Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study.

OBJECTIVE--To compare patient tolerance and treatment efficacy of subcutaneous interferon (IFN) alpha 2a plus cryotherapy versus cryotherapy alone in treatment of primary anogenital (AG) warts. DESIGN--Randomised placebo controlled observer blind study. Statistical analysis was by chi square and Mann Whitney U tests. PATIENTS--60 patients with newly diagnosed AG warts. INTERVENTION--29 and 31 patients were treated with subcutaneous IFN alpha 2a plus cryotherapy or placebo injections plus cryotherapy, respectively. MAIN OUTCOME MEASURES--Clinical presence or absence of AG warts. Patients wart-free at 8 weeks were asked to re-attend at 12 weeks; those with persistent warts at 8 weeks were withdrawn from the study. RESULTS--At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not significant); corresponding figures at 12 week review were 29.6% (8/27 patients) and 40% (10/25 patients) respectively (not significant). There was no difference in treatment response between males and females. Recurrence of warts at three month review, in patients cleared of warts at 8 weeks, was seen in 50% (8/16) and 37.5% (6/16) of patients in the IFN and placebo groups respectively (not significant). Multiple warts and the presence of perianal/anal canal warts, either alone or concurrent with warts on the genitalia, at first clinic attendance, were adverse prognostic indicators (p less than 0.001, and p = 0.05 respectively). Cervical human papilloma virus (HPV) infection, exophytic or subclinical, was present in 58.3% and 77.2% of females in the IFN and placebo groups respectively, at trial entry. Although these lesions were not directly treated, colposcopic resolution was seen in 12.5% of affected women, in both treatment groups, by the end of the 7 week treatment period. Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p less than 0.01). Severe influenza like symptoms occurred, after the first three injections only, in one patient treated with IFN; all other reported side effects were mild. CONCLUSIONS--Subcutaneous IFN alpha 2a combined with cryotherapy is no more effective than cryotherapy alone in the treatment of primary AG warts. The presence of multiple warts and perianal/anal canal warts are adverse prognostic indicators.     

Non-specific immunity in patients with primary anogenital warts treated with interferon alpha plus cryotherapy or cryotherapy alone.

Combination treatment of primary anogenital warts with subcutaneous interferon alpha 2a plus cryotherapy was no more efficacious than cryotherapy alone. Patients with primary AG warts showed no in vitro or in vivo suppression of non-specific immunity. In patients treated with interferon plus cryotherapy non-specific cellular immunity was stimulated, both in vitro and in vivo compared with patients treated with cryotherapy alone.     

Immunotherapy of genital warts with inosine pranobex and conventional treatment: double blind placebo controlled study.

In a multicentre, prospective, randomised, placebo controlled study of 55 patients with histories of genital warts for at least one year, a four week course of inosine pranobex 3 g a day improved the clinical response to conventional treatment (primarily podophyllin or trichloroacetic (now called trichlorethanoic) acid). Although more patients given inosine pranobex improved than those given placebo, the difference in general response between the two groups was not significant. When other variables (numbers of warts and extent of lesions) were considered, however, the patients given inosine pranobex fared significantly better. These results suggest that inosine pranobex may be worth considering as adjunct to treatment of patients with refractory genital warts.     

Intralesional triamcinolone alone or in combination with botulinium toxin A is ineffective for the treatment of formed keloid scar: A double blind controlled pilot study

Cutaneous injury can ignite excessive fibroproliferative growth that results in keloid formation. Keloids are associated with significant morbidity related to disfigurement and/or symptoms (e.g., pain and pruritus). First‐line treatment of formed keloids involves topical or intralesional steroids. Recurrent or resistant keloids are managed by surgical excision or cryotherapy, followed by steroidal application or adjuvant irradiation. Although adjuvant irradiation appears to be most efficacious, alternative therapeutic options are needed for patients without access to radiation centers. Botulinum Toxin A (BTA) appears to have similar inhibitory effects to irradiation on the cell cycle via downregulation of pathogenic cytokines. Herein, we conducted a study to compare the efficacy of intralesional triamcinolone used alone, or in combination with BTA, in the treatment of formed keloid scars. Twenty patients with a cumulative of 40 keloids completed the study. There was no significant difference between treatment arms with respect to height vascularization, pliability, and pigmentation scores. The addition of BTA resulted in significant symptomatic improvement of pain and pruritus as compared to intralesional triamcinolone alone (p < 0.001). Irradiation is only effective when administered in the adjuvant setting where inhibitory effects on cell cycle and migration are optimized. Future studies with intralesional triamcinolone and BTA should be performed adjuvantly.     

