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

The skin is an attractive target for gene therapy because it is easily accessible and shows great potential as an ectopic site for protein delivery in vivo. Genetically modified epidermal cells can be used to engineer three-dimensional skin substitutes, which when transplanted can act as in vivo ‘bioreactors’ for delivery of therapeutic proteins locally or systemically. Although some gene transfer technologies have the potential to afford permanent genetic modification, differentiation and eventual loss of genetically modified cells from the epidermis results in temporary transgene expression. Therefore, to achieve stable long-term gene expression, it is critical to deliver genes to epidermal stem cells, which possess unlimited growth potential and self-renewal capacity. This review discusses the recent advances in epidermal stem cell isolation, gene transfer and engineering of skin substitutes. Recent efforts that employ gene therapy and tissue engineering for the treatment of genetic diseases, chronic wounds and systemic disorders, such as leptin deficiency or diabetes, are reviewed. Finally, the use of gene-modified tissue-engineered skin as a biological model for understanding tissue development, wound healing and epithelial carcinogenesis is also discussed.     

Sinecatechins (Polyphenon E) ointment for treatment of external genital warts and possible future indications

Introduction: Sinecatechins was the first botanical drug licensed for treatment in humans in the US. It is approved for the topical treatment of external genital and perianal warts. Some properties of the polyphenolic components included in sinecatechins suggest additional therapeutic potential for other skin diseases.

Areas covered: Studies and articles describing therapeutic application of sinecatechins or green tea polyphenols in viral and proliferative skin diseases or investigating molecular activities relevant for the mode of action were identified by a PubMed search using ‘sinecatechins’, ‘green tea polyphenols’, ‘polyphenon E’ and ‘EGCG’, each combined with ‘skin cancer’ and ‘genital warts’ as search criteria. Although a number of molecular mechanisms of green tea polyphenols were described, the exact mode of action operative in regression of genital warts is not yet clear. It may involve both antiproliferative, pro-apoptotic and antiviral activities that probably also account for efficacy against other skin disorders.

Expert opinion: In addition to treatment of skin tumors, sinecatchins may also be used to protect against photocarcinogenesis. Considering antioxidative properties of polyphenols and the capability to enhance DNA repair, sinecatechins appears attractive for primary prevention of nonmelanoma skin cancer either as additive in sunscreens or as dietary supplement for oral administration.     

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.     

The treatment of warts

Warts are caused by the human papillomavirus and produce a variety of clinical manifestations, depending on the viral type and the site of the lesion. In this article, the pathophysiology of warts is reviewed briefly, and options for treatment, including liquid nitrogen, dinitrochlorobenzene, bleomycin, podophyllin, Duofilm, and surgical excision, are examined. Several case studies are also presented.     

化瘀膏外用防治静脉炎的临床观察

目的探讨化瘀膏对输液所致静脉炎的防治效果.方法1、将输注20%甘露醇的病人作为预防组,随机分为实验组与对照组.实验组于使用20%甘露醇时在静脉穿刺局部外敷化瘀膏,至输注完毕后30min;对照组不做处理.2、将因输液所致静脉炎病人150例作为治疗组,随机分为2组,每组75例.实验组用化瘀膏局部外敷,对照组用50%硫酸镁局部湿敷.结果预防组中的实验组静脉炎发生率低于对照组(p＜0.01),差异有显著性;治疗组中的实验组有效率高于对照组(p＜0.01),差异有意义.结论化瘀膏对静脉炎的防治有效,可广泛应用于临床.     

Modeling the impact of treatment options in genital warts: patient-applied versus physician-administered therapies

With the availability of new patient-applied treatments for genital and perianal warts, medical providers, physician groups, and health systems are reassessing the role of physician-administered therapies. Two key questions are: how cost-effective are physician- versus patient-administered therapies and, given patient preferences for the convenience and privacy associated with the latter therapies, which of the 2 presently available treatments-imiquimod and podofilox-is most appropriate? The purpose of this article is to examine, from the perspective of the health care purchaser, these questions and to undertake a pharmacoeconomic analysis of the direct cost-effectiveness of therapy options, given targets being set for the outcomes of genital warts therapy. The analysis employs a synthetic, decision-modeling framework in which data on sustained clearance and the direct costs of treatment are drawn from both clinical studies and previous studies on the resources used to support treatment. Once targets are set-and it is proposed here that physicians should aim for at least a 50% sustained clearance rate for genital warts--it becomes clear that in cost per sustained clearance terms, imiquimod, as first-line therapy, is the most cost-effective intervention. If we compare imiquimod with podofilox as first-line therapy (with cryotherapy as the second-line option), the cost per sustained clearance for the imiquimod treatment sequence is $1367 compared with the podofilox-initiated sequence of $1508.     

