Terapia

Therapy
Olivier AYNAUD1 Marc BUFFET1 Philippe ROMAN1 Françoise PLANTIER2 Nicolas DUPIN1
1

Eur J Dermatol 2008; 18 (2): 153-8

Department of Dermatology and Venereology, Pavillon Tarnier, Hôpital Cochin, APHP, 89 rue d’Assas, 75006 Paris, France 2 Department of Pathology, Pavillon Tarnier, Hôpital Cochin, APHP, 89 rue d’Assas, 75006 Paris, France

Study of persistence and recurrence ratesin 106 patients with condyloma and intraepithelial neoplasia after CO2 laser treatment
Our aim was to evaluate remission and relapse rates and the number of laser sessions necessary for treatment. Among the relapses observed, we sought to differentiate between the persistence and recurrence of an HPV-induced lesion. This retrospective study was performed in patients, immunocompetent or not,treated with CO2 laser for condylomatous or neoplastic anogenital lesions by the same operator over a period of 12 months. 106 treated patients were followed for 6 months. Three groups of patients were analysed: HIV(+) patients, patients with therapeutic immunosuppression (ImST) and immunocompetent patients (ImC). Twenty-seven (25.5%) patients presented with high-grade intraepithelial neoplasms (IENIII). IEN III lesions were more common in the HIV(+) group than in immunocompetent patients (47.4% versus 20.2%, p = 0.015). The development of HPV-induced lesions at several sites on the body was also more common in HIV(+) patients. Post-laser controls at one month demonstrated a clinical absence of HPV-induced lesions in 81.2% of cases, recurrence in 12.6% of cases and persistence in 6.6% ofcases. Remission rates at one month did not differ significantly between the three groups. 93% of patients in remission at one month were still in remission at three months. IEN III neoplasms in remission at one month remained so at six months. ImC and ImST patients presented more frequently with recurrence than persistence, when compared with HIV(+) patients. At six months, 83% of patients were inremission after 1.4 laser treatments. The excision of HPV-induced anogenital lesions using CO2 laser remains an efficient treatment, even if it needs to be repeated if lesions recur or persist. CO2 laser treatment under colposcopic guidance can achieve remission in both immunocompromised and non-compromised patients with longstanding lesions. Key words: condyloma, intra-epithelial neoplasia, laser,HPV, papillomavirus, persistence, recurrence

Reprints: O. Aynaud

Article accepted on 6/10/2007

doi: 10.1684/ejd.2008.0353

uman papillomavirus (HPV)-induced anogenital lesions are the expression of one of the most common sexually transmitted infections (STI). In the United Kingdom, the prevalence of anogenital condylamatosis is estimated at between 4% and 13% among patients attendingvenereal disease clinics [1], with a consistently increasing annual incidence [2]. In the USA in 1997, the prevalence of HPV-induced clinical lesions was approximately 1% in sexually active adults, and 15% of adults suffered from an infra-clinical infection detected by DNA screening for HPV [2]. In the United States, the incidence of high-grade vulvar intraepithelial neoplasia (VIN III) is estimatedat 4.5 per 100,000 women aged 35 to 54 years [3]. In the Ile-deFrance region around Paris, the incidence of high-grade penile intraepithelial neoplasia (PIN III) is estimated at 3.3 per 100,000 in the male population aged 20 to 60 years, and
EJD, vol. 18, n° 2, March-April 2008

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3.9 per 100,000 for VIN in females in the same age group [4]. These epidemiological evaluations demonstrate theimportance of efficiently treating HPV-induced anogenital lesions. Numerous therapeutic methods have been proposed, adapted either as a function of the clinical appearance of lesions, or their surface area, or their site. No method can achieve a cure in 100% of cases. Of these treatments, CO2 laser is proposed with a remission rate which ranges from 27% to 94%, and a relapse rate of between 7%...