A colposcopic case-control study of cervical squamous intraepithelial lesions in women with anogenital warts.

OBJECTIVE--To assess whether anogenital warts, present or past, are an indication for women to be referred for colposcopy. DESIGN--A case control study comparing patients with and without a history of anogenital warts. SETTING--A department of genitourinary medicine in West London. PATIENTS--468 patients examined by colposcopy between January 1985 and December 1987 of whom 147 (31%) had abnormal cytology, 163 (35%) had anogenital warts and 158 (34%) had both. MAIN OUTCOME MEASURES--Colposcopic findings and histology of cervical biopsies compared with behavioural and disease variables. RESULTS--Human papillomavirus infection (HPVI) of the cervix showed no relationship with a life time history of vulval warts, or with the presence of anogenital warts on clinical examination, or with any parameter of sexual behaviour included in the study. Cervical intraepithelial neoplasia (CIN) was strongly associated with current IUCD usage (RR = 7.75) and coitarche under 16 years of age (RR = 3.72), but a history of vulval warts yielded a negative association (RR = 0.34), suggesting a protective effect. This relationship held true when cytological dyskaryosis was made the dependent variable (RR = 0.24). CONCLUSIONS--Anogenital warts are not a risk for subclinical cervical HPVI or for CIN and therefore not an indication for colposcopy.     

Systemic interferon alpha-2b increases the cure rate in laser treated patients with multiple persistent genital warts: a placebo-controlled study.

Systemic treatment modalities for eradication of multiple therapy resistant genital warts are so far not available. In this study laser treated patients with multiple genital warts received postoperatively either interferon alpha-2b subcutaneously (s.c.) 5 x 10(6) IU or matching placebo three times weekly for four weeks. At the conclusion of the study, 6-8 weeks after discontinuation of therapy, a significantly higher cure rate was found in the group of interferon-treated patients (14 of 27 (52%) patients cured) than among placebo treated patients (5 of 22 (23%) patients cured) (p less than 0.05). The side effects of fever, chills, myalgia, headache and leukopenia occurred more commonly in the interferon treated group than in the placebo group. However, only three of 32 patients discontinued interferon therapy because of side effects. We conclude that the addition of s.c. administered interferon alpha-2b to laser treated patients with chronic therapy resistant genital warts is fairly well tolerated and that it significantly enhances the chance of eliminating the disease.     

窄谱中波紫外线联合他扎罗汀治疗的寻常性银屑病皮损他扎罗汀诱导基因2的表达

目的 探讨NB-UVB联合他扎罗汀治疗寻常性银屑病的作用机制。方法 用免疫组化和原位杂交的方法检测NB-UVB和（或）他扎罗汀治疗前后银屑病皮损及未受累皮肤中TIG2蛋白和m RNA水平的变化。结果 治疗前，银屑病皮损中几乎无TIG2的表达，单用NB-UVB治疗2周后，角化不全的角质层和棘层上部可见TIG2轻度着色，治疗6周后，可见TIG2阳性表达于棘层上中部。两者联合治疗2周后，可见棘层全层和基底层着色，且在棘层上部着色重于中下部，6周后则表达于表皮全层，且表皮变薄。用NB-UVB和（或）他扎罗汀治疗后，TIG2阳性表达起始于角化不全的角质层和棘层上部至中下部，直至基底层，而他扎罗汀和NB-UVB联合应用后可加速此过程。结论 NB-UVB联合他扎罗汀协同治疗银屑病的机制可能与上调银屑病皮损中TIG2的表达有关。     

Natural history of cervical epithelial abnormalities in patients with vulval warts. A colposcopic study.

