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1.
Dermatol Online J ; 26(7)2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898403

RESUMO

Poorly controlled and long-standing hidradenitis suppurativa (HS) increases the risk of squamous cell carcinoma (SCC). We report a 54-year-old woman with an over 20-year history of HS, who had previously undergone wide perineal excision with secondary intention healing and presented with a painful verrucous vulvar plaque and proximal non-healing perineal wound. The patient had four perineal scouting biopsies performed and excisional biopsy with no evidence of high-grade dysplasia or carcinoma on histology. Chromogenic in situ hybridization was negative for HPV 16 and 18 mRNA; the patient's HIV and HSV PCR were also negative. Our patient was treated with interferon alfa-2b with notable clinical improvement. There is currently no standardized stepwise approach to monitoring verrucous lesions in HS patients with significant risk factors for SCC. Our report highlights a vigilant approach to monitoring. If scouting biopsies are negative, complete testing for high risk HPV strains (HPV 16 and 18) is warranted. If negative, we recommend follow up every 6 months with no further biopsies except if overt clinical changes are observed. We also recommend treatment of verrucous changes to decrease risk of possible malignant conversion. Interferon alfa-2b was effective in decreasing the verrucous lesion burden in our patient and may be considered.


Assuntos
Hidradenite Supurativa/complicações , Interferon alfa-2/uso terapêutico , Verrugas/tratamento farmacológico , Biópsia , Carcinoma de Células Escamosas/prevenção & controle , Transformação Celular Neoplásica , Condiloma Acuminado/patologia , Diagnóstico Diferencial , Feminino , Hidradenite Supurativa/cirurgia , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/genética , Papillomavirus Humano 18/isolamento & purificação , Humanos , Pessoa de Meia-Idade , Períneo/patologia , RNA Viral/análise , Falha de Tratamento , Vulva/patologia , Verrugas/etiologia , Cicatrização
2.
PLoS One ; 15(4): e0231547, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32298328

RESUMO

BACKGROUND: The Victorian legislation prohibits sex workers from working when they have visible anogenital herpes or warts. The aim of this study was to determine the proportion of asymptomatic female sex workers (FSW) diagnosed with anogenital herpes or warts by genital examination. METHODS: We analysed all computerised medical records of consultations with FSW at the Melbourne Sexual Health Centre (MSHC) in 2018. All asymptomatic sex workers were offered screening sexually transmitted infections (STIs) and a genital examination to identify visible anogenital herpes or warts at MSHC. FSW consultations were categorised into either 'asymptomatic' or 'symptomatic' based on the presence of symptoms reported by the FSW to the triage nurse. The proportion of asymptomatic FSW diagnosed with visible anogenital herpes or warts during a routine screening examination was calculated. RESULTS: In 2018, 4055 consultations were provided to 1979 FSW. 3406 of these consultations were asymptomatic and all were examined by an experienced clinician for signs of STIs. Of these 3406 asymptomatic consultations, seven FSW (0.21%, 95% CI: 0.08% to 0.42%) were diagnosed with visible anogenital herpes and/or warts following a genital examination. Four were diagnosed with warts (0.12%, 95% CI: 0.03% to 0.30%), two with herpes (0.06%, 95% CI: 0.01% to 0.21%) and one with both herpes and warts (0.03%, 95% CI: 0.001% to 0.16%). CONCLUSION: Based on these data, approximately 500 asymptomatic FSW would need to be examined to identify one case of anogenital herpes or warts. Genital examinations consume considerable clinical resources, increase the duration of consultations and provide essentially no significant benefit to the mandated testing for gonorrhoea, chlamydia, HIV and syphilis. Our clinic will use self-collected samples and no longer examine FSW who are asymptomatic.


