CME
Review Article:
Therapy
of Cutaneous Human
Papillomavirus Infections
by
ALLISON
RIVERA MD (1)
&
STEPHEN K. TYRING MD, PhD, MBA (2)
Houston, TX, USA
on
August 29, 2005
(1) Department of Dermatology, Baylor College
of Medicine, Houston, Texas, USA
(2) Professor of Dermatology, University of Texas Health Science
Center, Houston, Texas, USA
Table 1.
Efficacy of HPV treatment regimens
| Therapy |
Application type |
Regimen |
Maximum
duration |
Clearance |
Recurrence |
| Podophyllin resin (6–8) |
P |
Once weekly |
6 weeks |
30–60% |
30–70% |
| Podophyllotoxin (7,9) |
S |
3 consecutive days alternating with 4 days of rest |
6 weeks |
45–75% |
30–70% |
| Salicylic acid (4) |
S |
Soak in water for 5 minutes and dry. File wart. The solution
and gel are applied two to three times daily and allowed to
dry. Discs are applied and covered for 48 hours before removal. |
20 weeks |
48–87% |
Insufficient data |
| TCA and BCA (11) |
P |
Once weekly |
“several” weeks |
81% |
36% |
| 5-FU topical (13,14) |
S |
Apply a thin layer one to three times each week and wash with
soap and water after 3–10 hours |
6–8 weeks |
47–68% |
10–70% |
| 5-FU intralesional (5,16,17) |
P |
Injection once weekly |
6 weeks |
55–77% |
58% |
| Bleomycin (18–20) |
P |
Intralesional injection; a variety of techniques available.
|
4 injections |
33–92% |
Insufficient data |
| Cryotherapy (1,8) |
P |
Anesthetic followed by freezing of the lesion and 1–2
mm of surrounding healthy tissue for 20–30 seconds |
6 weeks |
50–70% |
20–70% |
| Surgery (8) |
P |
Variety of techniques |
3 weeks |
100% |
5–30% |
| Laser (5,8,26–28) |
P |
CO2 or NdYag; exact regimen varies according to lesion |
3 weeks |
100% |
5–30% |
| Interferon intralesional (10,29–36) |
P |
Two to three times weekly |
8 weeks |
36–63% |
0–32% |
| Imiquimod (2,41–46) |
S |
Three times weekly for 6–10 hours |
16 weeks |
37–50% |
13–19% |
P: physician-applied; S: self-applied by patient. *variable follow
up.
Table 2.
Therapy indications by location
| |
Common |
Genital |
Anal |
Urethral |
Oral |
| Patient-administered |
Salicylic acid
Imiquimod |
Imiquimod, podophyllotoxin
Interferon* |
Cryotherapy |
|
|
| Physician-administered |
Cryotherapy
TCA/BCA surgical |
Cryotherapy
podophyllin
TCA/BCA surgical laser* |
Cryotherapy
TCA/BCA surgical |
Cryotherapy
Podophyllin |
Cryotherapy
Surgical |
*alternative treatment
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References
