Archive for the ‘Treatment Options’ Category

Condylox: Overview, Benefits, and Side Effects

Sunday, August 29th, 2010

Among the various types of conditions one can obtain, none are as humiliating as a wart. The odd, malformed skin bumps, although small, cause a severe amount of emotional distress. The problem only exacerbates when they are contracted in the genital region. Also known as venereal warts, genital warts are very embarrassing and has prompted scientists to create medications to eradicate or reduce their appearance and frequency; one such medication is Condylox.

Pathology: What’s a Wart?

A wart is a typically benign tumor that appears as the result of contracting a virus known as the Human Papilloma Virus or HPV. HPV is normally transmitted through open cuts or scabs on the skin, and once inside, begins to produce the tumors. In most cases, HPV is simply a cosmetic annoyance. But in rarer cases, HPV can cause certain types of cancer. In order to reduce the risk of contracting a severe case, doctors usually remove the warts with liquid nitrogen or lasers. Not only that, but there has recently been a vaccine that reduces the risk of contracting HPV.

In the case of genital warts, someone who has contracted HPV has sexual intercourse with a non afflicted partner. If unprotected, skin contact with a wart can result in the Human Papilloma Virus spreading to the genital areas. The result is warts in or near the anus, perineum, and the sexual organs.

How Does Condylox Work?

Condylox is a prescription gel-lotion that contains roughly .5% podofilox, a chemical found in rhizome tubers. Seeing that warts are simply cells reproducing at a rapid rate, the goal of the gel is to prevent the cells from dividing. The anti-mitotic agent in Condylox is podofilox, which when applied on the wart, prevents the cells from multiplying, causing them to die.

Note: Condylox is prescribed only for use on genital and perennial warts. Condylox also simply acts as a treatment for when warts appear; it is not a cure.

Benefits

Using Condylox offers a plethora of benefits. These include:

Non-invasive treatment: Instead of removing warts via freezing, electricity, or burning, all of which can be very painful, especially in the sensitive genital areas, Condylox is a simple topical gel that offers the same treatment with little pain. Not only that, but Condylox does not require one to return to their doctor to remove every wart. They must only obtain a prescription from them and visit for check-ups.

Immune Strengthening Method: Condylox appears as a simple topical cream, but when applied, the anti-mitotic chemical podofilox alerts the immune system that there are cells appearing to divide rapidly. This extra “heads up” allows the body to remove the warts quickly and reduces the amount of outbreaks one has.

Side Effects

Although Condylox appears to be the best method for treatment of genital warts, it should be noted that the medication does not work for everyone. Several side effects have known to occur from people using Condylox. These include:

-Itching
-Redness
-Burning sensations at site of application
-Headaches
-Stinging pain
-Inflammation

Fortunately these side effects are relatively mild and are usually caused by an over-application of the gel.

In rarer cases, people who are allergic to Condylox can experience more severe side effects which include:

-Rash
-Hives
-Wheezing/Difficulty breathing
-Tightness in chest
-Swollen face, throat, lips, and tongue
-Severe bleeding and irritation at application site
-Extreme burning sensation found at the application site

Note that these are very rare side effects that occur only if patient is allergic.

Imiquimod (Aldara)

Monday, February 1st, 2010

Brief Overview
Imiquimod (also known as its brand name Aldara) is used as a 5% cream for the topical treatment of Genital Warts.

Results have shown that Imiquimod helps to get rid of warts in about half the people who use it for four months. But one study found it didn’t help people who had HIV.

Imiquimod cream is supplied in single-use sachets. Each gram of the 5% cream contains 50 mg of imiquimod in a cream base. According to the US Center for Disease Control recommendations imiquimod 5% cream be applied by the patient once daily at bedtime, 3 times per week. The treatment area should be washed with mild soap and water 6-10 hours after the application. With more frequent applications (up to 3 times daily), the rate of success does not improve significantly. However, an increase in local adverse events, such as erythema, vesicle formation, ulceration, and excoriation may occur. The treatment is usually applied for up to 16 weeks, but is well tolerated for up to 32 weeks. This duration is longer than that of any other Genital Warts treatment.