Assuntos
Condiloma Acuminado/diagnóstico , Genitália Feminina/patologia , Herpes Genital/diagnóstico , Programas de Rastreamento/métodos , Exame Físico/métodos , Profissionais do Sexo , Adulto , Doenças Assintomáticas , Condiloma Acuminado/patologia , Feminino , Herpes Genital/patologia , Humanos , Exame Físico/estatística & dados numéricos , Estudos Retrospectivos , Profissionais do Sexo/legislação & jurisprudência , Fatores de Tempo , Vitória
3.
An Bras Dermatol ; 95(2): 144-149, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32146009

RESUMO

BACKGROUND: Anogenital warts are the leading sexually transmitted infection in patients seeking care at specialized clinics. They may display a vast array of forms, according to the interaction of the virus with the host's immunity. Cellular immunity is the epithelium's main form of defense against the virus, involving an active participation of the Langerhans cells and pro-inflammatory cytokines such as TNF-α. OBJECTIVE: To assess the epithelial immune response of anogenital warts in males, according to the number of lesions presented. METHODS: This is a prospective, cross-sectional study carried out at the dermatology outpatient clinic in a tertiary hospital. We included male patients over 18 years of age without comorbidities who had anogenital condylomata and no previous treatments.In order to evaluate the local epithelial immunity, the lesions were quantified, then removed and employed in CD1a immunohistochemistry assays for assessing the morphometry and morphology of Langerhans cells; TNF-α; reaction was used for determining cytokine positivity in the epithelium. RESULTS: 48 patients were included in the study. There was no statistically significant difference as to the number of Langerhans cells, in their morphology, or the presence of TNF-α. However, patients presenting with more Langerhans cells in the lesions had cells with a star-like and dendritic morphology, whereas in those with a lower cell count had cells with a rounded morphology and no dendrites (p<0.001). STUDY LIMITATIONS: Small number of patients analyzed. CONCLUSION: There was no difference in epithelial immunity between patients having few or many anogenital condyloma lesions as measured by the morphology and morphometry of Langerhans cells and TNF-α; positivity. Such an assessment employing immunity markers differing from the usual ones is expected to yield useful results.


Assuntos
Doenças do Ânus/imunologia , Condiloma Acuminado/imunologia , Doenças dos Genitais Masculinos/imunologia , Células de Langerhans/patologia , Fator de Necrose Tumoral alfa/análise , Doenças do Ânus/patologia , Condiloma Acuminado/patologia , Estudos Transversais , Células Dendríticas/imunologia , Células Dendríticas/patologia , Doenças dos Genitais Masculinos/patologia , Humanos , Imuno-Histoquímica , Células de Langerhans/imunologia , Masculino , Estudos Prospectivos , Valores de Referência , Fator de Necrose Tumoral alfa/imunologia
5.
Int J Surg Pathol ; 28(3): 265-272, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31735112

RESUMO

Penile intraepithelial neoplasia (PeIN) is currently classified in human papillomavirus (HPV)- and non-HPV-related subtypes with variable HPV genotypes. PeINs are frequently associated with other intraepithelial lesions in the same specimen. The aim of this study was to detect and compare HPV genotypes in PeINs and associated lesions using high-precision laser capture microdissection-polymerase chain reaction and p16INK4a immunostaining. We evaluated resected penile specimens from 8 patients and identified 33 PeINs and 54 associated lesions. The most common subtype was warty PeIN, followed by warty-basaloid and basaloid PeIN. Associated lesions were classical condylomas (17 cases), atypical classical condylomas (2 cases), flat condylomas (9 cases), atypical flat condylomas (6 cases), flat lesions with mild atypia (12 cases), and squamous hyperplasia (8 cases). After a comparison, identical HPV genotypes were found in PeIN and associated lesions in the majority of the patients (7 of 8 patients). HPV16 was the most common genotype present in both PeIN and corresponding associated lesion (50% of the patients). Nonspecific flat lesions with mild atypia, classical condylomas, and atypical condylomas were the type of associated lesions most commonly related to HPV16. Other high-risk HPV genotypes present in PeIN and associated nonspecific flat lesion with mild atypia were HPV35 and HPV39. In this study of HPV in the microenvironment of penile precancerous lesions, we identified identical high-risk HPV genotypes in PeIN and classical, flat, or atypical condylomas and, specially, in nonspecific flat lesions with mild atypia. It is possible that some of these lesions represent hitherto unrecognized precancerous lesions.


