附近機構
研究表明：派特靈對于祛除尖銳濕疣和清除不同亞型HPV感染有較好的治療效果。稀釋后的派特靈可以長期使用，能有效的清除周圍潛伏的HPV感染，從而提高臨床療效。
Introduction
Condyloma acuminatum (CA) is a sexually transmitted disease that is caused by human papillomavirus (HPV),and the main clinical manifestation is verrucous hyperplasia (Park et al,2015;Imbernón-Moya et al,2017). More than 100 subtypes of HPV have been identified,of which approximately 40 subtypes can cause infection and pathogenicity.According to the differences in the chances of the different HPV genotypes inducing genital tract malignant tumors, HPV viruses are generally classified into low-risk types, such as types 6 and 11,and high-risk types,such as types 16 and 18 (Kaliterna et al, 2018).There are many clinical treatments for condyloma acuminatum,such as microwave therapy,laser therapy and photodynamic therapy,but the treatment effects of eliminating latent HPV infections and preventing recurrences are not ideal (Mistrangelo et al,2018;Nucci et al,2010;Ying et al,2013).Paiteling is a traditional Chinese medicine with a certain antimicrobial activity.We used external applications of Paiteling in this study to treat 100 condyloma acuminatum patients and detected the HPV subtypes,after which we explored the clinical efficacy.
Materials and methods
One hundred patients with cases of condyloma acuminatum that were diagnosed by the Department of Dermatology and Venerology in our hospital from 2017 to 2018 were selected as the treatment group,which included 60 males and 40 females who were aged from 16- to 60-years-old. Their disease courses ranged from one to 24 months,and the numbers of cases in the balanic foreskin, vulva, perianal and anal canal regions were 48, 40, 25,and 20, respectively.
All of the condyloma acuminatum patients were treated with Paiteling (Beijing Paite Biotechnology Limited Company, China), and the treatment methods were performed according to the instructions. The initial treatment dose consisted of a crude solution for the first week at twice a day for 15 minutes and for three consecutive days of treatment. Afterwards, the treatment regimen was adjusted according to the skin reaction after the first week of treatment; 4% diluents were used in the second week at once or twice a day for 15 minutes, and this regimen continued for the next four weeks. The patients were told to avoid water contact on the treatment areas within the first week. All of the patients had follow-ups for 6 months.
With the use of the polymerase chain reaction (PCR) technique, cells that were acquired from all of the skin lesion sites were examined for definitions of HPV infections or the HPV subtypes before the first treatment and at 6 months after the last round of treatment. (Guangzhou Sai Xun Biological Technology Company, China).
Experimental results
Before the administration of the external Paiteling therapy, the numbers of cases of low-risk, high-risk and mixed types of HPV were 40, 35 and 25, respectively.
One hundred condyloma acuminatum patients completed five weeks of treatment. The therapeutic evaluation was based on the clinical outcomes both before and after 6 months of follow-up, as well as whether the HPV virus was determined to be negative or not (Figure 1). Ninety-two of the patients were clinically cured and exhibited no recurrence, and eight exhibited improvements but recurrences after follow-ups for 2 to 3 months.The incidences of HPV virus were reexamined after 6 months of follow-ups. Ninety of the clinically cured patients exhibited negative indications, two of the patients were determined to be positive for HPV and eight recurrence patients were still demonstrated to be positive for HPV. Six months after treatment, the numbers of negative cases of low-risk, high-risk and mixed types of HPV were 38,32 and 20,respectively (Table 1). There was no statistical difference among different HPV subtypes in clinical outcomes and HPV clearance (P>0.05).
During the course of the treatment, 10 patients presented with erythema edema and erosion to different degrees, especially in the perianal conditions, with 15 patients presenting with differences in the levels of pain(5 of these patients received analgesics one to two times)and 5 patients presenting with foreskin acrobystia edema.All of the adverse reactions disappeared within 5 days after the spraying of Jieyoushen and compound polymyxin B ointment for external use. No serious adverse reactions were observed,and none of the treatments had to be discontinued.
Table 1 Clinical efficacy of Paiteling in the treatment of condyloma acuminatum
Discussion
Condyloma acuminatum is a common sexually transmitted disease, with the main clinical manifestations including proliferative lesions in the genital and vulvar regions caused by HPV infections(Park et al, 2015; Imbernón-Moya et al, 2017).
Recurrence is one of the characteristics of the disease, which is mainly related to the different subtypes of HPV, the long latency of HPV,reinfection with HPV, self-vaccination and the subclinical infections of HPV (Kaliterna et al, 2018;Cong et al,2016).
Studies have demonstrated that HPV infections may exist in the skin or in the mucosa around the warts(Nadarzynski et al,2014;Na et al,2018).
