The Efficacy of Podophyllin Cautery Added to Surgical Excision for Eradication of Vulvar Condylomata Accuminata; Randomized Controlled Trial — Oak Academic Publishing
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The Efficacy of Podophyllin Cautery Added to Surgical Excision for Eradication of Vulvar Condylomata Accuminata; Randomized Controlled Trial
Department of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt
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Department of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, Giza, Egypt
1 Department of Surgical Oncology, National Cancer Institute, Cairo University, Giza, Egypt
2 Department of Gynecology and Obstetrics, Faculty of Medicine, Cairo University, Giza, Egypt
Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Participants: Sixty women were enrolled in a study that was conducted in Cairo from Jan-2017 to Mar-2018. Interventions: All women received the same preparations. After randomization; in the study group (N = 30), podophyllin cautery was added to surgical removal in the follow-up period. In the control group (N = 30), only surgical removal was used. Main Outcome Measure: The main outcome measure was the estimation of the recurrence of the lesion during the follow-up period. The secondary outcome measures were the incidence of adverse events. Results: Both groups were comparable (p-value > 0.05) with regard to the age and BMI. Recurrence was significantly lower (P = 0.001) in the study group than the control group. In the study group, five cases (17.2%) have recurrence whereas, in the control group, 18 (60.0%) had suffered recurrence. The ARR was 42.8% (CI 95%: 18 % - 60.9%) with RR of 0.29 (CI 95%: 0.12% - 0.67%) and NNT2 (CI 95%: 6% - 2%). During the follow-up period, 19 cases (65.5%) of the study group experienced pain versus only eight cases (26.7%) in the control group (p = 0.003). However, the development of scars was less in the study group 7 (24.1%) than in the control group 19 (63.3%), (p = 0.002). Conclusion: Podophyllin cautery, when added to surgical removal, is effective in decreasing the incidence recurrence in cases with condylomata acuminata.
Gall, S.A. (2001) Female Genital Warts: Global Trends and Treatments. Infectious Diseases in Obstetrics and Gynecology, 9, 149-154. https://doi.org/10.1155/S1064744901000278
Money, D.M. and Roy, M. (2007) Canadian Consensus Guidelines on Human Papillomavirus. Journal of Obstetrics and Gynaecology Canada, 29, S1-S56. https://doi.org/10.1016/S1701-2163(16)32573-7
Workowski, K.A. and Berman, S. (2010) Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines. MMWR Recommendations and Reports, 59, 1-110.
Lacey, C., Woodhall, S., Wikstrom, A. and Ross, J. (2013) 2012 European Guideline for the Management of Anogenital Warts. Journal of the European Academy of Dermatology and Venereology, 27, e263-e270. https://doi.org/10.1111/j.1468-3083.2012.04493.x
Beutner, K.R., Wiley, D.J., Douglas, J.M., Tyring, S.K., Fife, K., Trofatter, K. and Stone, K.M. (1999) Genital Warts and Their Treatment. Clinical Infectious Diseases, 28, S37-S56. https://doi.org/10.1086/514722
Beutner, K.R., Richwald, G.A., Wiley, D.J., Reitano, M.V. and AMA Expert Panel on External Genital Warts (1998) External Genital Warts: Report of the American Medical Association Consensus Conference. Clinical Infectious Diseases, 27, 796-806. https://doi.org/10.1086/514964
von Krogh, G., Lacey, C.J., Gross, G., Barrasso, R. and Schneider, A. (2000) European Course on HPV Associated Pathology: Guidelines for Primary Care Physicians for the Diagnosis and Management of Anogenital Warts. Sexually Transmitted Infections, 76, 162-168. https://doi.org/10.1136/sti.76.3.162
Cassidy, D.E., Drewry, J. and Fanning, J.P. (1982) Podophyllum Toxicity: A Report of a Fatal Case and a Review of the Literature. Journal of Toxicology: Clinical Toxicology, 19, 35-44. https://doi.org/10.3109/15563658208990364
Tyring, S.K., Arany, I., Stanley, M.A., et al. (1998) A Randomized, Controlled, Molecular Study of Condylomata Acuminata Clearance during Treatment with Imiquimod. The Journal of Infectious Diseases, 178, 551-555. https://doi.org/10.1086/517472
Leslie, K.O. and Shitamoto, B. (1982) The Bone Marrow in Systemic Podophyllin Toxicity. American Journal of Clinical Pathology, 77, 478-480. https://doi.org/10.1093/ajcp/77.4.478
Filley, C.M., Graff-Richard, N.R., Lacy, J.R., Heitner, M.A. and Earnest, M.P. (1982) Neurologic Manifestations of Podophyllin Toxicity. Neurology, 32, 308-311. https://doi.org/10.1212/WNL.32.3.308
Boillot, A., Cordier, A., Guerault, E., et al. (1989) A Rare Case of Severe Toxic Peripheral Neuropathy: Poisoning by Podophyllin. Apropos of 1 Case. Journal de Toxicologie Clinique et Experimentale, 9, 409-412.
