Therapy for anogenital verrucae in preadolescent children with topical and systemic treatment

Abstract

Background/Objectives Anogenital verrucae (AV) are benign, human papillomavirus (HPV)–induced tumors of the anogenital skin and mucosa. Medical therapy for AV in preadolescents has not been well studied. We explore the efficacy and safety profile of sinecatechins 15% ointment and imiquimod 5% cream in the treatment of AV, alone and in combination therapy with other commonly used medications. Methods A single‐institution, retrospective review of children under 12 years of age with AV treated with imiquimod 5% cream and sinecatechins 15% ointment was performed. Demographic data, side effects, and outcomes of therapy were recorded for each patient, and overall efficacy was determined. Results A total of 37 patients met inclusion criteria. Responses were seen in 8 out of 9 patients treated with sinecatechins 15% ointment (5 full, 3 partial, and 1 no response) and 9 out of 17 patients treated with imiquimod 5% cream (4 full, 5 partial, and 8 no response). Combination therapy with one or more of the following treatments (podophyllin, cimetidine, candida antigen injection, and HPV vaccine) were evaluated, but no combination was objectively superior to the others. No significant difference was found in overall efficacy between sinecatechins and imiquimod. Side effects were mild and limited to irritation and erythema. Conclusions Both imiquimod 5% cream and sinecatechins 15% ointment are moderately effective in the treatment of AV in preadolescent children, with a trend toward greater effectiveness of sinecatechins. Combination therapy with other treatments did not significantly increase the effectiveness of topical therapies. Each modality has a tolerable side effect profile with a low risk of serious complications.

Clearance of genital warts in a pediatric patient following administration of the nonavalent human papillomavirus vaccine

“…Unlike common warts, genital warts are rarely observed in children. Lesions may range in size and may present as multiple skin‐colored, brown, or pink papules of 1–5 mm diameter that may evolve into verrucous plaques (as in our patient indeed) 1 . Although they are usually asymptomatic, itching or bleeding may occur 2 …”

“…Anogenital warts, or condyloma acuminata, are benign skin neoplasms caused by the human papillomavirus (HPV). In adults, they are considered a sexually transmitted disease, but in childhood they can be acquired through the birth canal of an infected mother, by self‐inoculation of the child from other sites, or by sexual abuse 1 …”

Successful topical treatment of anal giant condylomata acuminata in an infant

“…In addition, 17 infant cases successfully treated with imiquimod for CA are reported in the literature ([imiquimod + condyloma + infant] has been researched on PubMed) (Table 1). 5‐15 …”

Green tea extract as a successful topical treatment option in children with perianal condylomata

“…However, treatment of children with green tea extract 10 % ointment is not mentioned in the expert information. There are only sparse data on topical treatment of anogenital warts in children, but the response rate of topical green tea extract 10 % ointment seems to be good in the available published data [6], which is why we decided to use this therapy for our patient. In order to keep the recurrence rate as low as possible, we decided on proactive therapy after the daily treatment.…”