogenesis, clinical manifestations, detection, and treatment of HPV infections of the anogenital tract.     

Cost-effectiveness of prophylactic nasal mupirocin in patients undergoing peritoneal dialysis based on a randomized, placebo-controlled trial.

The study objective was to measure the benefits of elimination of nasal carriage of Staphylococcus aureus by calcium mupirocin ointment in patients undergoing continuous ambulatory peritoneal dialysis. The design was a prospective, placebo-controlled, randomized clinical trial. The subjects were 267 patients recruited from nine renal units in Belgium, France and the UK. The main outcome measures were the rate of catheter exit site infection (ESI), rates of other infections and healthcare costs from the perspective of a hospital budget-holder. The rate of ESI caused by S. aureus was significantly reduced from one in 28.1 patient months to one in 99.3 patient months (P = 0.006) and there were also non-significant trends towards lower rates of ESI caused by any organism and peritonitis caused by S. aureus. In comparison with the placebo group, patients in the mupirocin group with ESI had lower antibiotic (P = 0.02) and hospitalization costs (P = 0.065). However, overall costs of antibiotic treatment, for all infections combined, were not significantly different (P = 0.2) and total antibiotic costs (including mupirocin) were significantly higher in the mupirocin group (P = 0.001). Mupirocin prophylaxis would have been cost-neutral if the rate of ESI increased to >75% in the placebo group, or if all healthcare costs increased by 40%, or if the cost of screening was reduced from Pound Sterling 15 to Pound Sterling 3 per patient, or if the cost of mupirocin treatment was reduced from Pound Sterling 93 to Pound Sterling 40 per patient year. In conclusion, savings in healthcare costs are unlikely to be sufficiently great to offset the cost of mupirocin and screening for nasal carriage of S. aureus. The decision about whether or not to implement mupirocin should depend on a local analysis of the value of preventing ESIs caused by S. aureus.     

女性生殖道人乳头瘤病毒与解脲支原体感染之间的相关性研究

目的：探讨女性人乳头瘤病毒（HPV）感染情况及与解脲支原体（UU）感染之间的相关性。方法采用 PCR-反向点杂交基因分型技术对412例女性患者宫颈分泌物进行23种 HPV 亚型感染检测;将 HPV 阳性的患者设为观察组,同时随机选取50例 HPV 阴性的患者作为对照组,运用实时荧光 PCR 同时检测上述2组 UU 的感染情况。结果HPV 总的感染率为12．86％（53/412）,有16种型别被检出,感染率最高的为高危 HPV 52型。HPV 阴性对照组的 UU 阳性率为30．00％（15/50）,而 HPV阳性观察组中 UU 的阳性率为60．38％（32/53）,明显高于 HPV 阴性对照组,差异有统计学意义（P ＜0．05）。结论HPV 感染与UU 感染具有一定的相关性,在临床治疗中应予以重视。     

女性外阴尖锐湿疣组织中HPV感染型别的回顾性研究

目的探讨女性外阴尖锐湿疣(外阴CA)组织中人乳头瘤病毒(HPV)感染型别的分布状况及临床意义。方法采用基因芯片结合聚合酶链式反应(PCR)技术对322例外阴CA组织行23种HPV基因型检测,并分析患者的临床病理资料。结果 322例外阴CA组织中检出HPV阳性者279例,HPV感染率为86.65%(279/322),单一型感染率56.52%(182/322),多型感染率30.12%(97/322)。结论 HPV感染与外阴CA的发病密切相关,HPV 11和6型是单一型感染最主流的型别,而11+18、11+16、6+11和6+16型是多型感染最常见型别。基因芯片联合PCR技术适用于临床开展HPV分型诊断,敏感性好、特异性高,对女性外阴CA的临床诊断、治疗及其疫苗研究意义重大。     

Comparison of HPV sign Genotyping Test with INNO-LiPA HPV Genotyping Extra assay on histologic and cytologic cervical specimens

An accurate tool for viral typing is important for management of patients with human papillomavirus (HPV) infection and to monitor HPV vaccine efficacy. This study evaluated the performance of the HPV sign® Genotyping Test by analyzing 87 archival cervical specimens and compared results with historical data by INNO-LiPA HPV Genotyping Extra assay. There was a substantial concordance for HPV detection in clinical samples (k 0.66), with an overall agreement rate of 85.1%. The genotyping overall agreement, considering one by one the HPV infection detected, was 95.7%. The HPV sign test showed, however, lower sensitivity than INNO-LiPA for HPV 31, 53, and 66. On the other hand, The HPV16 sensitivity was higher for HPV sign (90.0%, confidence interval [CI] 0.79–1.01) than for INNO-LiPA (83.3%, CI 0.70–0.97). Furthermore, HPV sign allowed identifying the presence of HPV16 intratype variants. In conclusion, HPV sign is a promising method for HPV genotyping and has revealed advantages in detecting a broad spectrum of HPV types and variants.     

