What is the first line of treatment for penile papilloma warts?

From the Guidelines

The first line of treatment for penile papilloma warts is typically patient-applied topical medications, with imiquimod 5% cream or podofilox 0.5% solution being common first choices. The treatment for penile papilloma warts, caused by human papillomavirus, can vary depending on the patient's preference, available resources, and the healthcare provider's experience 1. Some key treatment options include:

• Imiquimod 5% cream applied three times weekly for up to 16 weeks 1
• Podofilox 0.5% solution or gel applied twice daily for 3 days, followed by 4 days of no treatment, with this cycle repeated for up to 4 weeks 1
• Cryotherapy with liquid nitrogen applied every 1-2 weeks until warts resolve 1
• Trichloroacetic acid (TCA) 80-90% solution carefully applied to warts weekly 1 These treatments work by either directly destroying the wart tissue or by stimulating the immune system to fight the HPV infection. Treatment choice depends on wart location, number, size, and patient preference. Multiple treatment sessions are often required, and recurrence is common as these treatments address the warts but not the underlying viral infection. Patients should also be screened for other sexually transmitted infections, and sexual partners should be informed about potential exposure. It's essential to note that the safety of some treatments, such as podofilox and imiquimod, during pregnancy has not been established 1.

From the FDA Drug Label

1. 6 Patients Being Treated for External Genital Warts Dosing is 3 times per week to external genital/perianal warts. Imiquimod Cream treatment should continue until there is total clearance of the genital/perianal warts or for a maximum of 16 weeks. The first line of treatment for penile papilloma warts is Imiquimod Cream, applied 3 times per week, as stated in the drug label 2.

• The treatment should continue until total clearance of the warts or for a maximum of 16 weeks.
• It is recommended to wash the treatment area with mild soap and water 6-10 hours after application.
• Local skin reactions such as erythema, erosion, excoriation/flaking, and edema are common at the site of application or surrounding areas.

From the Research

Description of Dermatology of Papilloma Wart in Penile Area

• Papilloma warts in the penile area are caused by the human papillomavirus (HPV), specifically types HPV-6 and HPV-11 3.
• These warts typically present as asymptomatic papules or plaques, and may be filiform, exophytic, papillomatous, verrucous, hyperkeratotic, cerebriform, fungating, or cauliflower-like in appearance 3.
• Approximately one-third of penile warts regress without treatment, with an average duration of approximately 9 months before resolution 3.

First Line of Treatment for Penile Papilloma Warts

• The first line of treatment for penile papilloma warts includes patient-administered therapies such as podofilox (0.5%) solution or gel, imiquimod 3.75 or 5% cream, and sinecatechins (polypheron E) 15% ointment 3.
• Clinician-administered therapies include podophyllin, cryotherapy, bichloroacetic or trichloroacetic acid, oral cimetidine, surgical excision, electrocautery, and carbon dioxide laser therapy 3.
• Imiquimod cream has been shown to be effective in treating cutaneous warts, with a combined rate of complete response to therapy of 44% in immunocompetent patients 4.
• A randomized controlled trial comparing imiquimod and podophyllotoxin creams found similar efficacy for wart clearance, but with a wide confidence interval 5.

Treatment Options and Considerations

• The choice of treatment method should depend on the physician's comfort level with the various treatment options, the patient's preference and tolerability of treatment, and the number and severity of lesions 3.
• The comparative efficacy, ease of administration, adverse effects, cost, and availability of the treatment modality should also be taken into consideration 3.
• No single treatment has been shown to be consistently superior to other treatment modalities, and patients who do not respond to first-line treatments may respond to other therapies or a combination of treatment modalities 3.