From August 2010 to August 2012, our clinic applied co2 laser surgery combined with 5% imiquimod cream to treat condyloma acuminata with satisfactory results as follows.
1.Cases and methods
(1) Case selection
All cases are from our dermatological venereal disease department outpatient clinic, with reference to the “Practical Venereology” (second edition) edited by Ye Gan Yun, etc., the diagnosis of acromegaly patients, age 16-70 years, wart diameter ≤ 2cm, wart number ≤ 20, wart distribution in the vulva, labia majora and minora, perianal, around the urethra, glans, coronal sulcus and other places. Mou Huaguang, Department of Dermatology, Weifang Fifth People’s Hospital
Exclusion criteria: Patients with other obvious dermatological diseases that may affect the evaluation of the efficacy of the treatment; those with known allergy to imiquimod; those with severe cardiac, hepatic and renal impairment; those with diabetes mellitus as well as severe immunocompromised or those who need to take glucocorticoids for a long time; those who have received systemic treatment or local antiviral treatment within 2 weeks before enrollment. Intra-urethral, intravaginal, intracervical, intra-rectal or intra-anal warts were also excluded from the selection.
(2) General information
A total of 170 cases were enrolled, of which 160 cases completed observation and met the design requirements. Among them, there were 82 cases in the treatment group, 48 males and 34 females; age 16-68 years, average age 34.5 years, duration of disease 1 week to half a year, average 62.5 days. In the control group, there were 78 cases, 50 males and 28 females, aged 16-70 years, with a mean age of 35.5 years, and the duration of the disease ranged from 10 days to six months, with a mean of 64 days. The two groups were comparable in terms of gender, age, duration of disease and degree of illness.
(3) Treatment method
The treatment group used 5% lidocaine in the warts local anesthesia after using co2 laser vaporization to remove the warts, deep to the dermis, the range to the edge of the warts 2-3mm, the warts are not obvious but the white acetate test positive together with the removal. After the wound has healed, the topical application of 5% Imiquimod cream three times a week, the drug with a cotton swab applied to the affected area to the surrounding 1cm, gently massage several times, keep 8 hours and then wash, a total of 8 weeks. In the control group, the warts were removed by the same method until the wounds healed, then topical recombinant human interferon а-2b ointment was applied 4 times a day for 8 weeks.
(4) Observation index
Patients were rechecked once every 2 weeks to observe the site, number, shape and size of warts before and after treatment and at the time of follow-up, and to record local and systemic adverse reactions after medication.
(5) Efficacy evaluation criteria
The efficacy index is the number of warts and the total area, according to the standard evaluation of healing, effective, progressive, invalid 4 levels. The wart body is completely receded; effective for the wart body area reduction ≥ 60%,; progress for the wart body area reduction ≥ 20%; invalid for the wart body area reduction < 20% or continue to aggravate. The efficiency is calculated as (the number of healed cases + the number of effective cases)/total number of cases × 100%.
(6) Statistical methods Statistical methods using x2 test
2.Results
Adverse reactions: 46 cases and 5 cases occurred in the treatment group and the control group respectively, the incidence rate was 47.56% and 6.41% respectively, which were manifested as local erythema, edema, erosion, itching, stinging, burning and other local irritation symptoms, but the adverse reactions in the treatment group were relatively lighter than those in the control group. They were able to recover completely after temporary discontinuation or reduction of the number of doses, and all were able to adhere to the treatment. No significant systemic adverse reactions were seen.
3, Discussion
The co2 laser vaporization procedure is a commonly used treatment for warts and has the advantage of rapidly removing the warts, especially for warts that are visible to the naked eye. antiviral effect and achieves therapeutic purpose by enhancing phagocytosis of macrophages, enhancing the killing effect of T cells and the function of natural killer cells.
In this study, the efficiency of the treatment group within 2 months was significantly higher than that of the control group, which was different from that reported by Zhang Jigang et al. (6 months of topical imiquimod treatment after removal of warts with co2 laser, the recurrence rate was 24.14, and 32.14 after 6 months of topical а-2b interferon gel treatment), which may be related to the short time we observed and the inconsistent dosage form of а-2b interferon.
The above co2 laser vaporization combined with imiquimod cream for the treatment of condyloma acuminata was more effective (about 65%) than the 8-week efficacy of imiquimod alone for condyloma acuminata reported by Yunsheng Xu et al. We found that topical imiquimod had a higher chance of local adverse reactions than the а-2b interferon group, but there were no systemic adverse reactions, and the number of doses was low, the drug was easy to preserve, and the patients were easy to accept.