Warts & HAMLET: To Be or Not To Be?

Abstract

Clinical Pharmacology & Therapeutics| October 01 2004 Warts & HAMLET: To Be or Not To Be? AAP Grand Rounds (2004) 12 (4): 44. https://doi.org/10.1542/gr.12-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Warts & HAMLET: To Be or Not To Be?. AAP Grand Rounds October 2004; 12 (4): 44. https://doi.org/10.1542/gr.12-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: warts Source: Gustafsson L, Leijonhufvud I, Aronsson A, et al. Treatment of skin papillomas with topical α-lactalbuminoleic acid. N Engl J Med. 2004;350:2663–2671. Skin papillomas, or warts, caused by the human papillomavirus (HPV) are often refractory to current treatments such as topical salicylic acid and cryotherapy. They can be particularly troublesome in immunosuppressed patients. Swedish scientists from the University of Lund studied human-α-lactalbumin, a protein in human milk that appears to cause in-vitro apoptosis in transformed cells, but not in healthy, differentiated cells when combined with oleic acid. This protein and fat combination has been termed human-α-lactalbumin made lethal to tumor cells (HAMLET). Because of the promising laboratory data with this compound, the investigators attempted to determine the efficacy of HAMLET on common skin papillomas in both immunocompetent and immunocompromised patients. In this double-blind, placebo-controlled trial, 40 patients between ages 4 and 59 years with a median of 4 warts were randomized to receive either HAMLET or saline placebo applied daily to their papillomas for 3 weeks. Of note, 33 of the 40 patients had failed prior treatment efforts. Following the initial masked treatment period, an open-label phase of the trial was initiated where all patients were offered the chance to use the active compound for an additional 3 weeks. Compared with placebo, the active compound was extremely effective in treating the papillomas. All 20 of the patients treated with HAMLET experienced a marked reduction in the size of their warts with a median remaining volume of 14% of the original size. In contrast, the median remaining volume in the placebo-treated group was 81% of the baseline size. For those in the treatment group, 45% had resolution of 1 or more lesions compared with only 15% in the placebo arm. These positive results also applied to the small immunosuppressed subgroup (n=9) included in this study. Improvements in the papillomas were also seen in long-term follow-up, where nearly all of the patients who had received HAMLET during either the randomized or open-label portion of the investigation were wart-free. The authors concluded that HAMLET was extremely effective in treating skin papillomas, including those resistant to previous treatment and those in immunosuppressed patients. They also speculated that this new agent might prove beneficial in the treatment of other more morbid conditions such as malignancies. The compounds that exist in human milk continue to amaze us and further the notion that no formula can ever be created that will fully replace it. The results of this study are rather dramatic, given the vast difference between the treatment arm and the placebo cohort. They also provide an interesting contrast to the study published in 2002 that showed duct tape to be superior to cryotherapy for the treatment of warts1 (see also AAP Grand Rounds, January 2003;9:6–7). Now, there is evidence supporting both a very simple and a more sophisticated approach to warts. In the manuscript as well as in the editorial accompanying the... You do not currently have access to this content.