ABSTRACT
Introducción: Los condilomas o verrugas anogenitales son secundarios a una infección causada por el virus del papiloma humano en sitios específicos, como la piel de la región anogenital, en las mucosas vaginal y anal. Es una infección de transmisión sexual rara en la edad pediátrica, muy frecuente entre los adultos y adolescentes sexualmente activos; la causa en los infantes, sin descartar el abuso sexual podría ser: 1. En el momento del parto, en la etapa neonatal y durante los primeros años; 2. Autoinoculación o hetero-inoculación de los genitales de otros niños, de adultos, familiares como la madre o cuidadores. Podría manifestarse como pequeños papilomas o crecimientos verrugosos en la piel anogenital, en la mucosa de la vagina o el ano. Este caso tiene importancia clínica ya que los tratamientos convencionales presentan recidivas a corto plazo y muchos de ellos no son bien tolerados por los pequeños pacientes. Hay tratamientos agresivos como la criocirugía; el uso de medicamentos costosos como el Imiquimod; sin embargo, las reci-divas son muy frecuentes con estos tratamientos convencionales.Objetivo: Describir el uso de un esquema de terapia de tratamiento con podofilina en combina-ción con ácido glicirricínico y ácido tricloroacético, en una paciente pediátrica con diagnóstico de condiloma ano-perineal, para ayudar a disminuir las recidivas, los costos y sobre todo los efectos psicológicos que provocan los métodos dolorosos en los pequeños pacientes. Presentación del caso: Paciente que presentó lesiones verrucosas, puntiagudos en la región ano-perineal; y, luego de haber sido intervenida en un centro de salud por varios días mediante la topicación sobre las lesiones una solución de ácido tricloro acético a 5% combinada con podofi-lina al 50%; sin embargo, el cuadro se exacerbó extendiéndose las lesiones hasta cerca del área genital. Luego de lo cual acudió a nuestra consulta, donde además de la combinación anterior, más la adición de ácido glicirricinico tópico y logrando a los 30 días la remisión de las lesiones.Conclusiones y recomendaciones: La combinación de una sustancia corrosiva, el ácido tricloro acético, con una sustancia que detiene la multiplicación celular como la podofilina; y el ácido glicirricinico el cual disminuye la replicación de los virus en un estadio temprano, impide la salida del virión de su cápside y con esto su penetración a las células. La aplicación de esta triple terapia mejoró los resultados para condilomatosis en pacientes pediátricos.
Introduction: Anogenital condylomas or warts are secondary to an infection caused by the human papillomavirus in specific sites, such as the skin of the anogenital region, in the vaginal and anal mucosa. It is a rare sexually transmitted infection in pediatric age, very common among sexually active adults and adolescents; The cause in infants, without ruling out sexual abuse, could be: 1. At the time of birth, in the neonatal stage and during the first years; 2. Autoinoculation or he-tero-inoculation of the genitals of other children, adults, family members such as the mother or caregivers. It could manifest as small papillomas or warty growths on the anogenital skin, on the mucosa of the vagina or anus. This case has clinical importance since conventional treatments present short-term recurrences and many of them are not well tolerated by young patients. There are aggressive treatments such as cryosurgery; the use of expensive medications such as Imiqui-mod; However, recurrences are very common with these conventional treatments.Objective: To describe the use of a treatment regimen with podophyllin in combination with glycyrr-hizinic acid and trichloroacetic acid, in a pediatric patient diagnosed with anoperineal condyloma, to help reduce recurrences, costs and, above all, psychological effects. that painful methods cause in young patients.Case presentation: The patient presents sharp, verrucous lesions in the ano-perineal region; and, after having been operated on in a health center for several days by topicalizing a 5% trichloroace-tic acid solution combined with 50% podophyllin on the lesions; However, the condition worsened, with the lesions extending close to the genital area. After which he came to our consultation, where in addition to the previous combination, plus the addition of topical glycyrrhizinic acid and achie-ving remission of the lesions after 30 days.Conclusions and recomendations: The combination of a corrosive substance, trichloroacetic acid, with a substance that stops cell multiplication such as podophyllin; and glycyrrhizinic acid, which decreases virus replication at an early stage, prevents the release of the virion from its cap-sid and thus its penetration into the cells. The application of this triple therapy improved the results for condylomatosis in pediatric patients.