Assuntos
Carcinoma in Situ/virologia , Infecções por Papillomavirus/complicações , Infecções por Papillomavirus/genética , Neoplasias Penianas/virologia , Adolescente , Adulto , Idoso , Carcinoma in Situ/patologia , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Genótipo , Humanos , Microdissecção e Captura a Laser , Masculino , Pessoa de Meia-Idade , Papillomaviridae/genética , Neoplasias Penianas/patologia , Reação em Cadeia da Polimerase , Adulto Jovem
6.
Ann Diagn Pathol ; 43: 151402, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31473371

RESUMO

Heck's disease (focal or multifocal epithelial hyperplasia) is a benign, rare condition of the skin and mucous membranes induced by human papillomavirus (HPV) infection. Other entities that can induce large papillomatous lesions that involve the mucous membranes and skin include condyloma acuminatum, which is sexually transmitted, and white sponge nevus, often due to a mutation of cytokeratin 4 or 13. Six cases diagnosed as either Heck's disease (n = 2) or white sponge nevus (n = 4) and 6 oral condyloma were compared on histologic grounds and analyzed in situ for HPV DNA, including HPVs 6,11, and 13, as well as cytokeratins 4 and 13. Each case showed marked acanthosis, and para/hyperkeratosis. More variable histologic findings included rete ridge elongation, keratinocyte degeneration, and perinuclear halos. High copy HPV 13 DNA was evident in the squamous cells towards the surface in the two cases diagnosed as Heck's disease and in two cases diagnosed as white sponge nevus on clinical grounds. HPV 6/11 was found in each of the six condyloma. Marked decrease in either cytokeratin 4 or 13 was evident in the two cases diagnosed as white sponge nevus that were HPV DNA negative. It is concluded that in situ hybridization analyses including HPVs 6, 11, and 13 as well as immunohistochemistry for cytokeratins 4 and 13 can differentiate Heck's disease from condyloma and white sponge nevus, which can be difficult to differentiate on clinical and histologic grounds.


Assuntos
Condiloma Acuminado/patologia , Leucoceratose da Mucosa Hereditária/patologia , Nevo/patologia , Pele/patologia , Adulto , Biomarcadores/metabolismo , Diferenciação Celular , Condiloma Acuminado/virologia , DNA Viral/genética , Feminino , Hiperplasia Epitelial Focal/patologia , Humanos , Hiperplasia/patologia , Hibridização In Situ , Queratinas/metabolismo , Leucoceratose da Mucosa Hereditária/genética , Leucoceratose da Mucosa Hereditária/virologia , Masculino , Pessoa de Meia-Idade , Nevo/virologia , Papiloma/patologia , Papillomaviridae/genética , Infecções por Papillomavirus/patologia
8.
Am J Surg Pathol ; 43(11): 1547-1553, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31368913