Imiquimod can also help to reduce the chance of the warts coming back two to four months after you stop using it. It doesn’t seem to matter whether you use imiquimod once, twice or three times a day. It’s just as likely to work however often you use it.

Imiquimod cream can make your skin red, swollen and itchy. Using it twice a day causes more side effects than using it less often.

You shouldn’t use imiquimod if you’re pregnant.

Detailed Overview

New warts may develop during therapy, as imiquimod is not considered a cure. Recurrences appear in up to 20 % of patients. The safety of imiquimod during pregnancy is not established and thus its use is contraindicated in pregnancy.

The side effects of imiquimod are generally mild or moderate. Erythema, erosion, swelling, changes in skin color, itching, burning, pain/ tenderness, thickening/ hardening of the skin, peeling/ flaking/ scabbing/ crusting may occur with this treatment. In some few cases in which the skin reaction is severe (bleeding, formation of sores/ blisters/ ulcers), imiquimod may need to be temporarily stopped so that the skin can heal. Other side effects may include headache, loss of appetite, dizziness, diarrhea, nausea or back pain.
Imiquimod acts by stimulating a cell-mediated response against human pappiloma virus.

Efficacy and Recurrence

Several randomized controlled trials demonstrated that imiquimod 5% cream is an efficacious treatment for external anogenital warts when applied 3 times per week for up to 16 weeks. Complete clearance of warts occurred in up to 50% of patients, and recurrence rates ranged from up to 19% after 3 months and 23% after 6 months (Garland SM, 2001). Because the recurrence rates were similar at both 3- and 6-month follow-up, it appears that after 3 months, the risk of developing recurrence is low (Vexiau D, 2005). Similar results have been reported by other studies as well.

In a prospective, double-blind, placebo-controlled, clinical trial with 108 patients, imiquimod 5% cream was applied 3 times daily for up to 8 weeks. Complete wart clearance was achieved in 37% of the imiquimod treated patients and 0% of the placebo group. A 50% reduction in baseline wart area was noted in 76% of imiquimod-treated patients compared with 8% of the placebo group. For patients whose warts cleared completely, 19% experienced recurrences after a 10-week follow-up period. Side effects were predominantly mild or moderate in severity and included itching (54%), erythema (33%), burning (31%), irritation (17%), tenderness (13%), ulceration (10%), erosion (10%), and pain (8%) (Beutner, 1998).

Imiquimod 1% or 5% significantly increased the proportion of people with complete clearance and no recurrence at 10–16 weeks after treatment compared with placebo (Moore RA, 2001). In patients whose warts completely cleared, recurrence during the 10–16 weeks after the end of the treatment was similar with imiquimod 1% and placebo, but higher with imiquimod 5%.

Another study has found that imiquimod 5% cream (3 times a week for 12 weeks) significantly increased the proportion of patients with completely healed or improved genital warts compared with placebo, regardless of gender, initial wart size, duration of current outbreak of warts, previous wart treatment, and smoking status (Syed TA, 2000).

An open-label phase IIIB trial consisting of 943 patients recruited in 20 countries, imiquimod 5% cream was found to be 47.8% effective for overall complete clearance after 16 weeks of treatment. Recurrence rates at the end of 3- and 6-month follow-up were 8.8% and 23%, respectively. The sustained clearance rates after 3 and 6 months were 41.6% and 33%, respectively. The study also found that a greater proportion of female patients (75.5%) experienced complete clearance than did male patients (56.9%). (Garland 2001). Higher efficacy rates in female patients (71% – 77%) have also been reported by other investigators (Edwards L, 1998; Sauder DN, 2003). At least one adverse event was reported in 42% of patients; the majority of reactions were mild to moderate in severity. Local erythema was the most common local skin reaction, occurring in 67% of patients.

