Podophyllotoxin Solution Research Articles

Young women’s experiences of managing self-treatment for anogenital warts

ObjectivesThe purpose of this study is to explore the experiences of self-treatment for anogenital warts from the perspective of a group of young women who received it. Study designTen young Swedish women were interviewed in the study, aged between16 and 21. The young women had been diagnosed with anogenital warts and self-managed their treatment with 0.5% podophyllotoxin solution. ResultsSelf-management using 0.5% podophyllotoxin solution poses numerous difficulties. The nature of the treatment as a topical liquid is particularly testing for young women in terms of both application and genital pain, with implications for continuation of the treatment regime. The self-treatment challenges both personal integrity as well as interpersonal relations and creates a personal responsibility which appears to be somewhat overwhelming at times. ConclusionsHealth care professionals need to recognize the challenge that self-treatment poses to their clients. The issues that create difficulty in relation to topical liquid treatment regimes and importantly can lead to poor adherence to the treatment regime and discontinuation could easily be overcome by the use of different preparations. Continuity of care provider across treatments and alternative mechanisms of support would not only address some of the aspects that young women raise as particularly embarrassing and shameful, but also improve quality of care and increase general satisfaction with service provision.

Genital Warts Treated By Photodynamic Therapy

The patient, a 30-year-old man with numerous genital condylomata acuminata (CA), has had unsuccessful treatment with liquid nitrogen, 20% podophyllin, and repeated 0.5% podophyllotoxin solution with 5% imiquimod (Figure 1). Before the appearance of CA, he experienced acute orchiepididimitis and a Candida infection. The patient was immunologically examined, and the lower level of lymphocytes, slightly reduced level of IgM, and C4 complement were revealed. Results from a human immunodeficiency virus examination were negative. After the therapeutic failure mentioned above, photodynamic therapy (PDT) was initiated using 20% aminolevulinic acid (5-ALA) in a gel. The photosensitizer was applied to lesions and 10 mm of surrounding skin in a 1-mm-thick layer under occlusive dressing for 3 hours and then removed with saline and nonwoven gauze. The site was immediately irradiated with noncoherent red light with an emission spectrum of 580 to 680 nm wavelength (Medeikonos PDT-Model 200, Medeikonos AB, Sweden). The total light dose was 50 J/cm(2); light intensity ranged from 70 to 90 mW/cm(2). Because of persistent fluorescence during photodynamic therapy, the treatment was repeated 10 times in 2-week intervals with a follow-up of 1, 3, and 6 months after its completion. After the last PDT treatment, the persistent fluorescence disappeared completely. The absence of fluorescence corresponded with a healed clinical finding without scarring and pigmentation (Figure 2). The period from the initiation of PDT to the consolidation of CA was 22 weeks. During PDT treatment, the patient felt only mild burning, which disappeared after the illumination stopped. Six months after the therapy, there were no signs of recurrent disease.

Long‐term follow‐up of endoscopic therapy of anal canal condylomata acuminata with podophyllotoxin

Condylomata acuminata of the anal canal, a common sexually transmitted disease, are difficult-to-treat lesions with a high recurrence rate after initial successful treatment. Our aim was to evaluate by anoscopy the efficacy of podophyllotoxin 0.5% solution topically applied for the treatment of anal warts. We prospectively studied consecutive patients with condylomata acuminata of the anal canal that spared the rectum. They were treated with 0.5% podophyllotoxin solution topically applied on the warts, by anoscopy. Podophyllotoxin solution was administered on days 1, 2 and 3 every week (a treatment cycle) for a maximum of 4 weeks. Patients whose warts were not completely eradicated were classified as failures. Follow-up anoscopy was performed monthly for the first 6 months and every 6 months thereafter. Those who relapsed during the follow-up period were retreated. Twenty-two immunocompetent patients entered the study. The primary clearance rate was 22.7, 54.5, 68.1 and 86.3% after 1, 2, 3 and 4 treatment cycles, respectively. During the follow-up period (46, 12-60 months), seven patients (36.8%) relapsed. Four of them were successfully retreated. Thus, a complete cure was achieved in 16 out of 22 patients (72.7%). Adverse side-effects were mild. They included proctalgia in six (27.2%), bleeding in four (17.2%), and both proctalgia and bleeding in two (9%) patients. Endoscopic topical application of 0.5% podophyllotoxin solution is an effective and well-tolerated method for the treatment of condylomata acuminata of the anal canal.