RESUMO

Condyloma acuminatum rarely occurs in the urinary bladder and is considered to be a risk factor for squamous cell carcinoma, although there are only a few publications with limited cases. We studied 51 cases of condyloma acuminatum of the urinary bladder from transurethral resections of the urinary bladder of 38 patients from the consult files of one of the authors. Transurethral resections of the urinary bladder were obtained from 25 males with a median age of 73 years (range: 41 to 87 y) and 13 females with a median age of 68 years (range: 30 to 86 y). The follow-up period ranged from 15 months to 20 years (median: 6 y). Bladder lesions were accompanied by urethral lesions in 4 men. Eight patients (8/38; 21.0%) had a history of immunosuppression. Seven patients (7/8; 87.5%) from this group had multiple and/or recurrent condylomas. One patient (1/38; 2.6%) with renal transplantation had 10 separate bladder condylomas over time. One patient (1/38; 2.6%) had extensive anogenital condylomas and anal intraepithelial neoplasia grade 3. One patient (1/8; 12.5%) with renal transplantation presented with a solitary condyloma with synchronous squamous cell carcinoma in situ. Three female patients (3/38; 7.9%) had a history of premalignant vagina/cervix lesions. In total, 17 patients (17/38; 44.7%) had squamous cell carcinoma of the bladder, either invasive or in situ. In all cases, the squamous cell carcinoma (either in situ or invasive) was diagnosed either concurrent with the diagnosis of bladder condyloma or within 1 year of the condyloma diagnosis). In total, 9 of 38 (23.7%) patients had invasive squamous cell carcinoma with or without in situ squamous cell carcinoma. Eight of 38 (21.0%) patients had squamous cell carcinoma in situ only (without a definitive invasive component-in 3 cases invasive squamous cell carcinoma could not be excluded with certainty). In total, 19 patients (19/38; 50%) were positive for either low-risk human papillomavirus (LR-HPV) or high-risk human papillomavirus (HR-HPV) or both (3 were positive for both LR-HPV and HR-HPV, 12 patients for only LR-HPV, and 4 for only HR-HPV). Of the 19 patients that were negative for both LR-HPV and HR-HPV, 9 of 19 (47.4%) patients had associated squamous cell carcinoma. Of the 12 patients with only LR-HPV, 4 (33.3%) had associated squamous cell carcinoma (either invasive or in situ). Of the 7 patients with HR-HPV (with or without LR-HPV), 4 (57.1%) has associated squamous cell carcinoma. In summary, condyloma acuminatum of the urinary bladder shows a strong association with squamous cell carcinoma of the bladder, regardless of the condyloma's HPV in situ hybridization results. Immunosuppression is associated with condylomas of the bladder. It is important to distinguish bladder condylomas from papillary urothelial carcinoma, given their different risks for panurothelial disease and risk of squamous cell carcinoma. Recognition of bladder condylomas histologically is often challenging given their rarity, and that they can be negative for both LR-HPV and HR-HPV. The lack of a history of other anogenital human papillomavirus-related lesions further increases the difficulty in establishing the correct diagnosis.


Assuntos
Carcinoma de Células Escamosas/patologia , Condiloma Acuminado/patologia , Lesões Pré-Cancerosas/patologia , Doenças da Bexiga Urinária/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/etiologia , Condiloma Acuminado/diagnóstico , Condiloma Acuminado/etiologia , Diagnóstico Diferencial , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/etiologia , Fatores de Risco , Doenças da Bexiga Urinária/diagnóstico , Doenças da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/diagnóstico , Neoplasias da Bexiga Urinária/etiologia , Neoplasias da Bexiga Urinária/patologia
12.
Tech Coloproctol ; 23(4): 325-332, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31016550

RESUMO

BACKGROUND: The aim of the present study was to evaluate patient factors that affect the progression of anal dysplasia in human immunodeficiency virus (HIV)-positive individuals. METHODS: A retrospective cohort study of HIV-positive adults with human papilloma virus related anal lesions was performed from 2012 to 2017. All patients underwent surgical excision or biopsy and fulguration of lesions in the operating room without using high resolution anoscopy. Patients with initial presentation of squamous cell carcinoma were excluded. The study was designed to investigate progression between the first available histology and either the follow up histology or a negative examination. Patient files were reviewed and data was collected. A bivariate analysis of continuous and categorical variables was performed. RESULTS: One hundred and sixty-one patients met the inclusion criteria. Ninety-seven percent were male. Mean age was 41 years. Thirty-five percent were African American and 47% were Caucasian. After a median follow-up interval of 331 days (IQR 120-615 days) 14 (9%) of patients had progression of disease. Visible lesions on initial presentation, as opposed to lesions found  in patients undergoing examination under anesthesia because of HSIL on anal pap smear, was associated with progression (p = 0.0.2). A lower initial CD4 count (p = 0.01) and initial surgical pathology of anal condylomata (p = 0.01) were also associated with progression. High-risk serotype was associated with no change or regression (p = 0.01). CONCLUSIONS: In our large cohort of HIV-positive patients treated without high resolution anoscopy the rate of progression was low.  Most notably, visible lesions at initial presentation and CD4 count when lower were associated with progression. Initial surgical pathology of anal condylomata was associated with progression, while high-risk serotypes correlated with regression or stability. Identification of risk factors has important implications concerning postoperative surveillance and counseling of HIV-positive patients with anal condylomata/ anal dysplasia.