Another RCT consisting of 311 patients was randomized to 3 arms (109: 102: 100): imiquimod 5% cream, imiquimod 1% cream, or vehicle 3 times per week for a maximum of 16 weeks. Complete clearance of lesions was achieved in 50% of patients who received the imiquimod 5% cream, 21% of those who received imiquimod 1% cream, and 11% of those treated with the placebo. After a 3-month follow-up, the study found a recurrence rate of at least 1 wart in 13% of patients who receive imiquimod 5% cream. The complete clearance mean time ranged from 8 weeks for women to 12 weeks for men. Twelve weeks after the treatment was stopped, the recurrence rate of at least one wart was 13%. The side effects reported during this study included mild or moderate erythema, erosion, excoriation. (Edwards L, 1998).

In another prospective, multicenter, double-blind, RCT with 279 patients (Beutner KR, 1998), 94 patients used imiquimod 5% cream once-daily for up to 16 weeks. Complete wart clearance occurred in 52% of patients treated with imiquimod 5% cream, with 19% wart recurrence at a 3-month follow-up. These results were similar to those obtained with 3 applications per week. This regimen with 3 times per week treatment is preferable because it is associated with a lower rate of side effects. (Perry CM, 1999; Chang YC, 2005; Gupta AK, 2004).

Even in a lower concentration (3.75%) and applied daily for up to 8 weeks imiquimod was well tolerated and superior to placebo in a cohort of women with external anogenital warts. (Baker DA, 2011).

Longer duration of treatment seems to have no additional benefit. A one-month therapy with imiquimod 5% cream applied 3 times weekly in women with genital warts had similar efficacy to a 4-month treatment (Garland SM, 2001). The difference in complete clearance rates were not statistically significant (40% after 1 month and 51.6% after 4 months, p > 0.05).
Recent studies have found that imiquimod can be succesfully used even in children (Brandt HR, 2010; Masuko T, 2011).
However, in immunosuppressed (HIV-positive) patients it seems that imiquimod is less effective (Gilson, 1999).
Imiquimod 5% cream has had similar beneficial effects of GW as podophyllotoxin 0.5% solution. Also side effects were mild and comparable with both treatments (Komericki P, 2011).

Several studies have found that treatment with imiquimod 5% cream pre- or post surgical excision of warts resulted in a lower recurrence rate compared with surgery alone (Carrasco D, 2002; Kaspari M, 2002). Association of imiquimod to surgical treatment may provide long-term clearance of anogenital warts in patients for whom monotherapy is insufficient.

In conclusion, patient-applied imiquimod 5% cream is a first line topical treatment for anogenital warts that is both safe and efficacious. Further longer follow-up studied are needed to evaluate the efficacy and recurrence rate of different combination regimens.

Getting adequate treatment to take care of genital & venereal warts is very important. One of the products you will find out there is called Aldara. It is a type of topical cream that you will have to apply to the area for several days. Keep in mind that there is no cure for genital or venereal warts. Instead, you have to find a treatment that works well for you. Here is one that you may have heard of. Before you consider it though, get the facts.

Pros

There are many benefits to using Aldara to treat genital & venereal warts. This type of infection can be very itchy and painful. With the use of this medication, the itching and pain can be reduced. It can take action quickly and offer you relief. This particular medication is offered as a topical cream.

For those that take medications for various health concerns, that is important. They don’t want to risk the medication they take to treat genital & venereal warts to interfere with medications they take for other needs. This topical product is affordable too which is important. Not everyone has health insurance or has the money to pay for expensive prescriptions.

The use of Aldara can help to boost your immune system. This means that you are less likely to suffer from future outbreaks of genital and venereal warts. This is definitely a benefit because such breakouts can be very stressful as well as embarrassing.

There have been numerous studies with the use of Aldara. The findings are that it does work to help clear up genital and venereal warts for most individuals. These studies also so that there is very little risk involved with the use of this particular type of medication.

Cons- SIDE EFFECTS

Some individuals experience irritation in the genital area after they have used Aldara. For about 11% of users, there will be the development of some type of fungal infection. If you do experience that, you need to discontinue the use of Aldara right away. Make sure you consult with your doctor so that other forms of treatment can be considered. You will also need treatment to destroy the fungal infection.