Human papillomavirus infection: a potentially carcinogenic sexually transmitted disease (condylomata acuminata, genital warts)

Human papillomavirus is a sexually transmitted virus that has been associated with intraepithelial neoplasia. The incidence and prevalence of the disease has risen dramatically, to epidemic proportions, within the last two decades. Risk factors for HPV are similar to those for intraepithelial neoplasia: early onset of sexual activity, multiple sexual partners, high-risk sexual practices, and poor hygiene. Health care workers need to screen all patients for HPV through the use of a comprehensive history, including sexual history, a thorough physical examination, and appropriate laboratory methods. Pregnant women must be thoroughly screened because they are at increased risk for HPV, plus there has been an association between genital warts at the time of delivery and subsequent laryngeal papillomas in their infants. Treatment is aimed at the elimination of the lesions. Although in some cases lesions spontaneously resolve without treatment, in other cases there is a significant incidence of recurrence, even with treatment. Cell-mediated immunity seems to play a role in recurrence and regression as well as transformation to atypical cells. Transformation of HPV to neoplasia also seems to be related to co-factors that act synergistically in the oncogenic process. Public education, identification of high risk groups, and prevention are mandatory if the spread of HPV is to be contained. Equally essential is to remain cognizant of the fact that HPV is an STD with potentially carcinogenic properties; thus, screening and treatment of sexual partners are mandatory!     

二氧化碳激光联合祛疣洗剂治疗尖锐湿疣的疗效观察及护理

[目的]探讨二氧化碳（CO2）激光联合祛疣洗剂治疗尖锐湿疣的疗效。[方法]将127例尖锐湿疣病人随机分为3组：A组采用CO2激光联合祛疣洗剂治疗,B组采用CO2激光联合咪喹莫特乳膏治疗,C组单用CO2激光治疗,同时3组给予相同的护理干预措施。观察3组病人的治愈、复发及不良反应情况。[结果]A组治愈率和复发率分别为88．37％和11．63％,B组为81.40％和18．60％,C组为53．66％和46．34％;A组与B组相比,治愈率和复发率差异均无统计学意义（P〉0．05）;A组与C组相比,治愈率和复发率差异均有统计学意义（P〈0．01）。A组有3例病人发生不良反应,其发生率低于B组（P〈0．01）。[结论]CO2激光联合祛疣洗剂治疗尖锐湿疣疗效明显。     

Cryotherapy for treatment of anogenital warts.

Human papillomavirus is a group of viruses that produce anogenital warts for which there is no cure. Untreated anogenital warts can spread and form large clusters that are bothersome, painful, and embarrassing to the patient as well as being a significant health risk. One of the infectious disease clinics of the authors' hospital sees an average of 200 HIV-positive individuals per month. Approximately 10% of these patients have anogenital warts. The attending physicians asked the clinical nursing staff if they would be willing to be trained to remove these warts using cryotherapy techniques, if patient efforts at other remedies failed. This request provoked a decision-making challenge for the staff. This article will describe the decision-making process and conclude with the procedure that was created as a result of the decision making.     

他克莫司软膏治疗糖皮质激素依赖性皮炎临床观察

目的 观察他克莫司软膏治疗糖皮质激素依赖性皮炎的疗效.方法 40例患者分成两组,治疗组20例外用0.1%他克莫司软膏,对照组20例外用5%氟芬那酸丁酯软膏,均2次/日,连用4周.结果 两组治疗4周结束后及疗程结束2周后疗效比较,差异均有显著性意义(P<0.05).结论 他克莫司软膏治疗糖皮质激素依赖性皮炎疗效较氟芬那酸丁酯软膏好.