Assuntos
Neoplasias do Ânus/patologia , Carcinoma in Situ/patologia , Carcinoma de Células Escamosas/patologia , Infecções por HIV/patologia , HIV , Adulto , Canal Anal/patologia , Canal Anal/virologia , Neoplasias do Ânus/virologia , Biópsia , Carcinoma in Situ/virologia , Carcinoma de Células Escamosas/virologia , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Progressão da Doença , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Proctoscopia , Estudos Retrospectivos , Fatores de Risco
13.
J Eur Acad Dermatol Venereol ; 33(8): 1506-1512, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30720900

RESUMO

BACKGROUND: The quantification of human papilloma virus (HPV)-induced skin lesions is essential for the clinical assessment of the course of disease and the response to treatment. However, clinical assessments that measure dimensions of lesions using a caliper do not provide complete insight into three-dimensional (3D) lesions, and its inter-rater variability is often poor. OBJECTIVE: The aim of this study was to validate a stereophotogrammetric 3D camera system for the quantification of HPV-induced lesions. METHODS: The camera system was validated for accuracy, precision and interoperator and inter-rater variability. Subsequently, 3D photographs were quantified and compared to caliper measurements for clinical validation by Bland-Altman modelling, based on data from 80 patients with cutaneous warts (CW), 24 with anogenital warts (AGW) patients and 12 with high-grade squamous intraepithelial lesions of the vulva (vulvar HSIL) with a total lesion count of 220 CW, 74 AGW and 31 vulvar HSIL. RESULTS: Technical validation showed excellent accuracy [coefficients of variation (CV) ≤ 0.68%] and reproducibility (CVs ≤ 2%), a good to excellent agreement between operators (CVs ≤ 8.7%) and a good to excellent agreement between different raters for all three lesion types (ICCs ≥ 0.86). When comparing 3D with caliper measurements, excellent biases were found for diameter of AGW (long diameter 5%), good biases were found for diameter of AGW (short diameter 10%) and height of CW (8%), and acceptable biases were found for the diameter of CW (11%) and vulvar HSIL (short diameter 14%, long diameter 16%). An unfavourable difference between these methods (bias 25%) was found for the assessment of height of AGWs. CONCLUSION: Stereophotogrammetric 3D imaging is an accurate and reliable method for the clinical visualization and quantification of HPV-induced skin lesions.


Assuntos
Condiloma Acuminado/patologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/patologia , Fotogrametria/métodos , Dermatopatias Virais/patologia , Ensaios Clínicos Fase II como Assunto , Método Duplo-Cego , Feminino , Humanos , Masculino , Placebos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reprodutibilidade dos Testes
14.
Clin Exp Dermatol ; 44(6): 620-624, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30793382

RESUMO

BACKGROUND: Despite its high contagiousness, high recurrence rate and potential for malignant transformation, effective treatments for condyloma acuminatum (CA) have not yet been developed. Accordingly, it is necessary to clarify the mechanisms underlying CA development. AIM: To investigate the expression and significance of the proteins Wnt-1 and TSLC1 in patients with CA and in normal foreskin controls. METHODS: Wnt-1 and TSLC1 were assessed by immunohistochemistry in 45 patients with CA. RESULTS: Positive expression rates of Wnt-1 and TSLC1 were 82.22% (37/45) and 37.78% (17/45), respectively, in CA tissues, and 29.17% (7/24) and 91.67% (22/24), respectively, in normal foreskin controls. Wnt-1 expression intensity in CA was markedly higher (positive to strongly positive) than that in normal controls (negative to weakly positive), whereas TSLC1 expression intensity ranged from weakly positive to positive in CA, and nearly strongly positive in the normal control group. The differences in the positive expression rate and expression intensity of Wnt-1 and TSLC1 between the two groups were statistically significant (P < 0.05). In addition, Wnt-1 and TSLC1 were negatively correlated. (r = -0.336, P < 0.05). CONCLUSIONS: Overexpression of Wnt-1 and low expression of TSLC1 may be associated with the growth of CA. These findings may provide a basis for the development of therapies to prevent recurrence or malignant transformation of CA.


