Keratosis, Skin Spots, Warts, Benign Growths and Moles

BENIGN GROWTHS & MOLES

Everyone has skin growths. The dermatologist is the expert on determining which are harmless and which should receive attention.
This article is not a substitute for a medical exam. If you have any serious skin issues or concerns, you need to consult your physician.

Moles

Everyone has moles, from a few to several dozen. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance. They can be raised from the skin and very noticeable, or they may contain dark hairs. Having hairs in a mole doesn’t make it more dangerous.

Moles can appear anywhere on the skin, alone or grouped. They usually are brown in color and can be various sizes and shapes.  Special cells that contain the pigment melanin cause the brown color.  Facial moles are probably are determined before a person is born. Many of those that form in childhood and early adult life are now thought to be due to sun damage. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion. Moles may darken, which can happen after exposure to the sun, pregnancy and sometimes during therapy with certain steroid drugs. Moles can be safely removed for cosmetic or medical reasons.

Blood Moles

These are benign growths that consists of small blood vessels. These tumors can be located anywhere on the body. Some of the different types include spider angiomas, cherry angiomas, and angiokeratomas. We do not know the cause of most types of angiomas.

Age Spots

Multiple small brown spots that may appear on wrists, backs of the hands, forearms, and face could be solar lentigos. These are also called “liver spots” or “age spots” and occur later in life. The are flat and evenly colored.

Keratosis

After a person reaches middle age, he or she may acquire other dark areas that are not moles. The brown, wart-like growths that appear on the face or trunk and look as if they have been stuck to the skin may be seborrheic keratoses. Seborrheic keratoses are non-cancerous thickenings of the outer layer of skin. They may be just one growth or clusters. They are usually brown but can vary in color from light tan all the way to black. They’re different sizes as well –anywhere from a fraction of an inch in diameter to larger than a half dollar. A main feature of seborrheic keratoses is their waxy, pasted-on, or stuck-on look. They sometimes look like a dab of warm brown candle wax that has dropped onto the skin. Others have a rough surface.

Actinic Keratoses, also called solar keratoses, are caused by sun damage. They occur on body areas that have been heavily exposed to sunlight or exposed a little bit often for a lot of years. The face, hands, forearms and the V of the neck are the most common areas for actinic keratoses. They may get sore a times. These growths are more common among pale-skinned, fair-haired, light-eyed individuals. They are flatter, redder and rougher than seborrheic keratosis. Actinic keratoses are pre-cancerous, which means they may become skin cancers. The risk has been estimated at 1% per spot, per year,

WARTS
Warts are caused by a viral infection of the cells found in the top layer of the skin. The name of this virus is the human papillomavirus HPV). Warts are skin-colored and feel rough to the touch. Hand warts are usually found around the nails, on the fingers and on the back of the hand. They are more common where skin has been broken and in the areas where fingernails are bitten or hangnails picked. Foot warts are usually on the soles of the feet. These warts are called plantar warts (this has nothing to do with farming-the bottom of the foot is called the plantar side by doctors). Flat warts are much smaller and are less rough than hand or foot warts. They tend to grow in great numbers — 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are most often found in the beard area in men and on the legs in women. Skin irritation from shaving probably accounts for this.

Watch out for…

Melanoma is a serious form of skin cancer. Melanomas are often, but not always, very dark brown to bluish-black growths. Melanomas may be confused with seborrheic keratoses or moles because both can become very dark. It is wise to have any growth that turns dark or becomes irritated checked by a dermatologist. Early detection of skin cancer is the best way to assure successful treatment.

Information by : Dermatologist, Robert M Rosen, D. O.

Treatment of Anogenital Warts

Safety, Efficacy & Recurrence Rates of Imiquimod Cream 5% for Treatment of Anogenital

Imiquimod 5% cream (Aldara™, Graceway Pharmaceuticals) is an immune response modifier used for the topical treatment of anogenital warts in non-HIV-infected patients. Several randomized controlled trials have demonstrated that imiquimod 5% cream is a safe and efficacious treatment. Current data regarding efficacy shows that complete clearance of warts occurred in up to 50% of patients treated with imiquimod 5% cream applied once-daily, 3 times per week for up to 16 weeks. Recurrence rates ranged from up to 19% at 3 months to 23% at 6 months. Imiquimod 5% cream showed an acceptable safety profile; local inflammatory reactions were the most frequent adverse effects, with local erythema being the most common.

Imiquimod is an immune response modifier that was approved by the US FDA in 1997 for the topical treatment of anogenital warts in individuals 12 years old and older. An estimated 30%-50% of sexually active adults in the US are infected with human papillomavirus (HPV), and approximately 1%-2% of this same population have clinically evident genital warts.¹ This review will focus on studies that evaluate the safety, efficacy, and recurrence rates of imiquimod 5% cream in the treatment of anogenital warts in non-HIV-infected men and women. Local inflammatory reactions were the most frequent adverse effects, with local erythema being the most common. Overall, imiquimod 5% cream is a safe and efficacious treatment for anogenital warts.

