Abnormal anal cytology in women: Risk factors and association with sexually transmitted infection / Atipia anal citológica en mujeres: factores de riesgo y asociación con infecciones de transmisión sexual

Objective: High-grade anal intraepithelial neoplasia is considered a precursor of anal cancer. It is necessary to identify risk factors for AIN in women who could benefit from screening. Material and methods: For this retrospective study, we recruited women who underwent anal cytology screening over a 6-year period. We analyzed data on sexual habits, substance use, and the association with sexually transmitted infections, human papillomavirus infection, and HIV infection. We also analyzed HPV-related anogenital neoplasms. The groups were compared according to the cytology results. Results: Dysplasia was detected in 56 of 105 women and was confirmed as high-grade in 33.9%. The variables associated with abnormal anal cytology findings were higher educational level (p=0.031), ≥2 HPV-associated cancers (p=0.031), and a history of genital herpes (p=0.001) were associated with abnormal anal cytology. Neither anal sex nor high-risk anal HPV was associated with anal dysplasia. Abnormal cytology was more common in HIV-positive women. Conclusions: Anal screening is necessary because anal atypia is common in women. Genital herpes was associated with atypia, which could be explained by the synergistic effect of both infections simultaneously. Although high-risk HPV and HIV infection are risk factors for anal dysplasia, prospective studies are needed to design new screening algorithms

Objetivo: las neoplasias intraepiteliales de ano de alto grado son precursores de cáncer de ano .Son necesarios estudios que estimen factores de riesgo de NIA en mujeres que se beneficiarían del cribado. Material y métodos: estudio de cohortes retrospectivas de mujeres a las que se les tomó una citología anal en un periodo de 6 años. Analizamos hábitos sexuales, tóxicos, asociación con ITS, virus de papiloma y VIH, neoplasias en relación con VPH y comparamos las dos poblaciones de acuerdo al resultado de la prueba. Resultados: cincuenta y seis mujeres de 105 presentaron algún grado de atipia. En el 33,9% de ellas fue informada de alto grado. El nivel de estudios superior (p=0,031), dos o más patologías oncogénicas por VPH (p=0,031) y el herpes genital (p=0,001) se relacionaron con la atipia anal. Ni el sexo anal ni el VPH de alto riesgo se relacionaron con la positividad de la prueba. En las mujeres VIH positivas la atipia anal fue más frecuente. Conclusiones: la atipia anal es frecuente en las mujeres por lo que el despistaje citológico estaría justificado. El herpes genital se asoció con la atipia, lo que se explicaría por el efecto sinérgico de los dos virus. Aunque la patología genital por VPH de alto riesgo y el VIH en mujeres son factores de riego de NIA, son necesarios estudios en los que apoyen nuevos protocolos de despistaje

Sun Exposure Habits and Sun Protection Practices of Skaters.

Beach activities and outdoor sports are risk factors for developing skin cancer. Skateboarding is among the most popular sports among adolescents. The aim was to analyse the sun exposure habits and sun protection practices of skaters, in comparison with corresponding sun exposure and protection practices on the beach. This cross-sectional study is based on health surveys carried out into sun exposure and protection practices among young skateboarders. The study population was composed of 102 skaters, of whom 84 (82.4 %) were male. Fifty-eight (56.8 %) of the participants reported having suffered at least one sunburn event the previous summer. Eighty-seven (91.6 %) said they practiced outdoor sports more than 90 days per year, while only six (6.1 %) spent this long at the beach. Forty-nine (52.1 %) practiced outdoor sports for 5 or more hours a day compared to 42 (43.3 %) who spent comparable periods at the beach. A long-sleeved shirt was worn more frequently during sports than at the beach. Keen skaters are a risk group for the development of skin cancer due to excessive sun exposure, high rates of sunburn and scant use of sun protection measures. Specific educational and behavioural interventions should be aimed at this risk group.

Adolescents' Attitudes to Sun Exposure and Sun Protection.