Assuntos
Molécula 1 de Adesão Celular/metabolismo , Condiloma Acuminado/metabolismo , Proteína Wnt1/metabolismo , Adolescente , Adulto , Condiloma Acuminado/patologia , Feminino , Genes Supressores de Tumor , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Infecções por Papillomavirus/metabolismo , Proto-Oncogenes , Proteínas Supressoras de Tumor , Adulto Jovem
15.
Acta Dermatovenerol Croat ; 27(4): 270-272, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31969241

RESUMO

The prevalence of psoriasis is 2% of the world's population (1). Inverse psoriasis is characterized by the development of erythematous shiny plaques at intertriginous areas of the body. The prevalence of only anogenital involvement appears to be low, but involvement of the anogenital area together with other areas is found in up to 45% of patients with psoriasis (2). A 21-year-old female student with a 3-month history of mild psoriasis (erythematosquamous plaque on the elbows and nail pitting on the nails of the hand) was referred to our Department. One month earlier, suddenly appearance of erythematous, smooth, clearly demarcated plaques was observed on the labia majora, the mons pubis, the perineal and perianal region together with a brownish hyperkeratotic papule on the pubic region (Figure 1, a-b). The patient underwent excisional biopsy at the Department of Surgery, and the pathohistological finding was unavailable to us. The elbows were treated with corticosteroid-keratolytic preparation, whereas the anogenital lesions were treated with moderately potent topical corticosteroids. In addition to anogenital erythema, on clinical examination we noticed an erythematosquamous plaque on the site of excision with a hyperkeratotic verrucous papule on the edge of the lesion (the Koebner phenomenon on the site of skin injury). In the pubic region, we noticed two hyperkeratotic papules and a few verrucous papules on labia majora. Localized dermatophyte or candida infection were excluded with a KOH test and scrapings culture. Serology for syphilis, HIV, and hepatitis were negative. Cervical Pap smear was normal. Biopsy of erythematosus lesion from the mons pubis was conclusive for psoriasis, and of the keratotic papule with the genital wart with positive HPV 6 and 11. The patient's older sister had chronic plaque psoriasis. We employed physically ablative methods like liquid nitrogen cryosurgery, electrocauterization, and curettage, applied topical agents like 0.5% podophyllotoxin solution, 20% podophyllin, and 80% trichloroacetic acid, and treated the psoriatic lesions with a short course of moderate-potency corticosteroids and tacrolimus ointment. All therapeutic attempts were ineffective for curing both diseases. Our patient either had psoriasis with sparse genital warts or exacerbation of multiple anogenital warts (Figure 2, a-b). Anogenital psoriasis is a skin disease that causes great discomfort. The disease-related quality of life is significantly reduced, especially regarding sexual behavior. Therapy for either anogenital psoriasis or genital warts is not entirely satisfactory. Many topical agents suitable for use on the psoriatic lesions on the body, such as coal tar, anthralin, vitamin D derivatives or retinoids, may be too irritating in the anogenital region. The most useful therapy for treatment of anogenital psoriasis are moderately potent topical corticosteroids and topical tacrolimus or pimecrolimus (1). However, corticosteroid-induced atrophy is possible in intertriginous sites. The Koebner phenomenon isomorphic response is the appearance of new skin lesions on areas of cutaneous injury in otherwise healthy skin (3). About 25% of patients with psoriasis have elicitation of psoriatic lesions by injury to the skin (4). Other than in patients with psoriasis, the Koebner phenomenon can be found in other skin diseases like vitiligo, lichen planus, lichen nitidus, pityriasis rubra pilaris, flat warts, and keratosis follicularis (Darier disease) (5). According to Eyre at al., about 67% patients with psoriasis (4) present with clearing of psoriatic lesions following skin injury (positive "reverse" Koebner reaction) (4). There is no single treatment for genital warts that is 100% effective, and different types of treatment are very often combined. Accepted methods of treatment involve chemical and physical destruction or removal (6). Since psoriasis koebnerizes, any destructive technique may exacerbate the psoriasis. Coexistence of anogenital psoriasis and HPV presents a huge therapeutic problem because a therapy for psoriasis such as corticosteroids can provoke appearance and/or reappearance of HPV infection, while some therapies for anogenital warts, like cryotherapy, curettage, laser ablation, electrosurgery, or surgery can provoke the appearance and/or reappearance of psoriatic infection due to the Koebner phenomenon.


