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Condyloma Acuminatum

Definition

Condyloma acuminatum or anogenital wart is a common benign viral-induced lesion.

Etiology

Types 6 and 11 human papilloma virus (HPV) are the main causative organisms of the disease.

Main Clinical Features

The lesions are usually found on the anogenital area and rarely in the oral mucosa. Oral condyloma acuminatum may result from autoinoculation from anogenital lesions or during orogenital contact.

Oral Lesions

•Single or multiple small sessile or pedunculated painless nodules with cauliflower surface

•The lesions have normal or whitish color

•Lip and buccal mucosa, gingiva, and palate are the sites of predilection

Anogenital Lesions

•Discrete or multiple, sessile or pedunculated. exophytic, small nodules with cauliflower-like appearance

•Lesions may have whitish or brown color

•Size varies from 1-5 mm to several cm in diameter

Diagnosis

Biopsy and histopathologic examination confirms the diagnosis. In-situ hybridization may be useful in difficult cases.

Differential Diagnosis

•Verruca vulgaris

•Papilloma

•Verruciform xanthoma

•Focal epithelial hyperplasia

•Sialadenoma papilliferum

•Molluscum contagiosum

•Focal dermal hypoplasia syndrome

•Early verrucous carcinoma

Treatment

Basic Guidelines

•There is no specific antiviral therapy.

•The treatment of oral lesions should be followed by the treatment of anogenital lesions. if present.

•The oral lesions rarely recur.

•The treatment of anogenital warts must be provided by a dermatologist.

Suggested Therapies

•Conservative surgical excision of oral condyloma acuminatum is the treatment of choice—the procedure is quick and safe.

•Electrosurgery, cryotherapy, or CO₂ laser may be used as alternative therapeutic measures for the treatment of oral lesions.

•Anogenital lesions are treated with a) cytotoxic agents, b) physical procedures, and c) immunomodulatory agents.

Future Therapies

Prophylactic vaccination.

References

Coremans G, Margaritis V, Snoeck R, et al. Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. Dis Colon Rectum 2003;46:1103–1108.

Garland SM. Imiquimod. Curr Opin Infect Dis 2003;16:85–89.

Gunter J. Genital and perianal warts: New treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003;189(suppl 3):S3–11.

Smith KJ, Harnza S, Skelton H. The imidazoquinolines and their place in the therapy of cutaneous disease. Expert Opin Pharmacother 2003;4:1105–1119.

Stanley MA. Progress in prophylactic and therapeutic vaccines for human papillomavirus infection. Expert Rev Vaccines 2003;2:381–389.

Tsambaos D, Georgiou S, Monastirli A, et al. Treatment of condylomata acuminata with oral isotretinoin. J Urol 1997;158:1810–1812.