Using Imiquimod

Imiquimod cream is supplied in individual packets. Each gram of the 5% cream contains 50mg of imiquimod in an off-white oil-in-water vanishing cream base.² The US Center for Disease Control recommends that imiquimod 5% cream be applied once daily at bedtime, 3 times per week for up to 16 weeks. The product should be washed off with mild soap and water 6-10 hours following application.^2-4 Many considerations exist when using imiquimod. Some of these are listed in Box 1. The US FDA provides a full list of considerations.³

Mechanism of Action

Imiquimod is a Toll-like receptor agonist that induces the production of local cytokines from predominantly T helper (Th) 1-type cells, thus stimulating both acquired and cellular immunity, which is important for fighting virus-infected and tumor cells.^5-7 Cytokines such as interferon (INF)-á, tumor necrosis factor (TNF)-á, interleukin (IL)-1, -6, -8, -10, and -12 stimulate tissue-specific apoptosis of virus-infected keratinocytes, thus leading to a viral load reduction of HPV types 6 and 11 with subsequent wart regression and normalization of keratinocyte proliferation.^5,6,8 Regression of warts after treatment with imiquimod is strongly associated with evidence of tissue production of INF-á, -â, and -ã and TNF-á as well as a decrease in the presence of HPV DNA and in the expression of mRNA for both early and late viral proteins.⁹

Safety

In all the randomized controlled trials (RCTs) examined, topical imiquimod 5% cream showed an acceptable safety profile. Local skin reactions are associated with a local inflammatory reaction including itching, erythema, burning, irritation, tenderness, ulceration, erosion, and pain.¹⁰ In several studies, local erythema was the most common reaction.^11-13 There were no differences in adverse systemic reactions or flu-like symptoms among treatment groups.^10,12,13 The optimal dosing regimen is 3 times per week. With more frequent applications (up to 3 times daily), wart clearance does not improve significantly and is associated with an increase in local adverse events, such as erythema, vesicle formation, ulceration, and excoriation.¹⁴ Imiquimod 5% cream is effective for up to 16 weeks of treatment for external anogenital warts and is well-tolerated for up to 32 weeks.¹¹ Imiquimod is contraindicated in individuals with a history of sensitivity reactions to any of its components and should be discontinued if hypersensitivity to any of its ingredients is noted. Overall, patient-applied imiquimod 5% cream is an effective treatment for external genital warts and has a favorable safety profile.

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 treated with imiquimod 5% cream applied 3 times daily. At the end of 16 weeks, recurrence rates ranged from up to 19% after 3 months and 23% after 6 months.11 See Table 1 for comparisons. The recurrence rates of external genital warts were found to be similar at both 3- and 6-month follow-up, suggesting that after 3 months, the risk of developing recurrence is low.¹⁵

The studies that follow were chosen to evaluate imiquimod 5% cream for the treatment of anogenital warts because of sufficient data on efficacy, recurrence rates, and safety.^10-13 Studies that did not include this data were excluded. Several other studies focused on the treatment of anogenital or vulvar warts in the female population; however, the efficacy rates are generally higher for this population, ranging from 71%-77%.^12,16-18 To maintain continuity, this review focuses on comparing studies that include treatment of anogenital warts with imiquimod 5% cream in non-HIV-infected men and women.

Detailed Findings of This Study Can be Found Indexed by the US National Library of Medicine and PubMed

Monotherapy Compared with Combination Therapy: Imiquimod + Surgery

Carrasco et al.¹⁹ showed that treatment with imiquimod 5% cream followed by excision of remaining warts resulted in a lower recurrence rate compared with surgery alone. This strategy represents a viable option for those with residual lesions and may provide long-term clearance of anogenital warts in patients for whom imiquimod monotherapy is insufficient.¹⁹

Conclusion

Patient-applied imiquimod 5% cream is a first-line topical treatment for anogenital warts that is both safe and efficacious, and yields complete and partial responses in the majority of patients. Various studies demonstrate complete clearance rates of up to 50% and partial responses manifest as a 50%-90% reduction in baseline wart area.^12-14 Recurrence rates range up to 19% at 3 months and 23% at 6 months. More studies are needed to compare the efficacy of combination therapies vs. monotherapy vs. other treatment modalities. Longer follow-up is also needed to evaluate recurrence rates after monotherapy, as well as in combination with other treatments for anogenital warts.

Warts

M.L. Diamantis, BS¹; B.L. Bartlett, MD²; S.K. Tyring, MD, PhD³

1. The University of Texas Medical School at Houston, Houston, TX
2. Center for Clinical Studies, Houston, TX
3. The University of Texas Health Science Center at Houston and Center for Clinical Studies, Houston, TX