Adolescents are considered a risk group for the development of skin cancer in later life due to their high rates of sunburn. The aim of this study is to evaluate the association between attitudes to sun exposure and the sociodemographic characteristics of adolescents, their habits, practices and knowledge. As a secondary goal, we describe the magnitude and sign of the correlations between these attitudes. Cross-sectional study of adolescent students from 12 secondary schools in southern Spain, the subjects were asked to complete the 'Beach Questionnaire'. This instrument examines four dimensions of attitudes, with standardised scores of 0-100, related to the sun, sun tanning, sun protection and sun cream. The higher the score, the more positive the attitude. The study population was composed of 270 adolescents. The highest scores were obtained for attitudes towards sun protection practices (mean 66.2; SD 18.6) and towards sun tanning (mean 64.2; SD 21.1). The lowest scores were obtained for attitudes towards using sun cream (mean 50.1; SD 24.6). Significant differences were found for all four attitudes, with a positive sign for the relationship between the number of days of sun exposure and a higher score for attitudes towards sunbathing (27.3 points difference between response extremes) and for attitudes towards suntanning (20 points difference). Favourable attitudes towards sunbathing and sun tanning have most influence on inadequate habits of sun exposure and deficient measures of sun protection. Adolescents should be considered a priority group for targeted interventions to improve sun protection behaviour.

Efectividad del genotipado del virus del papiloma humano frente a la citología anal en la identificación de neoplasia intraepitelial de alto grado / Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology

INTRODUCCIÓN: La neoplasia intraepitelial anal de alto grado (NIAAG) está en aumento en determinados grupos de riesgo y en su etiopatogenia están implicados algunos genotipos del virus del papiloma humano (VPH). El cribado de la NIAAG contempla el uso sistemático de la citología anal y más recientemente el genotipado de VPH. Nuestro objetivo fue determinar la sensibilidad y especificidad de ambas herramientas diagnósticas en la identificación de NIAAG. MATERIAL Y MÉTODO: Estudio de correlación entre los hallazgos citológicos y microbiológicos con respecto a la biopsia anal de una cohorte de pacientes con conductas de riesgo de desarrollar neoplasia intraepitelial anal atendidos en la consulta de infecciones de transmisión sexual del área de Dermatología del Hospital Costa del Sol desde enero de 2008 a diciembre de 2014. RESULTADOS: De los 151 pacientes sometidos al cribado, se seleccionaron aquellos pacientes con las tres pruebas de cribado realizadas (citología anal, genotipado y biopsia guiada por anoscopia), 92 en total, de los que el 62% presentaban infección por VIH. La sensibilidad y especificidad para identificar NIAAG fue 52,8 y 85,7% para la citología anal (k: 0,328), y 78 y 62,8% de la presencia de dos o más genotipos oncogénicos VPH (k: 0,417). La detección de VPH oncogénicos permitió clasificar correctamente 23 casos de NIAAG confirmados por biopsia guiada por anoscopia e infradiagnosticados con la citología anal, 14 de ellos con al menos 3 genotipos de riesgo. CONCLUSIÓN: La citología anal ha mostrado una sensibilidad insuficiente para la detección de NIAAG. El genotipado del VPH, aunque como única herramienta de cribado daría lugar a un sobrediagnóstico, es una herramienta que puede complementar el procedimiento de cribado, especialmente con el objetivo de identificar los casos de NIAAG

INTRODUCTION: The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS: This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS: Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION: Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure

[Effectiveness of human papillomavirus genotyping for detection of high-grade anal intraepithelial neoplasia compared to anal cytology]. / Efectividad del genotipado del virus del papiloma humano frente a la citología anal en la identificación de neoplasia intraepitelial de alto grado.