Approximately 5% of people that use Aldara will develop symptoms that are very similar to the flu. However, most of the time they don’t make the connection. The symptoms should go away within a couple of days. If they don’t it is a good idea to consult with your doctor about alternative forms of treatment.

It is important to note that the use of Aldara is only to be for external warts. Don’t use it for anything that has developed inside of the body. It shouldn’t be used for anyone under the age of 12. You should only use it for the number of days your doctor tells you to. Applying too much or using it for too long can increase your chances of developing a very serious skin reaction.

It can take up to 16 weeks of use though to get the warts to clear up from a single outbreak. It can also be difficult to remember when to apply it since it should only be applied three times per week.

Consult with your Doctor

Never use Aldara for genital or venereal warts without first talking to your doctor. It isn’t a good idea to use a prescription medication given to someone else. Don’t be embarrassed to talk to your doctor about the situation and the use of this medication. Understanding the pros and cons of Aldara can help you to decide if it is a type of medication you are willing to try or not.

References

Baker DA, Ferris DG, Martens MG, Fife KH, Tyring SK, Edwards L, Nelson A, Ault K, Trofatter KF, Liu T, Levy S, Wu J. Imiquimod 3.75% cream applied daily to treat anogenital warts: combined results from women in two randomized, placebo-controlled studies. Infect Dis Obstet Gynecol. 2011;2011:806105.
Beutner KR, Tyring SK, Trofatter KF, Jr., et al. Imiquimod, a patient-applied immune-response modifier for treatment of external genital warts. Antimicrob Agents Chemother 42(4):789-94 (1998 Apr).

Beutner KR, Spruance SL, Hougham AJ, et al. Treatment of genital warts with an immune-response modifier (imiquimod). J Am Acad Dermatol 38(2 Pt 1):230-9 (1998 Feb).
Brandt HR, Fernandes JD, Patriota RC, Criado PR, Belda Junior W. Treatment of human papillomavirus in childhood with imiquimod 5% cream.An Bras Dermatol. 2010 Aug;85(4):549-53.
Carrasco D, vander Straten M, Tyring SK. Treatment of anogenital warts with imiquimod 5% cream followed by surgical excision of residual lesions. J Am Acad Dermatol. 2002;47(4 Suppl):S212-6.

Chang YC, Madkan V, Cook-Norris R, Sra K, Tyring S. Current and potential uses of imiquimod. South Med J. 2005 Sep;98(9):914-20.
Diamantis ML, Bartlett BL, Tyring SK. Safety, efficacy & recurrence rates of imiquimod cream 5% for treatment of anogenital warts. Skin Therapy Lett. 2009 Jun;14(5):1-3, 5.
Edwards L, Ferenczy A, Eron L, et al. Self-administered topical 5% imiquimod cream for external anogenital warts. HPV Study Group. Human PapillomaVirus. Arch Dermatol 1998;134:25–30.

Garland SM, Sellors JW, Wikstrom A, et al. Imiquimod 5% cream is a safe and effective self-applied treatment for anogenital warts–results of an open-label, multicentre Phase IIIB trial. Int J STD AIDS 12(11):722-9 (2001 Nov).

Gilson RJ, Shupack JL, Friedman-Kien AE, Conant MA, Weber JN, Nayagam AT, Swann RV, Pietig DC, Smith MH, Owens ML. A randomized, controlled, safety study using imiquimod for the topical treatment of anogenital warts in HIV-infected patients. Imiquimod Study Group. AIDS. 1999 Dec 3;13(17):2397-404.

Gupta AK, Cherman AM, Tyring SK. Viral and nonviral uses of imiquimod: a eview. J Cutan Med Surg. 2004 Sep-Oct;8(5):338-52.

