One hundred patients with cases of condyloma acuminatum that were diagnosed by the Department of Dermatology and Venerology in our hospital from 2017 to 2018 were selected as the treatment group,which included  60  males  and  40  females  who  were  aged  from  16- to 60-years-old.  Their  disease courses ranged from one to 24 months,and the numbers of cases in the balanic foreskin, vulva, perianal and anal canal regions were 48, 40, 25,and 20, respectively.

All of the condyloma acuminatum patients were treated with Paiteling (Beijing Paite Biotechnology Limited Company, China), and the treatment methods were performed according to the instructions. The initial treatment dose consisted of a crude solution for the first week at twice a day for 15 minutes and for three consecutive days of treatment. Afterwards, the treatment regimen was adjusted according to the skin reaction after the first week of treatment; 4% diluents were used in the second week at once or twice a day for 15 minutes, and this regimen continued for the next four weeks. The patients were told  to  avoid  water  contact  on  the  treatment  areas  within  the  first  week.  All  of  the  patients  had follow-ups for 6 months.

With the use of the polymerase chain reaction (PCR) technique, cells that were acquired from all of the skin lesion sites were examined for definitions of HPV infections or the HPV subtypes before the first treatment  and  at  6  months  after  the  last  round  of  treatment.  (Guangzhou  Sai  Xun  Biological Technology Company, China).

Before the administration of the external Paiteling therapy, the numbers of cases of low-risk, high-risk and  mixed  types of HPV were 40, 35 and 25, respectively.

One  hundred  condyloma  acuminatum patients  completed  five  weeks  of  treatment. The  therapeutic evaluation  was  based  on  the  clinical outcomes  both  before  and after 6 months of follow-up, as  well  as  whether  the  HPV  virus  was determined  to  be  negative  or  not  (Figure  1). Ninety-two  of  the  patients  were  clinically  cured  and exhibited no recurrence, and eight exhibited improvements but recurrences after follow-ups for 2 to 3 months.The incidences of HPV virus were reexamined after 6 months of follow-ups. Ninety of the clinically  cured  patients exhibited negative  indications, two of the patients were determined to be positive  for  HPV  and  eight  recurrence  patients  were still demonstrated  to  be  positive  for  HPV.  Six months after treatment, the numbers of negative cases of low-risk, high-risk and mixed types of HPV were 38,32 and 20,respectively (Table 1). There was no statistical difference among different HPV subtypes in clinical outcomes and HPV clearance (P>0.05).

During the course of the treatment, 10 patients presented with erythema edema and erosion to different degrees, especially in the perianal conditions, with 15 patients presenting with differences in the levels of  pain(5 of these patients  received  analgesics one to two times)and 5 patients presenting with foreskin acrobystia edema.All of the adverse reactions disappeared within 5 days after the spraying of Jieyoushen and compound polymyxin B ointment for external use. No serious adverse reactions were observed,and none of the treatments had to be discontinued.

Table 1 Clinical efficacy of Paiteling in the treatment of condyloma acuminatum

Condyloma  acuminatum  is  a  common  sexually  transmitted  disease, with  the  main  clinical manifestations  including  proliferative  lesions in  the  genital  and vulvar regions caused by HPV infections(Park et al, 2015; Imbernón-Moya et al, 2017).

Recurrence is one of the characteristics of the disease, which is mainly related to the different subtypes of HPV, the long latency of HPV,reinfection with HPV, self-vaccination and the subclinical infections of HPV (Kaliterna et al, 2018;Cong et al,2016).

Studies have demonstrated that HPV infections may exist in the skin or in the mucosa around the warts(Nadarzynski et al,2014;Na et al,2018).

Some patients and clinicians pay more attention to the removal of the warts that have grown outwards, and they will neglect the timely removal of the HPV infection around the warts, which can easily lead to recurrence.

Therefore, the treatment of condyloma acuminatum has gradually changed from the removal of the warts to the removal of the warts and the prevention of recurrence.

Paiteling is a pure traditional Chinese medicine preparation that has been used for the treatment of HPV infections in recent years.

It has strong permeability and can quickly cross the epidermal cell space to reach the basal layer of the epidermis without damaging the dermis and the subcutaneous tissue (Tao et  al,2017).

Paiteling may promote the exfoliation of the epidermal cells in condyloma acuminatum and its surrounding potential viral areas by accelerating the metabolism of the epidermal cells;

thus,the HPV virus can be completely eliminated with the exfoliation of the cells(Zhang et al, 2017).

Previous studies showed that paiteling can accelerate the clearance of HPV infection and the regression of cervical lesions (Tao et al, 2017).

In this study, Paiteling was applied for the treatment of condyloma acuminatum. The HPV infection was checked 6 months after the end of the treatment, and the clinical efficacy and negative conversion rate of HPV were observed.

The results demonstrated that Paiteling was effective in treating condyloma acuminatum and in clearing HPV of the different types of infection.

This may be related to the treatment with Pateling.The diluted Pateling can be used for a long period of time, which can more effectively remove latent HPV infections from surrounding tissues, thus improving the clinical efficacy and HPV clearance rate.

The limitation of this study is that the number of cases that were observed is small, and the possible mechanisms of the treatment has not been simultaneously studied.

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Figure 1.Before and after treatment with Paiteling in patients with condyloma acuminatum

Patients with condyloma acuminatum completed 4 weeks of treatment. (A) There were several neoplasms present on the foreskin before the treatment. (B) The foreskin lesions were eliminated after the treatment. (C) There were several different sizes of neoplasms on the perianal region before the treatment. (D) The perianal  lesions were eliminated after the treatment. (E) The  histopathological examination demonstrated parakeratosis and papillomatous hyperplasia of the epidermis(hematoxylin-eosin stain,×100). (F) The histopathological examination revealed a large number of vacuolated cells in the epidermis(hematoxylin-eosin stain,×400).