INTRODUCTION: The incidence of high-grade anal intraepithelial neoplasia (HGAIN) -with an aetiological based on high-risk types of human papillomavirus- is increasing in some high-risk groups. Screening for HGAIN includes routine anal cytology and, more recently, HPV genotyping. The main objective of this study was to determine the sensitivity and specificity of anal cytology and HPV genotyping for the detection of HGAIN. MATERIALS AND METHODS: This is a study to determine the correlation of cytological and microbiological findings with anal biopsy findings in a cohort of patients at high risk of developing AIN referred to the department of sexually transmitted infections of the Hospital Costa del Sol, Spain, between January 2008 and December 2014. RESULTS: Of the 151 patients subjected to screening, a total of 92 patients, all of them with the result of three screening test (anal cytology, genotyping and biopsy) were included in the study. Just under two-thirds (62%) of them were HIV-positive. The sensitivity and specificity of anal cytology to detect HGAIN were 52.8 and 85.7%, respectively (k: 0.328), and 78 and 62.8% to detect two or more HPV oncogenic genotypes (k: 0.417). The detection of oncogenic HPV genotypes allowed the identification of 23 new cases of HGAIN that had been underdiagnosed with anal cytology, with 14 cases containing at least three high-risk genotypes. CONCLUSION: Anal cytology did not show enough sensitivity in HGAIN screening. HPV genotyping has shown to be a useful tool to detect HGAIN cases, although it could lead to an over-diagnosis as a solitary screening procedure.

Tratamiento de la neoplasia vulvar intraepitelial con cidofovir tópico: presentación de un caso y revisión de la literatura / Treatment of vulvar intraepithelial neoplasia with topical cidofovir: a case report and literature review

La neoplasia vulvar intraepitelial (VIN) es una precursora del carcinoma vulvar invasivo. Aunque la cirugía es el tratamiento estándar, se están investigando nuevas terapias médicas con el fi n de mantener la anatomía y función sexual de la vulva. Nuestro objetivo es describir la utilidad del cidofovir tópico en la VIN. Presentamos una paciente con una VIN resistente a terapia fotodinámica e imiquimod tópico, que fue tratada con cidofovir tópico con respuesta completa a nivel vulvar y respuesta parcial a nivel perineal y perianal. El cidofovir puede ser una opción terapéutica en el manejo de la VIN. Se necesitan más ensayos futuros para investigar la eficacia y la posología más recomendada (AU)

Vulvar intraepithelial neoplasia (VIN) is a precursor of invasive vulvar carcinoma. Although the standard treatment is surgery, new medical therapies are under investigation to maintain the sexual anatomy and function of the vulva. Our objective was to describe the usefulness of topical cidofovir in VIN. We report a case of VIN resistant to photodynamic therapy and topical imiquimod, which was treated with topical cidofovir with complete response in the vulvar area and partial response in the perineal and perianal area. Cidofovir may be a therapeutic option in the management of VIN. Future trials are needed to investigate its efficacy and recommended dosage (AU)

Sun Protection Habits and Attitudes Among Healthcare Personnel in a Mediterranean Population.

Health professionals are key agents in healthcare promotion. In the field of skin cancer, they play a crucial role in the development of prevention strategies in the community. This paper aims to describe the sun exposure attitudes and habits of public healthcare professionals in the western Costa del Sol (Spain). A cross-sectional descriptive study was conducted in the Costa del Sol healthcare district to analyse sun exposure and protection practices and habits, and attitudes to tanning and sun protection. The respondents, all healthcare personnel in various professional categories and workplace situations, were asked to complete a self-administered questionnaire. Six hundred forty-three workers in the Costa del Sol healthcare district took part in the study. Of these participants, 450 were healthcare professionals. Of the 450 health professionals, 226 (50.2 %) were nurses or auxiliary nursing staff, and the remaining 224 were doctors. These two groups presented differences regarding habits of sun exposure: 15.3 % of the doctors went to the beach at least 30 days a year, compared to 30.9 % of the nurses (p < 0.001). With respect to workplace situation, there were differences (p < 0.001) between the sunburn events reported by healthcare staff who worked in hospitals (52.4 %) compared to those working in primary healthcare (30.4 %); comparable differences were found with respect to attitudes toward the use of sunscreen creams (p = 0.014). This study identifies two distinct subgroups within healthcare personnel: on one hand, primary healthcare professionals, who are key agents for future policy strategies, and on the other, specialist healthcare professionals, who are more likely to suffer sunburn events and therefore toward whom strategies should be addressed to encourage them to change their sun exposure attitudes and habits and sun protection practices.