Randomised controlled trial and economic evaluation of podophyllotoxin solution, podophyllotoxin cream, and podophyllin in the treatment of genital warts

Objectives: To evaluate the efficacy and cost effectiveness of self applied podophyllotoxin 0.5% solution and podophyllotoxin 0.15% cream, compared to clinic applied 25% podophyllin in the treatment of genital warts...

Er:YAG laser followed by topical podophyllotoxin for hard‐to‐treat palmoplantar warts

BACKGROUND AND OBJECTIVES: Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 μm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non‐responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)‐induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard‐to‐treat palmoplantar HPV warts was investigated.PATIENTS AND METHODS: Thirty‐five patients with hard‐to‐treat warts (palmar or plantar) with a mean age of (32.2±12.1) years, range 17–50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7–11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed.RESULTS: After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes, wound infections or scarring.CONCLUSION: The therapy of hard‐to‐treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.

Er:YAG laser followed by topical podophyllotoxin for hard-to-treat palmoplantar warts

BACKGROUND AND OBJECTIVES: Palmoplantar warts are often hard to treat. They tend to relapse and the course of therapy is frustrating in many cases. The erbium:YAG laser (Er:YAG) with a wavelength of 2.94 μm is capable of achieving a rapid and precise ablation of warts, but about 14% of patients are non‐responders as shown in a previous study. Podophyllotoxin is an established antimitotic agent derived from podophyllum plant resin, approved for human papilloma virus (HPV)‐induced genital warts. The combination of both ablative Er:YAG laser and topical 0.5% podophyllotoxin solution in hard‐to‐treat palmoplantar HPV warts was investigated.PATIENTS AND METHODS: Thirty‐five patients with hard‐to‐treat warts (palmar or plantar) with a mean age of (32.2±12.1) years, range 17–50 years, with various pretreatments that had failed, were treated once by Er:YAG laser ablation with a spot size of 3 mm, a frequency between 8 Hz and 10 Hz, and a fluence of 5.7–11.3 J/cm2. After wound healing, topical podophyllotoxin 0.5% solution was applied for 3 days followed by a break of 4 days. Four to six treatment cycles with podophyllotoxin were performed.RESULTS: After laser treatment followed by topical podophyllotoxin cream a complete response was observed in 31 patients (88.6%). Two patients with plantar warts and a complete response showed a relapse within 3 months after treatment (5.7%). None of the patients developed pigmentary changes, wound infections or scarring.CONCLUSION: The therapy of hard‐to‐treat warts with a combination of Er:YAG laser and topical podophyllotoxin is safe and effective. Compared with laser alone, the CR percentage seems to be higher and the percentage of relapses reduced.

Topical treatment of venereal warts: a comparative open study of podophyllotoxin cream versus solution

Podophyllotoxin solution (0.5%) is licensed for use in the treatment of condylomata acuminata (genital warts) in men in a number of European countries. In some countries, approval also extends to treatment of genital warts in women. This controlled randomized prospective study evaluated the efficacy and safety of a cream formulation of podophyllotoxin at 2 concentrations (0.15% and 0.3%), using 0.5% podophyllotoxin solution as a reference treatment. Two separate studies were initiated, to assess the 3 treatment groups in (a) male patients, and (b) female patients. Statistical evaluation was based on a "response rate' calculated at each clinic visit. The mean "response rates' in the male patient study at 4 weeks were 75.1%, 79.0% and 85.6% in the 0.15% cream, 0.3% cream and 0.5% solution groups, respectively. The corresponding "response rates' for the female patient study were 86.2%, 92.6%, and 93.1%, respectively. The relapse rates for both male and female patients were 6.0% in the 0.15% cream group, 8.6% in the 0.3% cream group and 8.6% in the 0.5% solution group. The results show that there were no statistically significant differences between the 3 treatments with regard to both efficacy and safety. This was true for both the male and female patient groups.

