Successful treatment of anal and perianal condyloma acuminata with imiquimod.

Condyloma acuminata are genital or perianal warts caused mainly by human papillomavirus (HPV) types 6 and 11. In HIV-positive patients and in men who have sex with men (MSM), the prevalence of anal HPV infection is particularly high (45-95%) (1). Current therapies for condylorna acuminata include surgical excision and ablation by cryotherapy, electrocautery, or lasers. Imiquimod, a topical immune-response modifier, is also effective against condyloma acuminata and skin tumours, such as basal cell carcinoma and actinic keratosis (2). However, it is not practical to apply this cream topically to the mucous membranes ofthe anal canal, particularly inside the dentate line. Imiquimod has therefore been applied via suppositories (anal tampons) to anal canal condylomas (3). We report here a recurrent case of perianal and anal condyloma acuminata that was treated successfully with topical imiquimod to the perianal area. This report supports the widely held belief that imiquimod can induce a field effect in an area, such that susceptible lesions adjacent to the treated area can also be eradicated.