Sensitivity to change of the Beach Questionnaire to behaviour, attitudes and knowledge related to sun exposure: quasi-experimental before-after study.

BACKGROUND: Health questionnaires must present accredited measurement properties such as validity, reliability and sensitivity to change, the latter being essential for interventions to be planned and for evaluating their effectiveness. The aim of this study was to evaluate the sensitivity to change of a Beach Questionnaire. METHODS: Quasi-experimental before-after study carried out in 2011, for a study population of adolescents attending schools in the Costa del Sol. First, the questionnaire was administered to the adolescents, after which a multicomponent educational intervention was carried out; finally, three months later, the same questionnaire was re-administered to the same adolescents. Changes were assessed in the categories of each item, using the McNemar test, and the changes in the scores, standardised to a range of 0-100, using the Student t test for paired samples, and including the mean of the differences and the 95% confidence interval. The level of statistical significance was set at p < 0.05. RESULTS: 228 adolescents, aged 14-17 years, and 55.3% were girls. Statistically significant changes were observed in sunburn experiences, exposure to the sun at mid-day and attitudes to sun exposure and suncreams. For the seven items related to knowledge about sun exposure, a higher rate of correct answers was observed. The analysis of changes, within the standardised range, revealed a significant improvement in the scores for sun exposure habits (MD 4.33; CI 95% 2.2-6.5), attitudes to sun exposure (MD 2.22; CI 95% 1.2-3.2) and knowledge (MD 9.10; CI 95% 7.1-11.1), but not in those for sun-protection practices (MD 0.23; CI 95% -1.2-1.7). CONCLUSIONS: The Beach Questionnaire on behaviour, attitudes and knowledge related to sun exposure is the first such instrument in Spanish language to provide sufficient sensitivity to change. It constitutes a useful tool for epidemiologic research into photoprotection and for skin cancer prevention programmes.

Utilidad de la detección del virus del papiloma humano en el cribado de neoplasia intraepitelial anal en pacientes con conductas de riesgo / Usefulness of human papillomavirus testing in anal intraepithelial neoplasia screening in a risk behaviour population

INTRODUCCIÓN: La incidencia de la neoplasia intraepitelial anal está en aumento en determinados grupos con conductas de riesgo, y en su etiopatogenia está implicada la infección por el virus del papiloma humano (VPH). Dentro de los programas de cribado implementados en las últimas décadas se encuentra el uso sistemático de la citología anal y, más recientemente, la detección del VPH mediante captura de híbridos y genotipado. MATERIAL Y MÉTODO: Estudio de cohortes retrospectivo de la población con conductas de riesgo de desarrollar neoplasia intraepitelial anal atendida en la consulta de Infecciones de Transmisión Sexual del área de Dermatología del Hospital Costa del Sol desde enero de 2010 a diciembre de 2012, a la que se le realizó cribado de neoplasia intraepitelial anal mediante toma de citología anal y genotipado de VPH. RESULTADOS: El 50% de la población estudiada tenía infección por VIH. Se encontró una alta frecuencia de displasia anal y presencia de VPH en la citología (82,1%) y genotipado (79%). Se obtuvo una asociación estadísticamente significativa (p < 0,005) entre la presencia de genotipos de VPH de alto riesgo y la presencia de displasia de alto grado en la segunda citología dirigida. El genotipado de VPH permitió identificar 17 casos (22%) de displasia severa infradiagnosticados en la primera citología. CONCLUSIÓN: La citología anal a ciegas puede infradiagnosticar casos de displasia de alto grado. La detección de VPH puede complementar este procedimiento, permitiéndonos identificar aquellos pacientes con mayor riesgo de desarrollar displasia anal de alto grado