The natural history of intraepithelial abnormalities of the cervix associated with human papillomavirus infection was investigated in a prospective study of 50 women with vulval warts, of whom 28 had colposcopic evidence of a cervical epithelial abnormality and 22 a normal cervix. Of the 28 with a cervical abnormality, 26 were re-examined by colposcopy after three months; the epithelial abnormality had persisted in 23 women. Nineteen women who had initially shown abnormality by colposcopy were re-examined six months after their first attendance; the epithelial abnormality had persisted in 14 women. Of the 22 women who initially had a normal cervix, 19 were re-examined after three months; the cervix remained normal in 18, but an epithelial abnormality had developed in one. Fourteen women who initially had a normal cervix were re-examined six months after their first attendance; the cervix was still normal in 11, but an epithelial abnormality had developed in three. Colposcopically directed biopsy specimens were obtained from 21 women who showed an epithelial abnormality; of these, evidence of wart virus infection was present in four, cervical intraepithelial neoplasia in two, both conditions in 13, and no abnormality in two. It is concluded that lesions of the cervix associated with wart virus infection show little evidence of short term regression.     

Natural history of cervical epithelial abnormalities in patients with vulval warts. A colposcopic study

The natural history of intraepithelial abnormalities of the cervix associated with human papillomavirus infection was investigated in a prospective study of 50 women with vulval warts, of whom 28 had colposcopic evidence of a cervical epithelial abnormality and 22 a normal cervix. Of the 28 with a cervical abnormality, 26 were re-examined by colposcopy after three months; the epithelial abnormality had persisted in 23 women. Nineteen women who had initially shown abnormality by colposcopy were re-examined six months after their first attendance; the epithelial abnormality had persisted in 14 women. Of the 22 women who initially had a normal cervix, 19 were re-examined after three months; the cervix remained normal in 18, but an epithelial abnormality had developed in one. Fourteen women who initially had a normal cervix were re-examined six months after their first attendance; the cervix was still normal in 11, but an epithelial abnormality had developed in three. Colposcopically directed biopsy specimens were obtained from 21 women who showed an epithelial abnormality; of these, evidence of wart virus infection was present in four, cervical intraepithelial neoplasia in two, both conditions in 13, and no abnormality in two. It is concluded that lesions of the cervix associated with wart virus infection show little evidence of short term regression.     

Comparative evaluation of single dose regimen with two dose regimen of fluconazole in the treatment of tinea versicolor: A double blind placebo controlled study

In a double blind randomised study to assess the efficacy of single dose fluconazole therapy, 30 patients of tinea versicolor (TV) were enrolled and were assigned into 2 groups. Group A (n=18) received fluconazole 400 mg single dose orally and Group B (n=12) received placebo. At the end of 2 weeks, 8 out of 18 (44.4%) of Group A patients and 1 out of 12 (8.3%) of Group B showed mycological cure (P=0.08). Ten patients of Group A who had KOH positivity after 2 weeks were given 2nd dose of 400 mg fluconazole 2 weeks after the 1st dose. Nine of these (90%) showed mycological cure at the end of subsequent 2 weeks. The difference between the efficacy of single dose fluconazole after 2 weeks and 2 doses of fluconazole after 4 weeks was statistically significant (P<0.01). None of the patients had any significant side effects. Therefore single dose therapy of fluconazole 400 mg is not satisfactory in TV. Instead, 2 doses of flluconazole (400 mg) given at 2 weeks intervals is safe and very effective.     

Mucous membrane manifestations of pemphigus vulgaris. A 25-year survey of 185 patients treated with corticosteroids or with combination of corticosteroids with methotrexate or heparin

One hundred and eighty-five patients with pemphigus vulgaris were treated and followed up over a period of 25 years, from 1962 to 1987, at the Department of Dermatology of Moscow Medical Stomatological Institute. In all these patients the diagnosis was confirmed clinically, histologically and cytologically, and in 152 patients by means of direct and indirect immunofluorescence. The patients were treated with corticosteroids or with a combination of corticosteroids with methotrexate or heparin. The initial manifestations of the disease and their development at the period before the treatment and during therapy were studied. The optimum regimens of the maintenance treatment were investigated including those in 31 patients whom the treatment could be discontinued. The treatment-related complications and 28 cases with fatal outcome are analysed.     

