Argon plasma versus electrofulguration in the treatment of anal and perianal condylomata acuminata in patients with acquired immunodeficiency virus

Argon Plasma Coagulation as Treatment for Anal Condylomas: A Narrative Review

OBJECTIVES

Anal condylomas are a manifestation of anal human papillomavirus infection and can be associated with precancerous lesions and squamous cell carcinomas. Several methods have been described for treatment, including argon plasma coagulation. A narrative review of the evidence published on this topic was conducted.

METHODS

A search was conducted using PubMed, Scopus, and Web of Science databases.

RESULTS

Five studies reported on anal/perianal condyloma treatment with argon plasma coagulation. In 3 of these studies, there was a comparison with other treatment methods (addition of imiquimod, electrofulguration, and electrocautery, respectively). Argon plasma coagulation settings varied between studies. This type of treatment was effective for ablation. Recurrence rates and follow-up times varied largely between studies. No major complications, such as pain, scarring, sexual dysfunction, or severe bleeding were described.

CONCLUSION

Studies indicate that argon plasma coagulation is an effective and safe therapy for anal and perianal condylomas.

Cold atmospheric plasma applications in dermatology: A systematic review

Cold atmospheric plasma (CAP) applications can potentially lead to effective therapy for numerous skin diseases. Our aim is to systematically review the available data and map the use of CAP in dermatology. PubMed, Embase and Web of science were explored before 2020 for studies regarding the use of CAP in dermatology. A total of 166 studies were finally included. 74.1% of these studies used indirect CAP sources. Most studies used plasma jet (67.5%). Argon was the mostly used working gas (48.2%). Plasma application itself could be direct (89.2%) and indirect (16.3%). The proportion of studies with in vivo results remained 57.2%, of which most concerned direct plasma treatment (97.9%). Analyses performed indicate that CAP has been beneficial in many skin disorders. While, most CAP applications were focused on wound healing and melanoma treatment. This study provides a brief overview of CAP sources and relative medical applications in dermatology.

Effectiveness of topical and ablative therapies in treatment of anogenital warts: a systematic review and network meta-analysis

OBJECTIVE

To generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs).

DESIGN

Systematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

PARTICIPANTS

People aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation).

INTERVENTIONS

Topical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other.

OUTCOME MEASURES

Complete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence.

RESULTS

Thirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence.

CONCLUSION

Of the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other.

TRIAL REGISTRATION NUMBER

CRD42013005457.

Therapeutic effect of photodynamic therapy combined with imiquimod in the treatment of anal condyloma acuminatum and its effect on immune function

Therapeutic effect of photodynamic therapy combined with imiquimod in the treatment of anal condyloma acuminatum (CA) was investigated to explore its effect on immune function. A total of 104 patients with anal CA were randomly divided into two groups: Patients in the study group were treated with photodynamic therapy combined with imiquimod, and ii) patients in the control group were treated with recombinant human interferon α-2b cream. Clinical efficacy and immune function related indicators were compared between the two groups. After treatment for 6 weeks, the cure rate and total effective rate of study group was 53.85 and 92.31%, respectively, which were significantly higher than those of the control group (30.77 and 75.00%, P<0.05). Recurrence rate of study group was 3.85% within 6 months after treatment, which was significantly lower than that of the control group (19.23%, P<0.05). After treatment, levels of CD4⁺, CD4⁺/CD8⁺ and IFN-γ in the study group were significantly higher than those in the control group, and levels of CD8⁺, IL-4 and IL-10 in the study group were significantly lower than those in the control group (P<0.05). Photodynamic therapy combined with imiquimod in the treatment of anus CA can regulate T lymphocyte subsets and cytokine levels, enhance immune function, improve clinical efficacy, reduce recurrence rate, and have almost no side effects. Therefore, this treatment should be popularized in clinical practice.