Genital Warts in Infants and Children <br>—Re-Evaluation of Podophylline 15% as an Effective Topical Therapy

Abstract

Background: Condylomataacuminata is an infection caused by Human Papilloma Virus, rarely reported in infants and children. Podophylline as a treatment for this condition has been used cautiously in this age group. Objective: To report the cases of anogenital warts including condy lomataacuminata in infants and children and to evaluate the effectiveness and side effects of 15% podophyllin in treatment of genital warts. Patient and Methods: Thirty infants and young children were seen in Department of Dermatology and Venereology-Baghdad Teaching Hospital in this case descriptive and therapeutic trial, in the period from January 2011 to August 2012. Their ages ranged from 8-72 (30.43 ± 15.85) months, 20 females and 10 males with a female:male ratio of 2:1. The duration of the disease ranged from 1-12 (5.26 ± 4.00) months. All demographics data were recorded in this study. History and examination were carried out to all patients. Family members including mothers were assessed about the presence of any type of viral warts in other location of body. Podophyllin (15%) in tincture benzoin was applied once weekly to all viral warts and the parents advised to wash out after 2 hours of application. The number of applications was repeated until full recovery. Follow-up after recovery was carried out for 6 months to watch for any relapse and to record local or systemic side effects. Results: The clinical pictures were mostly acondylomata acuminata in a form of cauliflower like warts in 20 (73.33%) patients, while in 10 (26.77%) patients there were ordinary verruca vulgaris like warts. The location of warts was perianal in 23 (76.66%) patients, genital only in 2 (6.66%) patients, and mixed in 5 (16.66%) patients. Topical applications of podophyllin 15% gave a full recovery in 27 (90%) patients, while in 3 (10%) patients there was partial response. The number of applications ranged from 1-4 (2.7 ± 1.42) applications. Follow up for 6 months after recovery showed relapse in only one patient, and no side effects were reported in any patients. Conclusion: There is upsurge of cases of anogenital warts among infants and children. Podophyllin (15%) in tincture benzoin is an effective therapy and no local or systemic side effects were recorded in any case.

Condyloma Acuminata in an Infant: Case Report in a Resource Limited Setting

“…Side effects include local erythema, tenderness, burning, erosions, and edema. If podophyllin is used in an extensive area or injected or ingested, central nervous system toxicity and respiratory depression may result [16]. Bargman has reviewed the whole subject of systemic toxicity to podophyllin including its reported teratogenicity.…”

“…Bargman has reviewed the whole subject of systemic toxicity to podophyllin including its reported teratogenicity. He concluded that the dangers of podophyllin toxicity have been overplayed, and that it is an extremely safe drug when used properly [16,20].…”

Vulval disorders in paediatric and adolescent patients and their management

“…The latest figures show a 95% reduction since 2016 among female adolescents aged 15-17 years. 47 Conservative management of AGWs is appropriate for children, as more than half of cases resolve spontaneously. When resolution does not occur, cryotherapy and medical treatments, including immune-modifying therapy (imiquimod) or cytotoxic medication (podophyllin), have also been trialled with good results.…”

“…When resolution does not occur, cryotherapy and medical treatments, including immune-modifying therapy (imiquimod) or cytotoxic medication (podophyllin), have also been trialled with good results. 15,47 The incidence of STIs sharply increases with puberty. The highest rate of new STIs diagnoses fall in the postpubertal age group (16-24 years) and young women are more likely to be diagnosed with an STI than their male counterparts.…”

“…Figure 10. a) Perianal anogenital warts in a female child; b) perianal anogenital warts in the intergluteal fold of a female child 47. …”