Antigen-free diet in adult patients with atopic dermatitis. A double-blind controlled study

The efficacy of an antigen-free diet on the activity of atopic dermatitis was examined in a double-blind study, comprising 33 adults with severe atopic dermatitis. The antigen-free diet (Vivasorb) was compared to a placebo diet during three weeks of hospitalization. Twenty-five patients were evaluable, two of whom had their diet stopped after a few days due to exacerbation. Nine patients improved, while 16 patients were unchanged. Among those who improved five patients had Vivasorb and four placebo diet. In the remaining group 11 patients had Vivasorb and five had placebo. Four patients reported of less pruritus, sleeplessness and antihistamine consumption (three Vivasorb, one placebo) while 21 did not (13 Vivasorb, eight placebo). Thus, there were no significant differences between the groups. Paraclinical studies of circulating eosinophilocytes, serum IgE, orosomucoid, HLA-antigens, and immunofluorescence of skin biopsies showed no differences between the Vivasorb and the placebo groups. The results from the examination of this relatively small number of patients suggest that elementary intolerance plays little role in the etiology of atopic dermatitis in adults.     

Imiquimod 5% cream for external genital or perianal warts in human immunodeficiency virus-positive patients treated with highly active antiretroviral therapy: an open-label, noncomparative study

Background  Human immunodeficiency virus (HIV)+ patients have an increased risk of anogenital warts. High-risk (HR) human papillomaviruses (HPVs), especially types 16 and 18, are major risk factors for precancerous and cancerous lesions of the anogenital tract, while low-risk (LR) HPVs are associated with benign lesions. Cure of genital warts with ablative techniques, surgical excision, podophyllotoxin or trichloroacetic acid is frequently difficult. Treatment with imiquimod cream showed a total clearance of external genital or perianal warts in about 50% of immunocompetent subjects. However, total clearance was reduced in HIV+ subjects not treated with highly active antiretroviral therapy (HAART).
Objectives  To assess clinically and by monitoring HPV content the efficacy of 5% topical imiquimod to treat anogenital warts in HIV+ subjects with at least partially restored immune functions.
Methods  Fifty HIV+ patients successfully treated with HAART (total CD4+ cells ≥ 200 cells mm⁻³ and plasma HIV RNA load < 10⁴ copies mL⁻¹) with anogenital warts were included. Imiquimod 5% cream was applied on external genital or perianal warts three times weekly for up to 16 weeks. Warts were tested at entry and after treatment for human LR- and HR-HPV DNA.
Results  Total wart clearance was observed in 16 of 50 (32%) patients at week 16. At enrolment, HPV DNA was present in more than 90% of lesions with a majority of lesions co-infected by HR- and LR-HPV. At study end, the HPV load decreased or became undetectable in 40% of cases studied.
Conclusions  Imiquimod 5% cream did not show safety concerns and is suitable for use in HIV+ subjects with anogenital warts and successful HAART treatment.     

A comparison of a 5% potassium hydroxide solution with a 5‐fluorouracil and salicylic acid combination in the treatment of patients with anogenital warts: a randomized,open‐label clinical trial

Anogenital warts are caused by human papillomavirus (HPV), over 30 types of which are infectious for the anogenital tract. Without treatment, warts may regress spontaneously, remain unchanged, or increase in number and size. This study compared the efficacy of a topical 5% potassium hydroxide (KOH) solution with that of a topical 0.5% 5‐fluorouracil (5‐FU) and 10% salicylic acid (SA) combination in the treatment of anogenital warts. Sixty patients were randomly assigned to receive topical KOH or 5‐FU + SA. Both groups demonstrated a significant decrease in numbers of lesions (P < 0.05), but this difference was not significant at week 12 (P > 0.05). The mean number of lesions decreased from baseline to week 12 from 17.03 ± 12.64 to 3.73 ± 7.30 and from 16.13 ± 12.97 to 3.10 ± 4.90 in the KOH and 5‐FU + SA groups, respectively (P < 0.001). Excellent clearance was achieved by 70.0 and 76.7% of patients in the KOH and 5‐FU + SA groups, respectively. Marked improvement was seen in 13.3 and 20.0% of patients in the KOH and 5‐FU + SA groups, respectively. At week 16, relapse was observed in two patients in the KOH group and three in the 5‐FU + SA group (P > 0.05). No serious adverse events were reported. Neither treatment was more efficacious. Safety and ease of application are important goals in treatments for anogenital warts. A 5% KOH solution is a promising alternative treatment because it is effective and inexpensive and causes minimal side effects.