Assuntos
Condiloma Acuminado/complicações , Condiloma Acuminado/terapia , Psoríase/complicações , Psoríase/terapia , Condiloma Acuminado/patologia , Feminino , Humanos , Psoríase/patologia , Adulto Jovem
16.
J Infect Dis ; 219(2): 275-283, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30137482

RESUMO

Background: Condylomata acuminata (anogenital warts [AGWs]) are prevalent in human immunodeficiency virus (HIV)-infected individuals and sexually active populations at risk for HIV acquisition and have been associated with HIV transmission. We compared AGW specimens to control tissue specimens for abundance, types, and location of HIV target cells and for susceptibility to HIV infection in vitro, to provide biologic evidence that AGWs facilitate HIV transmission. Methods: We used immunohistologic staining to identify HIV target cells in AGW and control specimens. We also inoculated HIV in vitro into AGW and control specimens from HIV-negative men and assessed infection by means of TZM-bl and p24 assays. Results: CD1a+ dendritic cells, CD4+ T cells, and macrophages were significantly more abundant in the epidermis of AGW specimens than control specimens. These HIV target cells also often appeared in large focal accumulations in the dermis of AGW specimens. Two of 8 AGW specimens versus 0 of 8 control specimens showed robust infection with HIV in vitro. Conclusions: Compared with normal skin, AGWs contain significantly higher concentrations of HIV target cells that may be susceptible to HIV infection. Condylomata may thus promote HIV transmission, especially in the setting of typical lesion vascularity and friability. Prevention or treatment of AGWs may decrease the sexual transmission of HIV.


Assuntos
Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Infecções por HIV/transmissão , Adulto , Idoso , Antígenos CD , Antígenos de Diferenciação Mielomonocítica , Linfócitos T CD4-Positivos/virologia , Linfócitos T CD8-Positivos , Condiloma Acuminado/imunologia , Células Dendríticas/imunologia , Células Dendríticas/patologia , Feminino , Granulócitos , Células HEK293 , Proteína do Núcleo p24 do HIV , Infecções por HIV/virologia , HIV-1 , Humanos , Antígenos CD15 , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Papillomaviridae , Infecções por Papillomavirus/virologia , Receptores CXCR4 , Pele/imunologia , Pele/patologia , Adulto Jovem
17.
Arch Pathol Lab Med ; 143(7): 821-831, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30203987

RESUMO

CONTEXT.­: Histologic distinction between condyloma acuminatum and various benign and malignant condyloma-like lesions in the anogenital area poses a common diagnostic challenge to pathologists across subspecialties. OBJECTIVE.­: To review the overlapping and distinguishing features of condyloma acuminatum and its mimics, and to clarify confusing terminology and diagnostic criteria for problematic entities. DATA SOURCES.­: A review of the literature on condyloma acuminatum (ordinary and giant types), verrucous carcinoma, warty/warty-basaloid high-grade squamous intraepithelial lesion and squamous cell carcinoma, papillary squamous cell carcinoma, bowenoid papulosis, verruca vulgaris, epidermolytic acanthoma, and verruciform xanthoma was performed. CONCLUSIONS.­: Correct diagnosis of condyloma acuminatum and condyloma-like lesions has important clinical implication and entails familiarization with their clinical presentations and histopathologic features. Contrary to historical belief, giant condyloma acuminatum and verrucous carcinoma should be considered distinct entities based on different pathogenetic pathways. Ancillary tools available for identifying and genotyping human papillomavirus can aid in diagnosis when histopathologic findings are inconclusive. Recognition of relatively rare entities such as bowenoid papulosis, epidermolytic acanthoma, and verruciform xanthoma would avoid overdiagnosis and unnecessary, overaggressive treatment.


