Giant Perianal Condyloma Successfully Treated with Podophyllin at 25% in Solid Petrolatum

Abstract

Purpose Giant perianal condyloma (GPC) is a rare condition. The effective treatment is a multidisciplinary challenge; topical treatments are usually ineffective, and surgical resection has significant morbidity. Podophyllin at 25% in solid petrolatum (25%PSP) can be an effective treatment option for GPC. The aim of the present study was to assess its response and tolerability. Methods This retrospective, single-center case series evaluated the clinical response of 14 patients with GPC treated with 25%PSP in a public hospital in Buenos Aires between December 2015 and December 2019. After obtaining a full history and performing a physical exam, the lesions were measured and photographed. Biopsies were performed to exclude malignancy, as well as exams to rule out pregnancy. Podophyllin at 25% in solid petrolatum was administered topically in cases of GPC and washed off by the patients at home after 4 hours. The patients underwent at least 4 weekly visits, which included interval history, photodocumentation of the lesions, and provider-applied 25%PSP. The response rate was assessed by comparing measurements and the overall decrease in volume of the GPC based on photos from the first and last sessions. Adverse outcomes were noted. Results In total, 10 men, 3 women, and 1 transgender woman with GPC unresponsive to prior treatments and a mean age of 34.5 years were included. A total of 12 patients were immunosuppressed. All the perianal lesions were circumferential and measured between 8 cm and 20 cm. Overall, 7 patients had genital condyloma outside of the anus and perianus; the histology showed low-grade squamous intraepithelial lesions in all cases. While on treatment, 7 patients reported dermatitis, and 71% of the patients had ≥ 75% reduction in lesion size. Conclusions Podophyllin at 25% in solid petrolatum is an effective, well-tolerated topical treatment option for GPC.

Infecciones transmisibles sexualmente que afectan colon, recto y ano.

“…Si bien la serie es pequeña, se concluyó que la podofilina al 25% en vaselina sólida es un fármaco eficaz y bien tolerado. 101 En una etapa previa al uso de podofilina, las plásticas anales con colgajos V-Y para reparar los grandes defectos posteriores a una exéresis, particularmente cuando había compromiso endoanal, constituían la primera opción tras el fracaso del tratamiento médico. 102 El 5 fluorouracilo (5FU) impide la síntesis del ADN del HPV, ocasionando la muerte celular.…”