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ADVANCES IN HOME THERAPIES FOR ANOGENITAL WARTS
NEW YORK, NY (October 28, 1998) - Warts are an age-old problem that can be a source of great concern and embarrassment. Warts are benign skin tumors produced by infection with any of several types of human papillomavirus (HPV). This infection is passed from one person to another. Common warts (skin-colored, hard bumps often found on fingers) and flat warts (small, flat spots most frequently found on the backs of hands and the lower legs) are generally transmitted by casual contact and are difficult to prevent.
Plantar warts (on the bottom, or plantar surface, of the foot) can be partially avoided by wearing shoes in public places or anywhere people with plantar warts may have walked barefoot.
Anogenital warts (condylomata acuminata) are most often sexually transmitted, although children can contract them during birth through an infected birth canal or from the hands of caregivers. Adults can minimize the risk of infection with genital HPV by using a condom, although abstinence is the most reliable means of avoiding genital wart infection.
Speaking today at the American Academy of Dermatology's Derm Update '98, Libby Edwards, MD, Clinical Associate of Dermatology, Bowman Gray School of Medicine, Winston-Salem, NC, discussed the most common treatment for warts and the most important recent advances in home therapies for anogenital warts.
Because no medications currently available eradicate the virus itself, there are no cures for HPV infection. Aggressive or prolonged therapies usually produce long-lasting or permanent eradication of the wart tumor, yet the wart virus may linger for years in normal-appearing skin in a dormant form.
"Patient education is extremely important, and therapy should begin with careful counseling about the infectious nature of warts, the current unavailability of a cure, the often prolonged therapy required to eliminate the wart bump, and the possibility of recurrence later, even in the absence of re-exposure. These issues are especially important for patients with anogenital warts. An additional concern for women with anogenital warts is the association of cervical carcinoma with some HPV infections," Dr. Edwards cautioned.
Most wart treatments eliminate the virus by destroying the skin that contains the virus. The subsequent disappearance of the wart may occur because the virus was removed as the destroyed skin sloughs, or because the disruption of cells and release of the virus stimulates the patient's immune system to eradicate the virus. The only patients whose infections are truly cured are probably those whose immune system recognize and eliminate the virus. Patients with immune system deficiencies due to HIV infection, cancer, or medications such as cortisones, usually experience regrowth of warts following treatment.
The most common treatment for warts are those that physically destroy the skin. The choice for treatment depends partially upon the location of the wart, and the success of treatment depends upon the location and number of warts, the number of treatments, and the aggressiveness of the caregiver. The common treatments include: salicylic acid; liquid nitrogen; laser surgery or electrocautery (electric needle); cantharidin; trichloroacetic and bichloroacetic acids; and interferon alpha. An important recent advance in the treatment of anogenital warts includes imiquimod. This cream which can be applied topically at home and eliminates warts, not by destroying skin, but by prompting the patient's immune system to attack the virus itself. About half of the patients experience removal of all treated warts, and warts shrink dramatically on most other patients. Most exciting is an apparent, but not yet proven, lower recurrence rate than that seen with other treatments. The other new medication is a gel form of podofilox, a purified and less irritating form of podophyllin, an old standby caustic office therapy for anogenital warts. This gel is easier to apply than the liquid, and podofilox is gentle enough for home use by a patient.
The American Academy of Dermatology is the world's largest society representing physicians who specialize in treating hair, skin and nail conditions.
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REFERENCE NOTE: Edwards, L., M.D.; et al.; Safety and Efficacy of 0.5% Podofilox Gel in the Treatment of Anogenital Warts, Archives of Dermatology, January 1998, pp. 33-38.
Edwards, L., M.D.; et al.; Self-administered Topical 5% Imiquimod Cream for External Anogenital Warts, Archives of Dermatology, January 1998, pp. 26-30.
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