INTRODUCTION: The incidence of intraepithelial anal neoplasia is increasing in certain risk behaviour groups, and human papillomavirus (HPV) infection is involved in its pathogenesis. The systematic use of anal cytology, and more recently HPV detection by hybrid capture and genotyping, have been introduced into screening programs in recent decades. MATERIAL AND METHODS: A retrospective cohort study was carried out on individuals with risk behaviours of developing intraepithelial anal neoplasia and who attended Sexually Transmitted Infections clinics in the Dermatology area of the Hospital Costa del Sol from January 2010 to December 2012. The intraepithelial anal neoplasia screening was performed using anal cytology and HPV genotyping. RESULTS: Half (50%) of the study population were HIV positive. A high frequency of anal dysplasia and presence of HPV in cytology (82.1%) and genotype (79%) was found. A statistically significant association (P < .005) was obtained between the presence of high-risk HPV genotypes and the presence of high-grade dysplasia in the second directed cytology. HPV genotyping enabled 17 cases (22%) of severe dysplasia to be identified that were under-diagnosed in the first cytology. CONCLUSION: Cases of high-grade dysplasia can be under-diagnosed by a first anal cytology. Detection of HPV can supplement this procedure, leading to the identification of those patients most at risk of developing high-grade anal dysplasia

Successful treatment of periungual warts with topical cidofovir.

Periungual warts represent a treatment challenge because of its high recurrence rate and recalcitrance. These are benign lesions produced by the human papilloma virus (HPV) that often do not respond to habitual treatment. Cidofovir is a potent antiviral drug that acts inactivating viral DNA polymerase. Topical cidofovir for the treatment of HPV-related cutaneous and mucous lesions is becoming increasingly common. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral periungual warts. We undertook a retrospective observational study of patients with periungual warts who received treatment with topical cidofovir between January 2010 and December 2013 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data were recorded about the rate of treatment response, the adverse effects and recurrences, as well as the characteristics of the patient cohort. We identified 41 patients who had received some previous treatment. The concentration of cidofovir was 3% in all cases, usually applied twice a day (in 37 of the 41 cases). A greater or lesser response was noted in 35 cases. There were six recurrences in the follow-up period. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant periungual common warts that fail to respond to usual treatment. Our experience with the use of this antiviral agent has been satisfactory, although in our opinion, it should be reserved for specific cases as its economical cost represents an important limitation.

[Usefulness of human papillomavirus testing in anal intraepithelial neoplasia screening in a risk behaviour population]. / Utilidad de la detección del virus del papiloma humano en el cribado de neoplasia intraepitelial anal en pacientes con conductas de riesgo.

INTRODUCTION: The incidence of intraepithelial anal neoplasia is increasing in certain risk behaviour groups, and human papillomavirus (HPV) infection is involved in its pathogenesis. The systematic use of anal cytology, and more recently HPV detection by hybrid capture and genotyping, have been introduced into screening programs in recent decades. MATERIAL AND METHODS: A retrospective cohort study was carried out on individuals with risk behaviours of developing intraepithelial anal neoplasia and who attended Sexually Transmitted Infections clinics in the Dermatology area of the Hospital Costa del Sol from January 2010 to December 2012. The intraepithelial anal neoplasia screening was performed using anal cytology and HPV genotyping. RESULTS: Half (50%) of the study population were HIV positive. A high frequency of anal dysplasia and presence of HPV in cytology (82.1%) and genotype (79%) was found. A statistically significant association (P<.005) was obtained between the presence of high-risk HPV genotypes and the presence of high-grade dysplasia in the second directed cytology. HPV genotyping enabled 17 cases (22%) of severe dysplasia to be identified that were under-diagnosed in the first cytology. CONCLUSION: Cases of high-grade dysplasia can be under-diagnosed by a first anal cytology. Detection of HPV can supplement this procedure, leading to the identification of those patients most at risk of developing high-grade anal dysplasia.

Behaviour, attitudes and awareness concerning sun exposure in adolescents on the Costa del Sol.