Some patients and clinicians pay more attention to the removal of the warts that have grown outwards, and they will neglect the timely removal of the HPV infection around the warts, which can easily lead to recurrence.
Therefore, the treatment of condyloma acuminatum has gradually changed from the removal of the warts to the removal of the warts and the prevention of recurrence.
Paiteling is a pure traditional Chinese medicine preparation that has been used for the treatment of HPV infections in recent years.
It has strong permeability and can quickly cross the epidermal cell space to reach the basal layer of the epidermis without damaging the dermis and the subcutaneous tissue (Tao et al,2017).
Paiteling may promote the exfoliation of the epidermal cells in condyloma acuminatum and its surrounding potential viral areas by accelerating the metabolism of the epidermal cells;
thus,the HPV virus can be completely eliminated with the exfoliation of the cells(Zhang et al, 2017).
Previous studies showed that paiteling can accelerate the clearance of HPV infection and the regression of cervical lesions (Tao et al, 2017).
In this study, Paiteling was applied for the treatment of condyloma acuminatum. The HPV infection was checked 6 months after the end of the treatment, and the clinical efficacy and negative conversion rate of HPV were observed.
The results demonstrated that Paiteling was effective in treating condyloma acuminatum and in clearing HPV of the different types of infection.
This may be related to the treatment with Pateling.The diluted Pateling can be used for a long period of time, which can more effectively remove latent HPV infections from surrounding tissues, thus improving the clinical efficacy and HPV clearance rate.
The limitation of this study is that the number of cases that were observed is small, and the possible mechanisms of the treatment has not been simultaneously studied.
References
Park IU,Introcaso C,Dunne EF.(2015) Human Papillomavirus and Genital Warts:A Review of the Evidence for the 2015 Centers for Disease Control and Prevention Sexually Transmitted Diseases Treatment Guidelines.Clin Infect Dis,15(Suppl 8):S849-55.Imbernón-Moya A, Ballesteros J.(2017) Initial Evaluation of the Adult Patient with Condylomata Acuminata.Actas Dermosifiliogr,108(3): 273-275.
Kaliterna V,Barisic Z.(2018)Genital human papillomavirus infections.Front Biosci(Landmark Ed),23: 1587-1611.
Mistrangelo M,Dal Conte I,Volpatto S,DI Benedetto G,Testa V,Currado F,Morino M.(2018)Current treatments for anal condylomata acuminata.Minerva Chir,73(1):100-106.
Nucci V,Torchia D,Cappugi P.(2010)Treatment of anogenital condylomata acuminata with topical photodynamic therapy:report of 14 cases and review.Int J Infect Dis,14(Suppl 3):e280-2.
Ying Z,Li X,Dang H. (2013)5-aminolevulinic acid-based photodynamic therapy for the treatment of condylomata acuminatain Chinese patients:a meta-analysis.Photodermatol Photoimmunol Photomed,29(3):149-59.
Cong X,Sun R,Zhang X,Wang Y,Wang L,Yu Y.(2016)Correlation of human papillomavirus types with clinical features of patients with condyloma acuminatum in China.Int J Dermatol,55(7):775-80.
Nadarzynski T, Smith H, Richardson D, Jones CJ, Llewellyn CD.(2014)Human papillomavirus and vaccine-related perceptions among men who have sex with men:a systematic review.Sex Transm Infect,90(7): 515-23.
Na K,Sung JY,Kim HS.(2018)Clinicopathological Characteristics of High-grade Squamous Intraepithelial Lesions InvolvingCondyloma Acuminatum.Anticancer Res,38(3):1767-1774.Tao P,Zheng W,Meng X,Chen J,Sun A,Shou Q,Wang Y,Yang B.(2017) Effect of paiteling on human papillomavirus infection of the cervix.Mol Clin Oncol,7(6):957-964.
Zhang Jing,Hu Rongying,Zhao Qianying.(2017)Clinical observation of clinical efficacy of treatment to different subtypes of HPV infected condyloma acuminata by Paiteling and microwave combined with recombinant human interferon α-2b cream.CHINESE Journal of AIDS&STD,23(11):1054-1056,1067.
Figure?legends
Figure 1.Before and after treatment with Paiteling in patients with condyloma acuminatum
Patients with condyloma acuminatum completed 4 weeks of treatment. (A) There were several neoplasms present on the foreskin before the treatment. (B) The foreskin lesions were eliminated after the treatment. (C) There were several different sizes of neoplasms on the perianal region before the treatment. (D) The perianal lesions were eliminated after the treatment. (E) The histopathological examination demonstrated parakeratosis and papillomatous hyperplasia of the epidermis(hematoxylin-eosin stain,×100). (F) The histopathological examination revealed a large number of vacuolated cells in the epidermis(hematoxylin-eosin stain,×400).
