Authored by Yang Meng
A 3-year-old female presented with neoplasms on the perianal for1 month.
Physical examination: Multiple needle tips appearing around the anus to millet size. A few vegetations are seen at the vaginal opening. Human papilloma virus (HPV).
Typing: HPV51 positive. HIV, TPPA, and RPR tests were negative.
Histopathology of skin lesions: hyperkeratosis of the epidermis with incomplete keratosis, hyperplasia and hypertrophy of the spinous layer, papilloma-like hyperplasia, vacuolated cells seen above the spinal layer.
Diagnosis: Condyloma acuminatum.
Treatment: 4 times of photodynamic therapy was ineffective, HPV-51 continued to be positive, and then switched to the Chinese medicine Paiteling three-stage therapy. No new warts were found after follow-up for 1 year, and the HPV-51 turned negative.
Introduction
Condyloma acuminata (CA), or anogenital verrucae, is a common sexually transmitted disease associated with human papilloma virus infection. It is principally transmitted through sexual intercourse and frequently occur in adolescents or adults. In the last decades, cases of CA in children gradually have increased that may be related to sexual abuse, vertical transmission and close contact with infected individuals. Guidelines for the treatment of CA in adults are available in the United States, but little has been published about the treatment in children [1]. At present the treatment options include destructive therapies such as cryotherapy and trichloroacetic acid, surgical excision, and topical modalities such as podophyllin, imiquimod, and sinecatechins [2]. But we know little about the safety and efficacy of these therapies in preadolescent children, there are not a consensus treatment guidelines of CA in children. The clinical treatment be directed based on the specific symptoms included the size, location and number of lesions. Paiteling is a pure traditional Chinese medicine preparation that has been used for the treatment of HPV infections in recent year [3]. Here, we report a case of refractory condyloma acuminata in a child treated with paiteling successfully.
Case Report
A 3-year-old female was admitted to our department with hyperplasia on the perianal for 1 month on June 12, 2018. A month ago, the mother of the child found several papules of needle-tip size around the anus when bathing her, without any special discomfort such as pruritus and pain. She did not pay attention to them. Later papules gradually increased and enlarged. She applied ointment such as “Dacron Cream” on her own, but there on any regression. The child’s skin lesions kept increasing, so she came for diagnosis and treatment. There is nothing special about past and personal history. There was no similar lesions on her family members. The child often plays in public swimming pools recently.
systematic physical examination showed no abnormality. Dermatological conditions found multiple needle-tip to millet size light pink hyperplasia around the anus and which were soft quality and partial fusion. A few vegetations were seen around the vaginal opening (Figures 1&2). Laboratory examination revealed the acetic acid white test was positive. Human papillomavirus test showed that HPV51 was positive and HPV11, HPV16, HPV18, etc. were all negative. No abnormality was found in blood, urine, stool, HIV, TPPA and RPR examination. The histopathology of the skin lesions showed hyperkeratosis of epidermis with parakeratosis, acanthosis, papillomatosis and vacuolated cells in the upper part of stratum spinosum (Figures 3&4). The histopathological diagnosis was condyloma acuminata.
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