Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod

Abstract

Human papillomavirus (HPV) is the most common sexually transmitted disorder in young, sexually active populations in the USA and Europe. Giant condyloma acuminatum (GCA) is a unique variant of condyloma acuminata, characterized by local aggressive behaviour despite benign histology. It carries a substantial risk of squamous cell carcinoma. Various treatments have been used, but response is often poor and recurrence rates high. We present a case of GCA successfully treated with a combination of surgical excision, oral acitretin and topical imiquimod. The diagnosis was based on histological examination, immunohistochemical analysis and in situ hybridization for HPV 6 and 11. We recommend a trial of oral retinoid and topical imiquimod in selected cases of GCA.

British Association of Dermatologists guidelines on the efficacy and use of acitretin in dermatology

“…There are a few case reports of warts clearing with acitretin, 81,82 but in one of these the warts only improved in bulk and recurred on stopping therapy. 82 Acitretin has been used anecdotally as an adjunct to therapy in giant condyloma acuminatum 83 but in this case response was arguably related to excision and imiquimod used in combination. In epidermodysplasia verruciformis acitretin has been suggested as an adjunct in combination with interferon alfa-2a 84 but as monotherapy was ineffective.…”

Buschke-Lowenstein Tumor

“…Clinically, BLT is presented as an exophytic lesion in anal, perineal or vulva regions. The latter is the most unusual location [2]. The patient had the rarest form of BLT and had no other risk factors besides diabetes.…”

“…BLT affects about 0.1% of population [1,2], is more frequent in men, elderly and immunocompromised patients [1,3]. Other risk factors include diabetes, HIV, pregnancy, alcoholism, smoking, poor hygiene and multiple sexual partners [4].…”

“…However, the histologic features, without nuclear atypia, has contrast with the invasive and destructive potential of these tumors [2].…”

“…Giant Condyloma acuminatum (GCA), or Buschke-Lowenstein tumor (BLT) is a slow-growing, locally destructive, rare tumor of the anogenital region [1,2], which diagnosis is defined by histopathological [1]. However, the histologic features, without nuclear atypia, has contrast with the invasive and destructive potential of these tumors [2].…”