外阴、阴道和宫颈尖锐湿疣组织中HPV感染的对比研究

目的研讨外阴、阴道和宫颈尖锐湿疣(CA)组织中人乳头瘤病毒(HPV)感染型别的分布状况以及临床意义。方法应用基因芯片结合PCR技术对63例外阴尖锐湿疣、61例阴道尖锐湿疣和65例宫颈尖锐湿疣组织行23种HPV基因型检测,并分析患者的临床病理资料。结果 63例外阴尖锐湿疣组织中检出HPV阳性者56例,HPV感染率为88.89%(56/63);61例阴道尖锐湿疣组织中检出HPV阳性者55例,HPV感染率为90.16%(55/61);65例宫颈尖锐湿疣组织中检出HPV阳性者62例,HPV感染率为95.39%(62/65)。结论 HPV感染与外阴、阴道和宫颈尖锐湿疣的发病密切相关,HPV6和11是主流型别,以外阴尖锐湿疣最为常见。基因芯片结合PCR技术是适合应用于临床行HPV分型诊断的一种方法,具有敏感性好、特异性高的特点。对女性外阴、阴道和宫颈尖锐湿疣的临床诊断、治疗及其疫苗的研究具有重要的意义。     

无锡地区妇女宫颈HPV感染及基因型别分析

目的 对疑似人乳头瘤病毒(HPV)感染的970例妇女进行HPV基因分型检测,以探讨其临床意义.方法 用专用官颈刷采取妇女宫颈的脱落细胞,采用基因芯片法检测970例HPV临床样本,并进行基因分型.结果 970例样本中,HPV感染390例,阳性率40.2%.共检出12种HPV亚型,检出感染单一HPV亚型260例(26.8%),感染两种亚型以上130例(13.4%).低危型主要为HPV6、11,高危型主要为HPVl6、33、52、58、18等.结论 无锡地区妇女宫颈HPV感染率较高,感染亚型主要是6、11型.HPV基因分型检测对于生殖道感染以及子宫颈癌的早期发现以及预防和治疗具有重要意义.     

无锡地区妇女宫颈HPV感染及基因型别分析

目的对疑似人乳头瘤病毒（HPV）感染的970例妇女进行HPV基因分型检测,以探讨其临床意义。方法用专用宫颈刷采取妇女宫颈的脱落细胞,采用基因芯片法检测970例HPV临床样本,并进行基因分型。结果970例样本中,HPV感染390例,阳性率40．2％。共检出12种HPV亚型,检出感染单一HPV亚型260例（26．8％）,感染两种亚型以上130例（13．4％）。低危型主要为HPV6、11,高危型主要为HPV16、33、52、58、18等。结论无锡地区妇女宫颈HPV感染率较高,感染亚型主要是6、11型。HPV基因分型检测对于生殖道感染以及子宫颈癌的早期发现以及预防和治疗具有重要意义。     

Comparison of topical tacrolimus 0.1 % in pectin ointment with clobetasol 0.5% ointment in adults with moderate to severe desquamative gingivitis: A 4-week, randomized, double-blind clinical trial

BACKGROUND: Desquamative gingivitis (DG) is a clinical condition characterized by red, painful, glazed, and friable gingiva, which might be a manifestation of some autoimmune mucocutaneous diseases. The time from the development of initial signs of DG to diagnosis can vary from months to years. Based on a literature search, no data concerning patients with DG without signs of autoimmune disease were available. OBJECTIVE: The aim of this trial was to compare the efficacy and tolerability of monotherapy with topical tacrolimus 0.1% in pectin ointment versus clobetasol propionate 0.5% ointment in adults affected by DG. METHODS: This randomized, double-blind clinical trial was conducted at the Dipartimento di Medicina Clinica e Sperimentale, Universita di Verona, Verona, Italy. Patients aged > or =18 years were selected using the department's electronic medical records based on a clinical diagnosis of moderate to severe DG. After a 2-week washout period, patients were randomly assigned to receive 2 mL of tacrolimus 0.1% in pectin (equivalent to 0.2 mg of tacrolimus) or 2 mL of clobetasol propionate 0.5% ointment (equivalent to 1 mg of clobetasol) QD for 4 weeks. Evaluations were performed before treatment (baseline), after the treatment period (week 4), and at 2 follow-up visits at weeks 6 and 8. The signs of DG (ie, erythema [atrophy] and desquamation [erosions/ulceration]) were quantified by a blinded investigator using a calculated score based on their surface extension, using a drawing in which the areas of various zones of the mouth were indicated as a percentage of the whole oral mucosa. Severity of erythema and desquamation was rated on a 4-point scale (0 = absent; 1 = involvement of <5% of surface [mild]; 2 = 5%-15% [moderate]; and 3 = >15% [severe]). The primary end point was the number of patients who achieved remission (severity score of 0) in either sign; the secondary end point was the proportions of patients achieving improvement (severity score of 0 or 1) in either sign. Before and after treatment, we measured the serum concentrations of tacrolimus and its metabolites with an immunoenzymatic assay kit. Tolerability was assessed using hematology, biochemistry, urinalysis, measurements of systolic/diastolic blood pressure and heart rate, patient interview, and spontaneous reporting. RESULTS: A total of 24 patients (18 women, 6 men; all white of Italian origin; age range, 21-65 years; 12 patients per treatment group) were enrolled in the study. In the tacrolimus group, 11 (91.7%) patients achieved remission of erythema and/or desquamation at weeks 4 and 6; at week 8, these rates were 9 (75.0%) and 8 (66.7%), respectively; none of the patients in the clobetasol group achieved remission of either sign at any time point (all, P < 0.001). At weeks 4, 6, and 8, significantly greater proportions of patients treated with tacrolimus had improved erythema and desquamation compared with those treated with clobetasol (all, P < 0.001). At week 4, all patients had undetectable serum tacrolimus concentrations (<1.5 microg/L). Six (50.0%) patients in the tacrolimus group reported a mild oral burning sensation, and 6 (50.0%) patients in the clobetasol group reported mild mouth dryness. No other adverse events were reported. CONCLUSIONS: The results of this small study suggest that topical tacrolimus 0.1 % in pectin was more effective compared with clobetasol propionate 0.5% ointment in the treatment of DG. Both treatments were generally well tolerated in the population studied.