Assuntos
Condiloma Acuminado/patologia , Doenças dos Genitais Femininos/patologia , Doenças dos Genitais Masculinos/patologia , Doenças Retais/patologia , Condiloma Acuminado/diagnóstico , Feminino , Doenças dos Genitais Femininos/diagnóstico , Doenças dos Genitais Masculinos/diagnóstico , Humanos , Masculino , Doenças Retais/diagnóstico
19.
Am J Case Rep ; 19: 1522-1525, 2018 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-30578409

RESUMO

BACKGROUND A condyloma acuminatum is a sexually transmitted, human papillomavirus (HPV) associated, neoplasm. In men, it is predominantly found on external genitalia and rarely progresses more proximally than the distal penile urethra. Condyloma acuminata of the prostatic urethra are rare and are usually seen as an extension of, or in association with external lesions. Therefore, it is not typically considered in the differential diagnosis of isolated papillary lesions limited to the prostatic urethra. CASE REPORT A 62-year-old male with rheumatoid arthritis treated with abatacept presented to urology due to a history of intermittent bladder self-catheterization for urinary obstruction. He underwent a transurethral resection of the prostate and had incidental findings of papillary lesions restricted to the prostatic urethra that were presumed to be urothelial carcinoma. Microscopic examination established the diagnosis of condyloma acuminata, and low-risk HPV 6 and 11 were detected by in-situ hybridization. Subsequent cystoscopy showed marked growth and extension of condyloma acuminata to near the external meatus. After multiple treatments with intraurethral 5-fluorouracil, several small lesions remained in the bulbous urethra. With follow up for 2 years since diagnosis, the patient has not developed external condylomata. CONCLUSIONS A condyloma acuminatum might present as an isolated papillary growth in the prostatic urethra without clinical or historical evidence of a visible lesion on external genitalia. Immunosuppression and/or urethral instrumentation might be a risk factor for such a presentation. Urologists and pathologists should be aware of this rare possibility in order to avoid misdiagnosis, and ensure that the patient receives appropriate therapy.


Assuntos
Condiloma Acuminado/diagnóstico , Doenças Uretrais/diagnóstico , Abatacepte/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Condiloma Acuminado/patologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doenças Uretrais/patologia , Cateterismo Urinário
20.
J Drugs Dermatol ; 17(10): 1100-1105, 2018 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-30365591

RESUMO

BACKGROUND: Nitric oxide (NO), a free radical gas, is endogenously produced in human cells. In high concentration, NO neutralizes many disease-causing microbes. The topical investigational drug SB206 releases NO and has the potential to treat skin diseases caused by viruses. Genital warts (condyloma acuminata) are primarily caused by human papillomavirus (HPV) types 6 and 11. Available treatments have low tolerability and efficacy rates and are inconvenient for the patient. Genital warts can recur if HPV is incompletely eradicated during treatment. OBJECTIVE: Topical SB206 (berdazimer sodium plus carboxymethyl cellulose hydrogel) was assessed for tolerability, safety, and efficacy for up to12 weeks in patients with external genital and/or perianal warts (EGW/PAW) in a phase 2, double-blind, randomized, dose-escalation study. METHODS: Patients (N=108) were randomly assigned to SB206 or vehicle in a 3:1 ratio: SB206 4% once (QD) or twice daily (BID), 8% QD, 12% QD, or corresponding vehicle. Treatment duration was up to 84 days. The primary efficacy endpoint was complete clearance of baseline EGW/PAW at or before week 12. Pearson's Chi Square tests compared the efficacy of active vs vehicle treatments. Safety was assessed through adverse event and tolerability reports, physical examination findings, and clinical laboratory test results. RESULTS: In the Intent-to-Treat population, the percentage of patients with complete clearance of baseline EGW/PAW at or before week 12 was higher for SB206 groups than for vehicle groups, with the greatest difference between SB206 12% QD (33.3%; P=0.010) and vehicle QD (4.3%). CONCLUSION: Berdazimer sodium (SB206) plus hydrogel was efficacious and well tolerated in the treatment of EGW/PAW. J Drugs Dermatol. 2018;17(10):1100-1105.


Assuntos
Antivirais/uso terapêutico , Condiloma Acuminado/tratamento farmacológico , Papillomavirus Humano 11 , Papillomavirus Humano 6 , Hidrogéis/uso terapêutico , Administração Cutânea , Adulto , Antivirais/administração & dosagem , Condiloma Acuminado/patologia , Condiloma Acuminado/virologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Humanos , Hidrogéis/administração & dosagem , Hidrogéis/química , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Índice de Gravidade de Doença , Resultado do Tratamento , Estados Unidos , Adulto Jovem
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