BACKGROUND: A history of sunburn and cumulative sun exposure during adolescence are the most important risk factors for the development of skin cancer. Skin cancer can be prevented by reducing sun exposure, particularly during adolescence, which is precisely the age group that could best benefit from primary prevention campaigns. OBJECTIVE: To determine the behaviour, attitudes and understanding of adolescents concerning sun exposure. METHODS: This cross-sectional descriptive study undertaken during 2011 included secondary school adolescents from randomly selected schools on the Costa del Sol, southern Spain. A validated beachside questionnaire was used to record data on demographics, skin colour, phototype, sun exposure habits, sunburns, practices, attitudes and knowledge about the sun. RESULTS: The study involved 270 students, aged 14-17 years, from 11 schools; 50.4% were female, 43.7% were aged 14 years, and 85.9% were Spanish. Most had a light skin colour (49.3%) and phototypes III (42.2%) or IV (34.8%). Most (71%) went to the beach on more than 16 days and 74.4% had had sunburn the previous summer. Sun cream was used by 47.8% and 1.1% wore long sleeves or trousers. Concerning attitudes, 60.7% stated they felt better when they were tanned, and concerning understanding, most were aware of the harmful effects of the sun on the skin. CONCLUSION: Adolescents comprise a special risk group with a positive attitude towards tanning. Further studies are required to assess educational stategies in order to reduce the desire to have a suntan, and improve sun protection practices and habits targeted at this age group.

Topical cidofovir for plantar warts.

Plantar warts are a common reason for dermatological consultations and their treatment can occasionally be a challenge. Plantar warts are benign lesions produced by the human papillomavirus (HPV) that often fail to respond to habitual treatment. Cidofovir is a potent antiviral drug that acts competitively, inhibiting viral DNA polymerase. Our aim was to assess the efficacy and safety of cidofovir cream for the treatment of viral plantar warts. We undertook a retrospective observational study of patients with plantar warts who received treatment with topical cidofovir between July 2008 and July 2011 at the Dermatology Service of the Hospital Costa del Sol, Marbella, Spain. Data about the rate of treatment response, the adverse effects, and recurrences, as well as the characteristics of the patient cohort, were recorded. We identified 35 patients who had received some previous treatment. The usual concentration was 3% (in 33 of 35 cases), applied twice a day (in 31 of 35 cases). A greater or lesser response was noted in 28 cases. There were two recurrences. Topical cidofovir seems to be a useful alternative for the therapeutic management of recalcitrant plantar common warts that fail to respond to usual treatment.

Tratamiento de verrugas anogenitales con cidofovir tópico / Treatment of anogenital warts with topical cidofovir

Introducción El cidofovir es un antiviral que inhibe la ADN-polimerasa de diferentes virus. Ha sido utilizado en infecciones originadas por el virus del papiloma humano. Métodos Estudio retrospectivo descriptivo en el que se incluyó a pacientes con verrugas anogenitales resistentes a terapias convencionales sobre las que se aplicó cidofovir crema. Resultados Se trataron 9 pacientes inmunocompetentes, con respuesta completa en 6 y parcial en 3.ConclusiónEl cidofovir podría ser una alternativa útil, aunque se precisan más estudios que establezcan su mejor posología y su coste-eficacia (AU)

Background Cidofovir is an antiviral agent which inhibits the DNA polymerase of different viruses. Its use has been described for papillomavirus infections. Methods Descriptive retrospective study, including patients with difficult to treat anogenital warts who were treated with cidofovir cream. Results Nine immunocompetent patients were treated, where 6 of them had a complete response and 3 of them a partial response. Conclusion Cidofovir cream could be a useful therapeutic alternative, although further studies are required to establish the best dosage and its cost-effectiveness (AU)

[Treatment of anogenital warts with topical cidofovir]. / Tratamiento de verrugas anogenitales con cidofovir tópico.

BACKGROUND: Cidofovir is an antiviral agent which inhibits the DNA polymerase of different viruses. Its use has been described for papillomavirus infections. METHODS: Descriptive retrospective study, including patients with difficult to treat anogenital warts who were treated with cidofovir cream. RESULTS: Nine immunocompetent patients were treated, where 6 of them had a complete response and 3 of them a partial response. CONCLUSION: Cidofovir cream could be a useful therapeutic alternative, although further studies are required to establish the best dosage and its cost-effectiveness.