Viral warts are benign proliferations of the skin and mucous membranes caused by infection with human papillomavirus. They can be located anywhere on the skin and are common on the hands, feet, and knees. Extragenital warts are usually asymptomatic, but can occasionally cause pain or deformity. Although spontaneous resolution is not uncommon, viral warts can persist for months or years, and are treated using a wide range of therapies. The most commonly used therapies include cryotherapy and topical treatments containing acidic or caustic compounds. Cases refractory to these therapies have been treated using intralesional bleomycin, topical 5-fluorouracil, imiquimod,1,2 photodynamic therapy,3,4 electrodesiccation, and oral cimetidine.
We present 2 cases of extragenital viral warts successfully treated with sinecatechins ointment.
The first patient was a 48-year-old woman who was referred to our clinic with viral warts on the sole of her left foot. The warts had developed 2 years earlier and caused local pain while walking (Fig. 1A). The patient had undergone the following unsuccessful treatments: topical salicylic acid; several sessions of cryotherapy; 6 sessions of photodynamic therapy with methyl aminolevulinate (Metvix); and imiquimod 5% 3 times a week.
Finally, treatment with sinecatechins ointment (Veregen) 3 times daily for 14 weeks resulted in complete resolution of the lesions with no adverse effects (Fig. 1B).
The second patient was a 24-year-old woman with a prior history of chronic idiopathic neutropenia. She was referred to our clinic with periungual viral warts on most of her fingers. She had previously undergone cryotherapy and treatments with salicylic acid and topical imiquimod 5%, without success. One month after completing the last of these therapies the patient began treatment with sinecatechins ointment 3 times a day for 16 weeks. This resulted in resolution of the lesions with no local or systemic adverse effects (Fig. 2).
Sinecatechins are a standardized extract of green tea leaves from Camellia sinensis, a species of the family Theaceae. The main components of sinecatechins are tea polyphenols, particularly flavonoids, 85% of which are catechins.5 Catechins bind to enzymes involved in the generation of inflammatory mediators, proteases that promote tumor invasion, and kinases involved in tumor cell signaling, modification of the cell cycle, and the induction of apoptosis. The therapeutic effects of sinecatechins have been attributed to these immunomodulatory, antioxidative, antiviral, and antitumor properties.6 Epigallocatechin gallate is the main catechin contained in the commercial product, and has the greatest biological activity of this group of compounds.7
Sinecatechins ointments are effective in the treatment of viral warts located on the external genitals and the perianal region, with clearance rates ranging from 64.9% to 45.5%. They are generally well tolerated; local skin reactions are the most commonly reported adverse effect.5,8,9
Only one case of extragenital viral warts treated with sinecatechins ointment has been described to date; a 35 year-old male whose facial viral warts resolved after treatment for 20 days.10
As spontaneous regression of viral warts is well documented, we cannot completely rule out this possibility in the 2 cases presented here. This is unlikely however, given the failure of previous therapies and the fact that the observed improvements coincided with the beginning of sinecatechins ointment treatment. Further studies with a larger number of patients will be required to fully assess the effectiveness and safety of sinecatechins ointment for the treatment of extragenital viral warts.
Please cite this article as: Alcántara González J, Pérez Carmona L, Ruano del Salado M, Calzado Villarreal L. Verrugas extragenitales tratadas con sinecatequinas en pomada. Actas Dermosifiliogr. 2015;106:139–140.