Audits of the treatment of genital warts: closing the feedback loop.

An initial audit of the treatment of patients presenting to the GUM Department at Leeds General Infirmary with a first episode of anogenital warts was reported in 1993. Treatment was found to be unselective and poorly monitored and the results of treatment were disappointing. As a consequence, guidelines for the management of new patients presenting with genital warts were devised. In order to establish whether these guidelines had produced any improvements in outcome, a second audit was performed looking at the results of treatment in patients with new genital warts who attended 6 months or more after the new guidelines were introduced. Progress was documented for 6 months after presentation. There was a significant fall in the numbers of patients receiving podophyllin 25% solution as first-line treatment, and corresponding increases in the initial use of cryotherapy, trichloracetic acid and, in men, podophyllotoxin solution. (Podophyllotoxin was not licensed for use in women at the time of the second audit.) There were significant improvements in the outcome of treatment. Originally 44% of men had warts despite receiving treatment for 3 months, and 32% were still attending for treatment 6 months after presentation. After the introduction of treatment guidelines, these figures had fallen to 8% and 3% respectively. In the first audit 38% of women still had warts after 3 months' treatment but in the second audit this figure was reduced to 18%. At 6 months, the percentage of women still attending for treatment was halved from 12% in the first audit to 6% in the second audit. The mean number of clinic visits fell from 5 to 3 in men and from 9 to 6 in women. The treatment protocols have been modified and now include the use of podophyllotoxin cream and solution in both men and women.

A single-blind study of podophyllotoxin cream 0.5% and podophyllotoxin solution 0.5% in male patients with genital warts.

To evaluate the efficacy-safety ratio of a new topical podophyllotoxin cream 0.5% compared with podophyllotoxin solution 0.5% (Condyline) in male patients with genital warts. In an observer-blinded controlled study a total of 136 and 133 wart lesions were treated with podophyllotoxin cream 0.5% and podophyllotoxin solution 0.5%, respectively. The preparations were applied twice daily for 3 days, repeated with 4 days intervals for a minimum of two and a maximum of four treatment cycles. At the conclusion of the study (8 weeks after completion of therapy) a significant reduction in mean wart area was observed in both the cream group (87.7, SD 8.4 to 20.6, SD 2.7) and in the solution group (92.3, SD 7.5 to 21.5, SD 2.8) (p < 0.01). At the same time all treated warts had completely cleared in 63% of patients in both study groups. Mild to moderate side effects occurred to the same extent in both podophyllotoxin cream and podophyllotoxin solution recipients. We conclude that podophyllotoxin 0.5% administered in a cream formulation does not give additional clinical benefits when compared with podophyllotoxin solution 0.5% in male patients with external genital warts.

Clinical efficacy of Condyline (0.5% podophyllotoxin) solution and cream versus podophyllin in the treatment of external condylomata acuminata

A single-blind randomized controlled trial was performed to compare the clinical efficacy of Condyline (0.5% podophyllotoxin) solution with Condyline (0.5% podophyllotoxin) cream and 20% podophylli...

PODOPHYLLOTOXIN IS BETTER THAN PODOPHYLLIN FOR GENITAL WARTS.

Podophyllin is a recommended treatment for genital warts; however, it has a significant failure rate and can cause local adverse reactions. In a letter to the Lancet, Lassus reports the effectiveness of pure podophyllotoxin solution in …