Introduction

Cutaneous infections caused by human papillomavirus (HPV) are usually recurrent and are among the most troublesome conditions presenting to dermatologists.

HPV causes a myriad of infectious lesions, out of which common warts are the most prevalent. Warts are usually self-limiting but spontaneous resolution may take months to years. Spontaneous clearance rates are also painfully low (23% at 2 months, 30% at 3 months and 65-78% at 2 years), hence underlining the need for intervention.[1] The fact that they can recur even after complete physical removal makes them extremely frustrating both for the patient and the physician. Recalcitrant warts may reflect a localized or systemic cell-mediated immune (CMI) deficiency to HPV. Various reasons like lack of production of memory T cells to target HPV infection, failure of clonal expansion of lymphocytes to adequate stimulation, inability of T lymphocytes to traffic to sites of infection and weak effector response mechanism have been hypothesized.[2] Consequently, warts are particularly exuberant in patients with Hodgkin’s disease, AIDS and those on immunosuppressants.

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Genital warts pose an even bigger challenge to dermatologists. Firstly, because of the reluctance of patients to consult a physician, and secondly, because of their propensity to relapse. Individuals with frequent relapses suffer a substantial psychological morbidity. Thus, drugs with immune-stimulating properties are potentially useful agents in them.

Many modalities of treatment are in use; most of the provider-administered therapies are destructive and cause scarring, such as cryotherapy, chemical cauterisation, curettage, electrodessication and laser removal. Most patient-applied antimitotic agents like podophyllotoxin have the risk of application-site reactions such as erythema, edema and ulceration. Recurrence rates are also high due to the possibility of some microbial organisms remaining after physical destruction of the visible lesions. Recurrence rates of warts up to 30% have been reported with cryotherapy, probably due to a lack of immune response. Thus, immunotherapy is a potential logical modality which could lead to resolution without any physical changes or scarring and in addition would augment the host response against the causative agent, thereby leading to complete resolution and decreased recurrences. Though many immunomodulators have been tried, none of them has been found to be ideal, due to inadequate sample sizes in studies, impracticality of use, adverse effects or limited efficacy.[3] Hence, the search for the ideal drug still continues! Table 1 lists the various agents that have been tried as immunomodulators in the treatment of warts. However, the treating physician must remember that none of the treatments discussed in the review are FDA approved (except Polyphenon – E) for the treatment of warts.

Source: https://t-tees.com
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