Comparação entre a eficácia da cimetidina e do sulfato de zinco no tratamento de verrugas múltiplas e recalcitrantes

Abstract

INVESTIGAÇÃOResumo: FUNDAMENTOS: Verrugas são proliferações epiteliais na pele e mucosas causadas por diversos tipos de HPV. Elas podem involuir espontaneamente ou aumentar em número e tamanho de acordo com estado imunitário do paciente. A cimetidina e o sulfato de zinco têm importante efeito no sistema imune, sendo usados como imunomoduladores no tratamento de diversas doenças. OBJETIVO: Comparar a eficácia terapêutica de cimetidina e sulfato de zinco no tratamento de verrugas cutâneas de difícil tratamento. MÉTODOS: Estudo prospectivo duplo-cego randomizado. Dezoito pacientes com verrugas múltiplas foram divididos em dois grupos, um recebeu cimetidina 35mg/kg/dia (máximo 1.200mg/dia), e o outro, sulfato de zinco 10mg/kg/dia (máximo de 600mg/dia) por três meses. RESULTADOS: Dos 18 pacientes do estudo, nove receberam cimetidina, e nove, sulfato de zinco; apenas um do grupo do sulfato de zinco não completou o tratamento devido a náuseas e vômitos. Cura foi obtida em cinco pacientes tratados com sulfato de zinco, e apenas um não obteve alteração das lesões. Do grupo da cimetidina cinco não apresentaram modificação, e quatro apresentaram diminuição inferior a 30% das lesões iniciais. CONCLUSÕES: Sulfato de zinco na dose de 10mg/kg/dia parece ser mais efetivo que cimetidina para o tratamento de crianças e adultos com verrugas múltiplas e de difícil manejo. A pequena casuística deste trabalho não permite, entretanto, conclusão categórica. Palavras-chave: Cimetidina; Papillomaviridae; Sulfato de zinco; Verrugas; Verrugas/terapia Abstract: Background: Warts are epithelial proliferations on the skin and mucous membrane caused by various types of HPV. They can decrease spontaneously or increase in number and size according to patient's immune status. Cimetidine and zinc sulphate have important effects on the immune system and are used as immunomodulators in the treatment of various diseases. Objective: To compare the efficacy of cimetidine and zinc sulphate in the treatment of multiple and recalcitrant warts. Methods: A random double-blind prospective study. Eighteen patients with multiple warts were divided into two groups: one took 35mg/Kg/day of cimetidine (maximum 1200 mg/day) and the other 10 mg/Kg/day of zinc sulphate (maximum 600 mg/day) for three months. Results: Among the 18 patients who participated in the study, nine took cimetidine and nine zinc sulphate. Just one patient in the zinc sulphate group did not complete treatment due to nausea and vomiting. Five patients who were treated with zinc sulphate were cured and only one did not show modifications in lesions. Among the group who was treated with cimetidine, five did not show modifications in lesions and four showed decrease from baseline below 30%. Conclusions: 10 mg/Kg/day zinc sulphate dose seems to be more effective than cimetidine for the treatment of children and adults with multiple and difficult-to-handle warts. However, the small number of patients did not enable any definitive conclusion.

Evolving role of immunotherapy in the treatment of refractory warts

“…[ 44 ] It has been found to be more effective than cimetidine. [ 45 ] Topical 5% and 10% zinc solution has been used in cutaneous warts, 3 times a day for 4 weeks with only 5% and 11% response, respectively. [ 46 ] Topical zinc oxide 20% ointment showed almost similar efficacy as salicylic acid–lactic acid combination.…”

Efficacy of oral zinc therapy in epidermodysplasia verruciformis with squamous cell carcinoma

“…Medical management for EV includes topical imiquimod and 5-fluorouracil, systemic retinoids, interferon-alpha, cimetidine, zinc, and combination therapy [ Table 2 ]. [ 1 7 8 9 10 11 12 ]…”

“…Oral zinc had been used by many authors either alone as well as in combination therapy with satisfactory to good results [Tables 2 and 3 ]. [ 1 7 8 9 10 11 12 ] Prescribing zinc is due to its immunomodulatory effects. Zinc is a micronutrient that is necessary for the normal functioning of cells.…”