Kaspari M, Gutzmer R, Kaspari T, Kapp A, Brodersen JP. Application of imiquimod by suppositories (anal tampons) efficiently prevents recurrences after ablation of anal canal condyloma. Br J Dermatol. 2002;147(4):757-9.
Komericki P, Akkilic-Materna M, Strimitzer T, Aberer W. Efficacy and safety of imiquimod versus podophyllotoxin in the treatment of anogenital warts. Sex Transm Dis. 2011 Mar;38(3):216-8
Masuko T, Fuchigami T, Inadomi T, Inamo Y, Hashimoto K. Effectiveness of imiquimod 5% cream for treatment of perianal warts in a 28-month-old child. Pediatr Int. 2011 Oct;53(5):764-6.
Moore RA, Edwards JE, Hopwood J, Hicks D. Imiquimod for the treatment of genital warts: a quantitative systematic review. BMC Infect Dis. 2001;1:3.

Perry CM, Lamb HM. Topical imiquimod: a review of its use in genital warts. Drugs. 1999 Aug;58(2):375-90.

Sauder DN, Skinner RB, Fox TL, et al. Topical imiquimod 5% cream as an effective treatment for external genital and perianal warts in different patient populations. Sex Transm Dis2003;30:124–128

Syed TA, Hadi SM, Qureshi ZA, Ali SM, Kwah MS. Treatment of external genital warts in men with imiquimod 2% in cream. A placebo-controlled, double-blind study. J Infect. 2000 Sep;41(2):148-51.

Vexiau D, Decuypère L, Moyse D, et al. [Efficacy and safety of 5% imiquimod cream in external genital warts: a 6 month follow-up evaluation]. Ann Dermatol Venereol 132(11 Pt 1):845-51 (2005 Nov).

Cryotherapy

Monday, February 1st, 2010

Your doctor can freeze off your warts using liquid nitrogen in a treatment called cryotherapy. You can have this treatment every one to three weeks depending on how quickly the area heals after each treatment and what happens to your warts.

Two RCTs found that cryotherapy worked about as well as treatment with acid. After six weeks of either treatment, about two-thirds of people had gotten rid of their warts.22 Warts came back in about one-third of people two months later, whichever treatment they had.

It isn’t clear whether cryosurgery works better than using an electrical current (electrosurgery) to get rid of the warts.

Cryotherapy can sometimes cause an infection, but this is rare.

It is safe to have cryotherapy if you’re pregnant.

CRYOTHERAPY

Cryotherapy is a procedure to treat anogenital warts by freezing. It involves application of nitrous oxide or liquid nitrogen (-196°C) to warts. This very low temperature induces dermal and vascular damage and edema, leading to cellular necrosis in both epidermal and dermal layers of the skin.
Discomfort of the procedure is mild, so anesthesia is not needed. However, a mild topical pain reliever may be administered before the procedure. There are several ways to perform cryotherapy. Liquid nitrogen can be poured into a container with a long, pointed device (cryoprobe). It is then sprayed directly onto the wart. Liquid nitrogen can also been applied with a cotton-tipped swab. Either way, freezing of the wart is done for 10-60 seconds, until it is completely covered with ice. A halo of the surrounding tissue is common. The subsequent thaw is followed by cell death. Treated area dries up and falls off in several days or weeks. If necessary, the freezing and thawing cycle can be repeated several times, although trials have not established the optimal number of applications. This depends on the size of the wart and the area being affected.
Cryotherapy causes little scarring after re-epithelialization. The treatment does not have systemic side effects and only affects tissue to which it is directly applied. Color changes may occur, but they are usually short term.
Efficacy and Recurrence
Cryotherapy was applied in a trial to 64 patients, using a fine needle-spray technique (Damstra RJ, 1991). Warts resolved in 83% within 4 weeks and 96% after 6 weeks. The results were significantly better compared with the control group of 70 patients (13% and 45% after 4 weeks and 6 weeks, respectively). Other studies have found clearance rates of 54-88 % and recurrence rates of 21-40 % (Handley JM, 1991; Eron LJ, 1993; Abdullah AN, 1993; Godley MJ, 1987). ). Most warts cleared with fewer than three treatments. It has been suggested that the recurrence occurs often at sites of previous GW, as a result of the reactivation of virus (Ho GY, 1998). Conversely, if the tissue containing the virus is completely destroyed, the risk of recurrence on the same site is much less. Recurrences in other sites may be explained by re-exposure to HPV or from reactivation of a latent virus.
It seems that cryotheraphy is as effective as trichloroacetic acid (TCA) or podophyllin in terms of clearance rates.