Subject(s)
Humans , Female , Child, Preschool , Anal Canal/abnormalities , Podophyllin , Condylomata Acuminata , PapillomaviridaeABSTRACT
O tumor de Buschke-Lowenstein (TBL) é variante extremamente rara do condiloma acuminado que, apesar de manifestar-se clinicamente por lesões de grandes proporções, apresenta comportamento biológico e características histológicas benignas. Existem diversas abordagens terapêuticas disponíveis, muitas delas apoiando-se em abordagens cirúrgicas extensas e mutilantes. Apresentamos dois casos de pacientes com TBL tratados com podofilina tópica, cujas respostas terapêuticas foram extremamente favoráveis em ambos os casos.
Buschke-Lowenstein tumor (BLT) is an extremely rare variant of condylomata acuminata that despite being clinically presented by large lesions, presents a benign biological behavior and histological characteristics. There are a number of therapeutic approaches available, many of which rely on extensive and mutilating surgical procedures. We present two cases of patients with BLT treated with topical podophyllin whose therapeutic responses were extremely favorable in both cases.
ABSTRACT
ABSTRACT Sexually transmitted infections are mainly caused by viruses and bacteria. They are transmitted trough sexual intercourse, without a condom, with an infected individual. The anus, vagina, and mouth may become involved. This study aimed to present six clinical cases with the diagnosis of sexually transmitted infections, but in which different treatment approaches were required. This demonstrates the dynamic and unique character of the disease in each individual. That is, the behavior of sexually transmitted infections will vary not only according to its causative microorganism (virus or bacteria), but also according to the characteristics of the combination of etiologic agent and host.
RESUMO As infecções sexualmente transmissíveis são causadas, principalmente, por vírus e bactérias. Por meio do contato sexual, sem preservativo, com um indivíduo que esteja infectado. O ânus, a vagina e a boca podem se tornar órgãos acometidos. O objetivo deste trabalho é apresentar 06 casos clínicos com o diagnóstico de infecções sexualmente transmissíveis, mas que para serem tratados foram necessárias diferentes abordagens. Isso demonstra o caráter dinâmico e singular da doença em cada indivíduo. Ou seja, o comportamento das infecções sexualmente transmissíveis vai variar não somente conforme o seu microrganismo causador (vírus × bactéria), mas também de acordo com o conjunto (agente etiológico + hospedeiro).
Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Middle Aged , Podophyllin , Sexually Transmitted Diseases , Imiquimod , HIVABSTRACT
Papulose bowenóide é uma doença que acomete a pele da região anogenital e que se caracteriza pelas múltiplas pequenas pápulas planas ou aveludadas e de coloração que varia do róseo ao castanho-escuro. É provocada pelo HPV e a transmissão sexual é a forma mais freqüente de contaminação. As queixas mais comuns são prurido e dor. O aspecto é característico e o exame histopatológico confirma o diagnóstico. Junto com a doença de Bowen e a eritroplasia de Queyrat, é considerada como carcinoma in situ, ou neoplasia intra-epitelial de alto grau (NIAA), a lesão precursora do carcinoma espinocelular (CEC) anal. Sem tratamento, a maioria das lesões permanece benigna e estável. Várias modalidades terapêuticas estão disponíveis, incluindo as medicações tópicas para citodestruição e as técnicas ablativas. Os esquemas tópicos são efetivos. Cabe ao profissional médico escolher a terapia adequada, tendo em mente que a doença é benigna e raramente evolui para carcinoma. Como as recidivas são freqüentes e ainda persistem dúvidas quanto ao potencial de malignização, os doentes devem ser examinados periodicamente para diagnosticar as lesões iniciais.
Bowenoid papulosis is an anogenital skin disease characterized by multiple little papules, flat or velvet, which color varies from pink to dark brown. It is provoked by HPV and its transmission is sexual. Most common symptoms are anal pain and itching. Its appearance is characteristic and hystopathological examination confirms diagnosis. Together with Bowenïs disease and Queyrat erythroplasia, is considered as an in situ carcinoma, or high grade intra-epithelial neoplasia (HAIN), a precursor of the squamous-cell carcinoma. Most of lesions remain benign and stable without treatment. There are several kinds of treatment including topical drugs for cytodestruction and ablative techniques. Topic schemes are effectives. The consultant doctor may choose the most adequate therapy, keeping in mind this disease is benign and rarely evolutes to invasive carcinoma. As recurrences are frequent and remain doubts about malign potential, patients must be examined periodically to diagnose initial lesions.