Treatment of cutaneous and genital warts in immunocompromised patients
Keywords:
Human papillomavirus, Warts, Immunocompromised, immunosuppression, Solid organ transplantAbstract
Immunocompromised patients are usually more predisposed to widespread resistant wart lesions and have higher risk of relapse and malignant transformation of untreated lesions. In this review, we decided to evaluate the treatment of cutaneous and genital warts in immunocompromised patients. We searched Pubmed, Medline, Web of Science, and Google Scholar with related keywords. Inclusion criteria were articles that evaluated efficacy of different treatments on cutaneous or genital warts in immunocompromised patients since January 2010 to September 2023. Eventually, 30 articles were chosen for this review. Based on literature review, the most common treatment approaches were replacement/dose reduction of immunosuppressive drugs and immunotherapy methods. Combination of destructive methods (such as lasers) with antiproliferative therapies (such as cidofovir, retinoids and podophyllotoxin) can lead to superior results. Surgical excision especially is recommended in patients with giant condyloma acuminata. Administration of oral retinoids, cidofovir (topical or intralesional) and topical imiquimod should be precluded in renal transplant recipients or patients with impaired renal function. Replacement of traditional immunosuppressive drugs with novel immunomodulators such as sirolimus and leflunomide can be the first step against widespread recalcitrant lesions in immunocompromised patients. Intralesional immunotherapy can be recommended as the first-line of therapy in immunosuppressed patients with resistant warts.References
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