Case presentation ORAL ISOTRETINOIN IN THE TREATMENT OF LARGE BENIGN CONDYLOMA ACUMINATA

ORAL ISOTRETINOIN IN THE TREATMENT OF

LARGE BENIGN CONDYLOMA ACUMINATA OF
ANOGENITAL AREA – A CASE REPORT
https://doi.org/10.26574/rojced.2017.4.4.214

Cikim Ahu Çiler1, Duysak Sibel2, Terzi Erdinç3

1
Department of Dermatology, Istanbul Aydın University, School of Medicine, Istanbul, Turkey
²Department of Dermatology, Biruni University, School of Medicine, Istanbul, Turkey
³Department of Dermatology, Istinye University, Liv Hospital, Istanbul, Turkey

Corresponding author:
Dr. Erdinç Terzi,
Department of Dermatology, Istinye University,
Liv Hospital, Suleyman Demirel Street, No 1,
Esenyurt, Istanbul, Turkey
Tel.: 00905382667840
E-mail: erdincterzi@yahoo.com
Open Access Article

Abstract
Condyloma acuminata is a gross, exophytic cutaneous lesion most
Keywords: commonly occurring in the anogenital region. It is caused mostly by sexually
transmitted human papilloma virus. Genital human papilloma virus infection
is the most common sexual transmited disease worldwide and a leading
condyloma acuminata, cause of mortality among young women. Conventional topical therapy is
oral isotretinoin, generally ineffective, in large and extensive lesions, whereas a wide and
large benign sometimes mutilating surgical excision is necessary in many cases.
Condyloma acuminata. We aim to present the case of a 26 year-old HIV-negative woman presenting
with a four-month history of large benign Condyloma acuminata on the
anogenital area, which has been treated successfully with oral isotretinoin
Cite this article:
Cikim Ahu Çiler, Duysak Sibel, Terzi Erdinç. Oral without surgery. As a result, low dose oral isotretinoin monotherapy may
isotretinoin in the treatment of large benign represent an efficacious, safe, fairly well tolerated, noninvasive and cost
condyloma acuminata of anogenital area – a case effective alternative systemic therapy for anogenital Condyloma acuminata.
report. RoJCED 2017;4(4):214-216
https://doi.org/10.26574/rojced.2017.4.4.214
https://doi.org/10.26574/rojced.2017.4.4.214

Introduction Case report

Condyloma acuminata is a gross, exophytic cuta-
neous lesion most commonly occurring in the ano-
genital region. It is caused by sexually transmitted
human papilloma virus (HPV). Benign condyloma
are usually caused by HPV types 6 and 11, whereas
HPV types 16, 18, 31 and 33 are often found in le-
sions with neoplastic transformation (1). Genital
HPV infection is important because of its high inci-
dence and prevalence, but also because of its as-
sociation with cervical cancer. The latter is the most
common malignancy worldwide and a leading
cause of mortality among young women (2). Con-
ventional topical therapy is generally ineffective in
large and extensive lesions, whereas a wide and
sometimes mutilating surgical excision is necessary
in many cases.
A 26 year-old HIV-negative woman presented
with a four-month history of Condyloma acuminata
on the anogenital area, which had not been treated
before. The patient had no history of any internal
disease or immunosuppressive medication.
In the anogenital region, a soft, verrucous, cauli-
flower-like shaped, vegetative mass of 16 x 5 cm
in diameter was observed (Fig. 1A). There were no
palpable regional lymph nodes. There was no evi-
dence of invasion to suggest anal sphincter involve-
ment. The other systems were normal.
Routine laboratory tests, including complete
blood count, blood chemistry, immunological and
serological investigations [tests for hepatitis A, B, C,
HIV, herpes simplex virus type 1, 2 (HSV), syphilis,
Epstein-Barr virus and Cytomegalovirus] were ne-

