for 12 months or more is useful in the treatment of coccidioidomycosis.
•Ketoconazole 200-400 mg/day for 12 months or more has resulted in improvement in patients with lung, skin, bone, and joint lesions.
•Fluconazole 100-300 mg/day may be useful.
•Amphotericin B 0.5-0.7 mg/kg per day for about 12-14 weeks is recommended in severe disease, particularly in patients with meningitis.
Future Therapies
Voriconazole has been shown to have in-vitro activity against C. immitis.
References
Diaz M, Puente R, de Hoyos LA, Cruz S. Itraconazole in the treatment of coccidioidomycosis. Chest 1991;100:682–684.
Drutz DJ. Amphotericin B in the treatment of coccidioidomycosis. Drugs 1983;26:337–341.
Ghannoum MA, Kuhn DM. Voriconazole: Better changes for patients with invasive mycoses. Eur J Med Res 2002;7:242–256.
Graybill JR, Stevens DA, Galgiani JN, et al. Itraconazole treatment of coccidioidomycosis. Am J Med 1990;89:282–290.
Condyloma Acuminatum
Condyloma acuminatum or anogenital wart is a common benign viral-induced lesion.
Types 6 and 11 human papilloma virus (HPV) are the main causative organisms of the disease.
The lesions are usually found on the anogenital area and rarely in the oral mucosa. Oral condyloma acuminatum may result from autoinoculation from anogenital lesions or during orogenital contact.
Oral Lesions
•Single or multiple small sessile or pedunculated painless nodules with cauliflower surface
•The lesions have normal or whitish color
•Lip and buccal mucosa, gingiva, and palate are the sites of predilection
Anogenital Lesions
•Discrete or multiple, sessile or pedunculated. exophytic, small nodules with cauliflower-like appearance
•Lesions may have whitish or brown color
•Size varies from 1-5 mm to several cm in diameter
Biopsy and histopathologic examination confirms the diagnosis. In-situ hybridization may be useful in difficult cases.
•Verruca vulgaris
•Papilloma
•Verruciform xanthoma
•Focal epithelial hyperplasia
•Sialadenoma papilliferum
•Molluscum contagiosum
•Focal dermal hypoplasia syndrome
•Early verrucous carcinoma
Basic Guidelines
•There is no specific antiviral therapy.
•The treatment of oral lesions should be followed by the treatment of anogenital lesions. if present.
•The oral lesions rarely recur.
•The treatment of anogenital warts must be provided by a dermatologist.
Suggested Therapies
•Conservative surgical excision of oral condyloma acuminatum is the treatment of choice—the procedure is quick and safe.
•Electrosurgery, cryotherapy, or CO2 laser may be used as alternative therapeutic measures for the treatment of oral lesions.
•Anogenital lesions are treated with a) cytotoxic agents, b) physical procedures, and c) immunomodulatory agents.
Future Therapies
Prophylactic vaccination.
References
Coremans G, Margaritis V, Snoeck R, et al. Topical cidofovir (HPMPC) is an effective adjuvant to surgical treatment of anogenital condylomata acuminata. Dis Colon Rectum 2003;46:1103–1108.
Garland SM. Imiquimod. Curr Opin Infect Dis 2003;16:85–89.
Gunter J. Genital and perianal warts: New treatment opportunities for human papillomavirus infection. Am J Obstet Gynecol 2003;189(suppl 3):S3–11.
Smith KJ, Harnza S, Skelton H. The imidazoquinolines and their place in the therapy of cutaneous disease. Expert Opin Pharmacother 2003;4:1105–1119.
Stanley MA. Progress in prophylactic and therapeutic vaccines for human papillomavirus infection. Expert Rev Vaccines 2003;2:381–389.
Tsambaos D, Georgiou S, Monastirli A, et al. Treatment of condylomata acuminata with oral isotretinoin. J Urol 1997;158:1810–1812.
Contact Cheilitis
Contact cheilitis is an acute or chronic inflammatory disorder of the lips resulting from contact with various allergens or irritants.
The most common causes are lipsticks, lip salves, toothpastes, mouthwashes, foods, etc.
•Mild edema and erythema, followed by scaling and fissures or plaques
•Dryness and a burning sensation are common
•Rarely blisters may develop