Two trials found no significant difference between trichloroacetic acid and cryotherapy in wart clearance after 6 or 10 weeks of treatment (Abdullah AN, 1993; Godley MJ, 1987). The success rates at 6 weeks were: 21/33 (64%) with trichloroacetic acid v 37/53 (70%) with cryotherapy, RR 0.91, 95% CI 0.67 to 1.25. At 10 weeks the rates were: 43/49 (88%) with trichloroacetic acid v 46/57 (81%) with cryotherapy, RR 1.08, 95% CI 0.92 to 1.24). One of the studies found no significant difference in recurrence at 2 months after the end of 10 weeks of treatment (36% with trichloroacetic acid v 39% with cryotherapy; RR 0.91, 95% CI 0.51 to 1.61) (Godley MJ, 1997).
A randomised, double-blind, multicentre controlled trial (Gilson RJ, 2009) has found that initial combination of 0.15 % cream podophyllotoxin and cryotherapy may be more beneficial in some patients, compared with cryotherapy alone, although overall the clearance rates were similar in both groups. By intention-to-treat analysis, clearances at 4 and 12 weeks were higher in the combination group than with cryotherapy alone, although not statistically significant (RR 1.31, 95% CI 0.95 to 1.81). By week 24 there was no difference between the groups (68.6% and 64.3%, respectively; RR 1.07, CI 0.84 to 1.35). Wart clearance was significantly higher in men (p = 0.001) and those with a past history of warts (p = 0.009) at week 4, but these differences were not longer noted at week 12. The group receiving cryotherapy alone was more prone to relapse.
Two trials compared cryotherapy plus interferon (IFN) injection versus cryotherapy alone. Subcutaneous IFN alpha 2a combined with cryotherapy was no more effective than cryotherapy alone in the treatment of GW (Handley JM, 1991). At 8 weeks 60.7% (17/28 patients) of the IFN group and 67.9% (19/28 patients) of the placebo group were clinically wart-free (not statistically significant); at 12 weeks, the differences between the 2 groups were, again, not significant. Similar response rates were not influenced by gender. In patients cleared of warts at 8 weeks, the recurrence rate at three months was 50% (8/16) and 37.5% (6/16) in the IFN and placebo groups respectively (not significant). Systemic side effects were significantly more common in the IFN than in the placebo group, 50% versus 10.7% of patients (p < 0.01). The presence of multiple warts and perianal/anal canal warts were factors of adverse prognostic. Recurrence of GW following cryotherapy seems not to be prevented by systemically administered interferon (Eron LJ, 1993). A number of 49/97 patients with recurrent GW were treated with cryotherapy plus subcutaneously administered interferon alpha-2a. The rest (48 patients) received cryotherapy plus placebo. The recurrences occur in 10 (28%) interferon recipients and 16 (43%) placebo recipients by completion of IFN therapy. At six months follow-up, 25 (69%) interferon and 27 (73%) treated patients experienced recurrences. In a single blind study, 42 male patients with ano-genital warts were randomly allocated to either cryotherapy or electrocautery. Patients undergoing cryotherapy required a mean of 2-6 sessions, while those receiving electrocautery required a mean of 1-4 treatments. There was no significant difference in wart clearance at 3 month follow-up between cryotherapy and electrosurgery (10/18 [56 %] with cryotherapy v 10/24 [42%] with electrosurgery; RR 1.33, 95% CI 0.71 to 2.50). Cryotherapy was qualitatively much more acceptable to the patients, as it did not require injections of local anesthetic. This treatment seems particularly suited to patients with widely scattered warts who are unable to attend for regular treatment. (Simmons PD, 1981). A recent study (Mi X, 2011) has found that cryotherapy plus photodynamic therapy may be more efficient than cryotherpay alone in treating GW. After