Aldara™ as treatment for condylomata acuminata in the prepubertal child

Abstract

BACKGROUND: Treatment of condylomata acuminata in the prepubertal child has previously presented difficulties. Initial treatment has often involved the expense and morbidity of general anesthesia and CO2 laser. Adult modalities have been tried such as tricarboxylic acid (TCA) or intralesional interferon but often are discontinued because of significant pain and/or morbidity. AldaraTM is the brand name for an Imiquimod containing cream. Imiquimod is an immune response modifier. It has been approved by the FDA for the treatment of genital and perianal warts in the population 18 years of age and older.METHODS: JH is a 7-YO WF seen for evaluation for sexual abuse. The perpetrator is known. She had a normal hymeneal circumference and STD cultures and serologies. However, her exam was complicated by multiple condylomata of the clitoral, periclitoral, labia majora and minora, and perihymeneal area. She was significantly symptomatic with burning and itching that was mildly helped by the constant use of Desitin cream. One condyloma was selected for a test dose of the AldaraTM cream (enough to cover a Calgiswab). The mother was asked to give her daughter a sitz bath in six hours and to continue them BID until return.RESULTS: Upon return in one week, patient described no untoward complaints. All of the condylomata were gone except one perihymeneal area at 7 o'clock. The previous areas were still slightly red but this resolved over time. Sitz baths were continued. Two weeks later the remaining perihymeneal lesion was excised and sent for documentation at the request of the prosecuting attorney and the mother. To date, at three months, there has been no recurrence.CONCLUSION: The exact mechanism of AldaraTM upon the eradication of genital warts is unknown. Side effects are usually mild to moderate. Most common side effects are redness, peeling, and swelling in the area where the AldaraTM is applied. This patient had mild redness with only a very small test dose. Other reported side effects not experienced by this patient are burning, itching, swelling and difficulty with urination. There may be a significant role for AldaraTM in the treatment of symptomatic genital condyloma in the prepubertal child. More research and experience is needed especially in establishing correct dosing and safety for this population.