Eficacia y efectos adversos del tratamiento con Imiquimod en la mujer con condilomas vulvoperineales

  1. Ángel García Iglesias 1
  2. Silvia García Valle 1
  3. Miguel Gauro 1
  4. Joaquín López Marcos 1
  5. Tomás Rodríguez Bravo 1
  6. Consuelo Crespo Martínez 1
  7. Rafael Collazos Robles 1
  1. 1 Departamentos de Obstetricia y Ginecología, Farmacia y Cirugía. Facultad de Medicina y Hospital Clínico Universitario
Revista:
Revista Electrónica de Biomedicina

ISSN: 1697-090X

Ano de publicación: 2010

Número: 3

Páxinas: 34-41

Tipo: Artigo

Outras publicacións en: Revista Electrónica de Biomedicina

Resumo

The genital warts constitute a benign process which appears on young people and it is produced by the HPV. In the course of several years different technics have been used with the goal of settling these kinds of lesions in a fast and safe way. Aim: To assess the response of the treatment of vulvo-perineal condylomas treated with 5% Imiquimod and the adverse events arised from its use. Material and methods: The studied population is constituted by 112 patients who presented vulvo-perineal condylomas. Pregnant and HIV positive patients were not included. All of them underwent a complete gynecological study and specifically, cytology, colposcopy, a PCR for HPV and a vulvoscopy to assess the location of the condylomas, size and number of such. Lesions were treated with Imiquimod 5% in cream at alternate nights. Tests were carried out to verify the results of the treatment at 4, 8, 12 and 16 weeks. The maximum time of application was 16 weeks. Results: The multiple locations were the most common, followed by those ones of the perineal area and the ano-fourchette. The disappearance of condylomas occurred in the highest percentage between 4 and 8 weeks of treatment, and 3 months later no lesions were 88.8%. 87,5% had no lesions at 6 months.The most common side effects were erythema and pruritus. Conclusions: In view of the results, the treatment with 5% Imiquimod can be considered as an alternative to other destructive therapies, which in turn, acts on the latent infection.

Referencias bibliográficas

  • de Villers EM, Fauquet C,Broker TR,Bernard HU, Zur HH. Clasification of papillomaviruses Virology 2004;324:17- 27.
  • Gross G,Ikerberg H,Gissmann L, Gissmann L, Hagedorm M. Papillomavirus infeccion of the anogenital region: Correlation between histology, clinical oicture, and virus tipe. Proposal of a new nomenclature. J Invest Dermatol 1985;85:147-152.
  • Lacey CJ. Therapy for genital human papillomavirus-related disease. J Clin Virol 2005;32:S82-90.
  • Dunne EF, Unger ER, Sternberg M,Mcquillan G, Swan Dc, Patel SS et al. Prevalence of HPV infection among females in the United States.JAMA 2007;297:813-819.
  • Lee PK, Wilkinns KB. Condyloma and other infections including human immunodeficiency virus. Surg Clin North Am 2010;90:99-112.
  • Mahony C. Genital wart: Current and future management options. Am J Clin Dermatol 2005;6:239-243.
  • Scheurer ME, Tortolero-Luna G, Adler.Storthz K. Human papillomavirus Infection: Biology, epidemiology and prevention. Int J Gynecol Cancer 2005;15:727-746.
  • Heber CM, Laimimins LA. Human papillomaviruses basic mechanisms of pathogenesis and oncogenicity. Rev Med Virol 2006;16:83-97.
  • Monteiro EF, Lacey CJ,Merrick D. The interrelation of demographic and geospatial risk factor between four common sexually transmitted deseases. Sex Transm Infect 2005;81:41-46.
  • Mayeaux EJ, Dunton C. Modern management of external genital warts. J Low Genit Tract Dis 2008;12:185-192.
  • Stefanaki C, Hadjivassilou M, Katzouranis I, Betimousltis G, Nicplaidou E, et al. Prognostic factors for the response to treatment in males with genital warts. J Eur Acad Dermatol Venereol. 2009;23:1156-1160.
  • Renauud-Vilmer C. Infección de transmission sexual: Como tratar los condilomas de los genitales externos. Prac Ginecol Obst.2009; 44:4-5.
  • Muñoz N, Kjaer SK, Sigurdsson K, Iversen OE, Hernandez-Avila M, Wheeler CM et al. Impact of human papillomavirus (HPV)-6/11/16/18 vaccine on all HPV-associated genital diseases in young women. J Natl Cancer Inst 2010;102:325-339.
  • Aractingi S. Imiquimod en crema al 5% es un tratamiento seguro y eficaz para las verrugas genitales externas y perineales. 20 Th World Congress of Dermatology. Paris 1-5 Jul. 2002. Excerpta Méd. 2002: 12-13.
  • Baya G, Centeno C, Xercavins J. Condiloma y su tratamiento. XI Cong. Of cervical Pathology and Colposcopy. Barcelona 9-13, Jun 2002. Excerpta Med 2002:6-7.
  • Moore RA, Adwards JE, Hopwood J, Hicks D. Imiquimod for treatment of genital warts: A quantitative systematic review. Ach Dermatol 2002;138: 1599-1601.
  • Diamantis ML, Bartiett BL, Tyring SK; Safety, Efficacy and recurrence rates of imiquimod Cream 5% for treatment of anogenital Warts. Skin Therapy Letter 2009;14: 1-3.
  • Takahashi S, Tsukamoto T. Condyloma acuminatum. Nippon Rinsho 2009;67;153-156.
  • Wagstaff AJ, Perry CM. Topical imiquimod: A review of its use in the management of anogenital warts, actinic keratoses, basal cell carcinoma and other skin lesions. Drugs 2007;67:2187-2210.
  • Gunter J. Genital and perianal warts: new treatment opportunities for human papillomavirus infection. Am J Obst Gynecol 2003;189:3-11.
  • Jacobs AA, Snavely N, Markus J, Rosen T. Vasodilatory adverse events associated with topical imiquimod 5 percent cream. Dermatol Online J. 2008;15:14-16.
  • Taylor CL, Masien M, Kapembwa M. A case of severe eczema following use of Imiquimod 5% cream. Sex Transm Infect 2006;82:227-228.
  • Beutner KR, Tyning SK,Trofaller KF. Imiquimod a patient-aplied immune-response modifier for treatment of external genital warts. Antimicrobial Agent And Chemot. 1998;42:789-794.
  • Brodell LA, Mercurio MG, Brodell RT. The diagnosis and treatment of human papillomavirus mediated genital lesions. Cutis 2007;79:5-10.
  • Schofer H. Evaluation of imiquimod for the therapy of external genital and anal warts in comparison with destructive therapies. Br J Dermatol. 2007;157:52-55.
  • Hober D, Ajram L, Chehadeh W, Lazrek, M et al: Mecanismes de l'activité antivirale indirecte de l'imiquimod. Ann Biol Clin 2005;63:155-163.
  • Carrasco D, Vander Straten M, Tyning Sk. Treatment of anogenital warts with Imiquimod 5% cream followed by surgical excision of residual lesions. J Am Acad Dermatol 2002;47:212-216.
  • Mahto M,Nathan M,O'Mahony C. More than a decade on:Review of the use of Imiquimod in anogenital intraepithelial neoplasia. Int J STD AIDS 2010;21:8-16.