two treatments, the complete response rates in the combined group were 32.4% (36/111) and 32.6% (43/132) in the cryotherapy group. The recurrence rates in the combined group and cryotherapy group were 24.3% (27/111) and 31.1% (41/132). The adverse effects in each group included mild to moderate pain, edema, erosion and skin discoloration. Cryotherapy for treatment of GW was safely and successfully used in pregnant women. (Bergman A, 1984). Thirty-four pregnant women in the second (4 cases) and third (30 cases) trimesters of pregnancy underwent cryosurgery. No fetal, maternal or neonatal complications occurred during or following treatment. No recurrences were observed before or six weeks following delivery. Cryotherapy eliminated the need for elective cesarean section in many patients with GW. It appears that cryotherapy can be safely used in pregnancy, irrespective of the gestational age. In a 3-month follow up period, cryotherapy was also efficient in children aged 1-11 years of age (Stefanaki C, 2011). Overall, the advantages of cryotherapy include ease of application and rapid destructive effect. It may have special benefit in treating bulky lesions, grouped lesions, and lesions on hair-bearing areas. With no systemic side effects and only minor local ones, cryotherapy is an effective method for treating GW. References Abdullah AN, Walzman M, Wade A. Treatment of external genital warts comparing cryotherapy (liquid nitrogen) and trichloroacetic acid. Sex Transm Dis. 1993 Nov-Dec;20(6):344-5. Bergman A, Bhatia NN, Broen EM. Cryotherapy for treatment of genital condylomata during pregnancy. J Reprod Med. 1984 Jul;29(7):432-5. Buck H Jr. Warts (genital). Clin Evid (Online). 2007 Aug 1;2007. pii: 1602 Damstra RJ, van Vloten WA. Cryotherapy in the treatment of condylomata acuminata: a controlled study of 64 patients. J Dermtol Surg Oncol. 1991 Mar;17(3):273-6. Eron LJ, Alder MB, JM OR, Rittweger K, DePamphilis J, Pizzuti DJ. Recurrence of condylomata acuminata following cryotherapy is not prevented by systemically administered interferon. Genitourin Med. 1993 Apr;69(2):91-3. Gilson RJ, Ross J, Maw R, Rowen D, Sonnex C, Lacey CJ. A multicentre, randomised, double-blind, placebo controlled study of cryotherapy versus cryotherapy and podophyllotoxin cream as treatment for external anogenital warts. Sex Transm Infect. 2009 Dec;85(7):514-9 Godley MJ, Bradbeer CS, Gellan M, Thin RN. Cryotherapy compared with trichloroacetic acid in treating genital warts. Genitourin Med. 1987 Dec;63(6):390-2 Handley JM, Horner T, Maw RD, Lawther H, Dinsmore WW. Subcutaneous interferon alpha 2a combined with cryotherapy vs cryotherapy alone in the treatment of primary anogenital warts: a randomised observer blind placebo controlled study. Genitourin Med. 1991 Aug;67(4):297-302. Ho GY, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998 Feb;338(7):423-8. Mi X, Chai W, Zheng H, Zuo YG, Li J. A randomized clinical comparative study of cryotherapy plus photodynamic therapy vs. cryotherapy in the treatment of multiple condylomata acuminata. Photodermatol Photoimmunol Photomed. 2011 Aug;27(4):176-80. Rasi A, Soltani-Arabshahi R, Khatami A. Cryotherapy for anogenital warts: factors affecting therapeutic response. Dermatol Online J. 2007 Oct 13;13(4):2. Scheinfeld N, Lehman DS. An evidence-based review of medical and surgical treatments of genital warts. Dermatol Online J. 2006 Mar 30;12(3):5. Review. Simmons PD, Langlet F, and Thin RN. Cryotherapy versus electrocautery in the treatment of genital warts. Br J Vener Dis. 1981 August; 57(4): 273–274. Stefanaki C, Barkas G, Valari M, Bethimoutis G, Nicolaidou E, Vosynioti V, Kontochristopoulos G, Papadogeorgaki H, Verra P, Katsambas A, Katsarou A. Condylomata Acuminata in Children. Pediatr Infect Dis J. 2011 Dec 23. Wiley DJ. Genital warts. Clin Evid. 2002 Dec;(8):1620-32.