clobetasol and Papillomavirus-Infections

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Inflammatory Agents; Candidiasis, Vulvovaginal; Clobetasol; Diflucortolone; Female; Herpes Genitalis; Humans; Middle Aged; Papillomavirus Infections; Telangiectasis; Time Factors; Vulvar Lichen Sclerosus; Young Adult

Topics: Administration, Topical; Adrenal Cortex Hormones; Adult; Aminoquinolines; Antineoplastic Agents; Carcinoma in Situ; Clobetasol; Contraceptives, Oral; Female; Humans; Imiquimod; Papillomavirus Infections; Pemphigus; Treatment Outcome; Vulvar Diseases; Vulvar Neoplasms

Using a highly sensitive polymerase chain reaction (PCR) technique, based on general GP5+/GP6+ PCR primers covering 34 different human papillomavirus (HPV) types, the presence of HPV DNA was studied in paraffin-embedded penile biopsies from 20 men treated topically with corticosteroids. Clobetasol propionate was applied for 2-16 (mean 7) weeks by 19 men (age 18-73; mean 40) with lichen sclerosus. High-risk HPV was detected prior to therapy in three patients (16%) who lacked clinical or histopathological signs of HPV infection. Following therapy high-risk HPV was detected in biopsies from four men (21%), of whom three also exhibited clinical and/or light microscopic signs of HPV infection. Low-risk HPV DNA was not detected in any of these samples. Four biopsies were collected during a 5-year period from a 51-year-old man who was treated repeatedly with topical mild-moderate potent corticosteroids at intervals of up to 10 weeks for penile erosive lichen planus, followed by nine clinical outbreaks of typical condylomas that consistently showed the presence of low-risk HPV DNA only. These observations indicate that long-lasting topical corticosteroid therapy occasionally may be associated with opportunistic reactivation of a latent high- and low-risk mucosotrophic HPV type infection. The importance of clinical follow-up is underlined.

Topics: Administration, Topical; Adolescent; Adult; Aged; Biopsy, Needle; Chi-Square Distribution; Clobetasol; Condylomata Acuminata; Culture Techniques; DNA, Viral; Humans; Lichen Planus; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Polymerase Chain Reaction; Prospective Studies; Recurrence; Risk Assessment

Treatment with clobetasol propionate 0.05% cream is effective against lichen sclerosus et atrophicus (LSA) of the vulva.. The purpose of this study was to retrospectively evaluate whether clinical and histologic responses to topical clobetasol can be accomplished in penile LSA.. A self-assessment questionnaire was obtained from 22 men with LSA, and a clinical examination was performed in 21 of them. Biopsy specimens from 15 cases were compared before and after treatment.. Itching, burning, pain, dyspareunia, phimosis, and dysuria decreased significantly (P < .001 to .05) after 1 to 2 daily applications, for a mean of 7.1 weeks (2-16 weeks). Additional operation for phimosis was required in 6 of the 22 men. All histologic LSA criteria were significantly (P < .01 to .05) reduced after treatment.. Topical treatment of penile LSA with clobetasol propionate represents a safe and effective therapy with no risk of epidermal atrophy but with some potential for triggering latent infections, most importantly human papillomavirus.

Topics: Administration, Topical; Adolescent; Adult; Aged; Anti-Inflammatory Agents; Biopsy; Candidiasis; Clobetasol; Glucocorticoids; Humans; Lichen Sclerosus et Atrophicus; Male; Middle Aged; Papillomaviridae; Papillomavirus Infections; Penile Diseases; Retrospective Studies; Treatment Outcome; Tumor Virus Infections