214 R O M A N I A N J O U R N A L o f C L I N I CA L a n d E X P E R I M E N TA L D E R M ATO LO GY

Figure 1A. So , verrucous, broccoli like shaped,
vegeta ve mass on the anogenital area
Figure 1B. A er two months treatment
Figure 1C. Complete remission a er five months
treatment
gative. Papanicolau smear was within normal limits.
HPV type 6 was identified with Polymerase Chain
Reaction (PCR). Candida was positive in vaginal
Cikim Ahu Çiler, Duysak Sibel, Terzi Erdinç
discharge with potassium hydroxide (KOH) exami-
nation, and fluconazol treatment was given 150 mg
once a week for two weeks. Bacteriuria was found in
the urine analyses and the urine culture was posi-
tive for E. coli. Ciprofloxacin was given 500 mg twice
daily for a week.
Colposcopy and proctoscopy did not detect any
HPV lesions in the genital and gastrointestinal trac-
tus. There was no evidence of invasion, dysplasia
or malignant transformation on histopathological
examination of the biopsy specimen. Histological
examination of skin biopsy specimens and clinical
features of the lesion established the diagnosis of
large benign condyloma acuminatum.
We decided to start a treatment with oral isotreti-
noin. The patient gave her written consent and re-
ceived treatment with 0.5 mg/kg/day isotretinoin.
No other topical or systemic medication were ad-
ministered during the treatment period. The pa-
tient was advised against pregnancy. Toxicity was
monitored on a monthly basis, both clinically and
through laboratory tests, which included complete
blood counts, renal and hepatic parameters and
lipidic profile. Two months after the onset of the
treatment there was an impressive regression of the
lesions (Fig. 1B) and a complete remission has been
achieved after five months of continuous treatment
(Fig. 1C).
Discussion
Condyloma acuminata is a disease in which HPV
is active and shows epithelial overgrowth. It is most
commonly seen in the genital, anal, and perianal re-
gions. It has an incidence rate of 0.1% in the general
population (3).
The mechanism through which retinoids exert
their beneficial effect in HPV infection remains un-
known. It has been suggested that retinoids may
have some immunomodulatory activity (4). The
hallmark of HPV infection is epithelial hyperplasia
and retinoids have an endogenous antiproliferative
effect. It has been proposed that the retinoids, by
altering keratinisation, are able to inhibit viral repli-
cation and assembly, which requires keratinocytes
in an advanced rate of differentiation (1). An inverse
relation was observed between concentration of
retinoids and HPV-DNA within infected epithelial
cells, suggesting a downregulation of viral replica-
tion by retinoids (5). Retinoids have been shown to
induce regression of cervical dysplasia as well as to
be effective against skin and cervical cancer (6).
Conventional therapies for HPV infection are
often associated with unsatisfactory response
rates and high recurrence rates. The use of a sys-
temic agent may control the virus more effectively.
Some studies regarding isotretinoin monotherapy
have shown promising results. Georgala et al. re-
ported that 32.1% (9 of 28) of the women treated
with isotretinoin achieved complete clearing on
4/December/2017 215
Case presentation ORAL ISOTRETINOIN IN THE TREATMENT OF LARGE BENIGN CONDYLOMA ACUMINATA
0.5 mg/kg/day (2) and Tsambaos et al. demon-
strated a 37.5% (21 of 56) complete clearing rate in
men on 1 mg/kg/day (7). In this case, we decided to
use oral isotretinoin treatment for several reasons,
including high incidence of recurrence, complica-
tions, concern of cosmetic results in large lessions
after surgery, and cost effectiveness.
In this case, we saw a efficacy with isotretinoin in
anogenital Condyloma acuminata. Because of its
teratogenic effect, selection of patients for the treat-
ment and strict contraceptive measures are of cru-
cial importance.
In conclusion, low dose oral isotretinoin mono-
therapy may represent an efficacious, safe, fairly
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Conflicts of interest: none declared.
Financial disclosure: none declared.
Patient consent obtained.
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