Sinecatechins and imiquimod as proactive sequential therapy of external genital and perianal warts in adults

Abstract

This review about the proactive sequential therapy (PST) of external genital and perianal warts (EGW) is based on the most current available clinical literature and on the broad clinical experience of a group of international experts, physicians who are well versed in the treatment of human papillomavirus-associated diseases. It provides a practical guide for the treatment of EGW, including epidemiology, etiology, clinical appearance, and diagnostic procedures for these viral infections. Furthermore, the treatment goals and current treatment options, elucidating provider- and patient-applied therapies, and the parameters driving treatment decisions are summarized. Specifically, the mode of action of the topical treatments sinecatechins and imiquimod, as well as the PST for EGW to achieve rapid and sustained clearance is discussed. The group of experts has developed a treatment algorithm giving healthcare providers a practical tool for the treatment of EGW which is very valuable in the presence of many different treatment options.

Position statement for the diagnosis and management of anogenital warts

“…Podophyllotoxin stops division of infected cells causing tissue necrosis . It can be self‐applied by patients twice‐daily for three consecutive days, separated by a 4‐day treatment‐free period and repeated for up to 4 weeks.…”

“…Studies have shown that a combination of ablative techniques followed by immunotherapy may lead to even lower recurrence rates; ablation provides rapid clearance but has high recurrence rates while immunotherapy has slow clearance rates and a lower risk of recurrence . A study of 211 patients showed that imiquimod 5% applied within 3 weeks after laser therapy (to ensure complete wound healing) was associated with a low rate of wart recurrences of 11.8% over 6 months of follow‐up .…”

“…30 Other topical therapies Podophyllotoxin 0.15% cream or 0.5% alcoholic solution Podophyllotoxin stops division of infected cells causing tissue necrosis. 20,31,35 It can be self-applied by patients twicedaily for three consecutive days, separated by a 4-day treatmentfree period and repeated for up to 4 weeks. Patients need to carefully apply the solution to the lesions and avoid contact with healthy skin.…”

“…Clearance rates from clinical studies range from 45 to 94%, with common side-effects including pain, itching, burning, erosion and inflammation. 20,31,[35][36][37][38][39][40][42][43][44]63 Nitric zinc Nitric-zinc complex is a solution for topical application containing nitric acid, zinc, copper and organic acids, currently used to treat common warts. 64 It has a caustic effect on the wart through mummification and protein denaturation or a coagulation action.…”

“…18 Recurrence rates with conventional ablative techniques are relatively high (Table 3), since these methods only remove the visible wart without affecting the underlying HPV infection. 44,66 Of currently available treatments, recurrence rates are very low with immunotherapies, imiquimod (6-19%) 20,23,28,41,56,57,60,62 and sinecatechins (4-12%), [32][33][34] as these treatments stimulate the host's immune response to clear the warts.…”