Management of Cutaneous Human Papillomavirus Infection: Pharmacotherapies

Abstract

A plethora of different treatment modalities for treating human papillomavirus (HPV) are available, offering a range of efficacies and balancing several patient needs. Here we discuss pharmacotherapies for HPV, focusing in particular on the mechanism of action and treatment efficacy. Immunomodulators such as Candida antigen, imiquimod and squaric acid stimulate cell-mediated immunity and induce production of antiviral cytokines. Proapoptotic and antiviral treatments such as podophyllin resin, podophyllotoxin gel, bleomycin, 5-fluorouracil, cidofovir and interferon α interfere with the viral reproduction cycle. Other therapies include trichloroacetic acid, acitretin, cantharidin and sinecatechins, some of which operate by epidermal destruction, effects on cellular proliferation and other mechanisms of which are poorly understood. Overall, given the high HPV recurrence rates, adjunctive use of antiviral agents should be considered in treatment, especially when managing severe or complicated presentations.

Cantharidin is superior to trichloroacetic acid for the treatment of non-mucosal genital warts: a pilot randomized controlled trial

“…Although rare side effects such as ring warts, lymphangitis, infection and varicelliform 18 vesicular dermatitis have been reported, none were encountered in our studies 19,20 .…”

Advancements in Pharmacotherapy for Noncancerous Manifestations of HPV

“…The treated skin heals in 4 to 7 days [5]. Repeat application should occur every 2 to 4 weeks [9]. Cantharidin is contraindicated for the facial, genital and perianal regions as well as the mucosal membranes [5,9].…”

“…Repeat application should occur every 2 to 4 weeks [9]. Cantharidin is contraindicated for the facial, genital and perianal regions as well as the mucosal membranes [5,9]. Furthermore, cantharidin use near the eyelids or eyes is discouraged due to the risk of scleral erosion [5].…”

“…If used properly, side effects are rare; however, the most common side effects associated with cantharidin are burning, erythema, pain and pruritus. Also, cantharidin increases the risk of developing donut warts, or warts where the central portion resolves but the peripheral portion persists [9]. With appropriate physician application, cantharidin typically does not lead to scarring [5].…”

An overview of early investigational drugs for the treatment of human papilloma virus infection and associated dysplasia

“…However, recent improvements in their application combined with the development of new modalities means some of these approaches have now "come-of-age" 17 and these will now b e discussed with respect to their ability to fulfil the aforementioned criteria.…”