Giant condyloma acuminatum of the vulva Mx with topical Rx
Giant condyloma acuminata (GCA) is a large condyloma of the anogenital region with a cauliflowerlike appearance. The tumor is extremely rare and is related to human papilloma virus (HPV) infection (HPV type 6 and 11 in 90% of cases). The definitive treatment is wide surgical excision, but topical medical treatment can be effective in selected cases.

Published in the Journal of the Amercian Academy of Dermatology, the authors report the first case of complete regression of vulvar GCA after treatment with topical imiquimod (5% cream) therapy, with no recurrence reported over a 3-year follow-up period.

A 21-year-old woman presented with severe perineal pain, dysuria, and burning micturition. For the past 2 months, she complained of vulvar pruritus and burning and recently had vulvar edema. The patient had not received any prior HPV vaccination.

Physical examination found a large exophytic cauliflowerlike vulvar tumor, measuring 15 × 11 × 7 cm, involving both labia majora, extending anteriorly to mons pubis and posteriorly to the perineum. Biopsy confirmed that it was a giant condyloma acuminatum without evidence of malignant disease. The tumor was positive for HPV 6 and 11.

Even though surgical excision is the treatment of choice for giant condyloma acuminatum, it was decided to begin treatment with topical imiquimod (imiquimod cream 5%, applied once a day and left for 12 hours) because of the size, location, and extension of the lesion, and the risk of vulvar scarring and distortion after surgery.

The treatment was overall well tolerated with no major side effects reported; the patient only complained of pain in the vulvar area, which was treated with oral morphine, and local irritation in the adjacent healthy vulvar tissue successfully treated with aloplastine cream.

A clear regression of the lesions was noted after 2 months of treatment along with an improvement of symptoms. The lesions and symptoms completely disappeared after 6 months of treatment. No recurrence was reported during a 3-year follow-up period.

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