Gorin, F., Kindall, D. and Seyal, M. (1989) Dorsal Radiculopathy Resulting from Podophyllin Toxicity. Neurology, 39, 607-608. https://doi.org/10.1212/WNL.39.4.607
Yang, C.M., Deng, J.F., Chen, C.F. and Chang, L.W. (1994) Experimental Podophyllotoxin (Bajiaolian) Poisoning: III. Biochemical Bases for Toxic Effects. Biomedical and Environmental Sciences, 7, 259-265.
Kao, W.F., Hung, D.Z., Tsai, W.J., Lin, K.P. and Deng, J.F. (1992) Podophyllotoxin Intoxication: Toxic Effect of Bajiaolian in Herbal Therapeutics. Human & Experimental Toxicology, 11, 480-487. https://doi.org/10.1177/096032719201100607
Tomczak, R.L. and Hake, D.H. (1992) Near Fatal Systemic Toxicity from Local Injection of Podophyllin for Pedal Verrucae Treatment. The Journal of Foot Surgery, 31, 36-42.
Chan, Y.W. (1991) Magnetic Resonance Imaging in Toxic Encephalopathy Due to Podophyllin Poisoning. Neuroradiology, 33, 372-373. https://doi.org/10.1007/BF00587830
Conard, P.F., Hanna, N., Rosenblum, M. and Gross, J.B. (1990) Delayed Recognition of Podophyllum Toxicity in a Patient Receiving Epidural Morphine. Anesthesia & Analgesia, 71, 191-193. https://doi.org/10.1213/00000539-199008000-00013
Oliveira, A.S., Calia, L.C., Kiyomoto, B.H., Povoa, E.F., Schmidt, B. and Gabbai, A.A. (1996) Acute Necrotizing Myopathy and Podophyllin Toxicity: Report of a Fatal Case. Arquivos de Neuro-Psiquiatria, 54, 288-292. https://doi.org/10.1590/S0004-282X1996000200017
Douglas, J.M., Eron, L.J., Judson, F.N., et al. (1990) A Randomized Trial of Combination Therapy with Intralesional Interferon α 2b and Podophyllin versus Podophyllin Alone for the Therapy of Anogenital Warts. The Journal of Infectious Diseases, 162, 52-59. https://doi.org/10.1093/infdis/162.1.52
Edwards, A., Atma-Ram, A. and Thin, R.N. (1988) Podophyllotoxin 0.5% v Podophyllin 20% to Treat Penile Warts. Genitourinary Medicine, 64, 263-265. https://doi.org/10.1136/sti.64.4.263
Gabriel, G. and Thin, R.N. (1983) Treatment of Anogenital Warts. Comparison of Trichloracetic Acid and Podophyllin versus Podophyllin Alone. The British Journal of Venereal Diseases, 59, 124-126. https://doi.org/10.1136/sti.59.2.124
Hellberg, D., Svarrer, T., Nilsson, S. and Valentin, J. (1995) Self-Treatment of Female External Genital Warts with 0.5% Podophyllotoxin Cream (Condyline) vs. Weekly Applications of 20% Podophyllin Solution. International Journal of STD & AIDS, 6, 257-261. https://doi.org/10.1177/095646249500600407
Kinghorn, G.R., McMillan, A., Mulcahy, F., Drake, S., Lacey, C. and Bingham, J.S. (1993) An Open, Comparative, Study of the Efficacy of 0.5% Podophyllotoxin Lotion and 25% Podophyllotoxin Solution in the Treatment of Condylomataacuminata in Males and Females. International Journal of STD & AIDS, 4, 194-199. https://doi.org/10.1177/095646249300400403
Lassus, A., Haukka, K. and Forsstrom, S. (1984) Podophyllotoxin for Treatment of Genital Warts in Males: A Comparison with Conventional Podophyllin Therapy. European Journal of Sexually Transmitted Diseases, 2, 31-33.
Jensen, S.L. (1985) Comparison of Podophyllin Application with Simple Surgical Excision in Clearance and Recurrence of Perianal Condylomataacuminata. The Lancet, 2, 1146-1148. https://doi.org/10.1016/S0140-6736(85)92677-7
Khawaja, H.T. (1989) Podophyllin versus Scissor Excision in the Treatment of Perianal Condylomataacuminata: A Prospective Study. British Journal of Surgery, 76, 1067-1068. https://doi.org/10.1002/bjs.1800761027
Duus, B.R., Philipsen, T., Christensen, J.D., Lundvall, F. and Sondergaard, J. (1985) Refractory Condylomataacuminata: A Controlled Clinical Trial of Carbon Dioxide Laser versus Conventional Surgical Treatment. Genitourinary Medicine, 61, 59-61.