Clinical dermatoscopical response of glycyrrhizinic acid 0.1% spray in treating external anogenital warts in HIV patients: a case series

Patients with human immunodeficiency virus (HIV) disease are more likely to develop anogenital warts (AGW) compared to HIV-negative people, and are susceptible to treatment failures and illness recurrences. Glycyrrhizinic acid (GA) is extracted from licorice root (Glycyrrhiza glabra). Previous studies have demonstrated the efficacy of GA 0.1% spray as a treatment for external AGW, but its role in immunocompromised patients has not been explored. The current study reported two cases of HIV-positive patients with AGW who experienced partial remission using GA 0.1% spray. The treatment was applied by the patients three times a day for eight weeks. Treatment evaluation were made by using visual inspection and dermoscopy image analysis. After twelve weeks, clinical observation revealed poor improvement with only slight reduction in number and size of the lesions; although dermoscopy findings revealed an evolution from finger-like to knob-like pattern. GA facilitate the development of T helper lymphocytes in cell-mediated immune response, whereas in HIV, there are a decreased number of T helper lymphocytes. This may explain poor therapeutic response in our patient. Dermoscope is useful in the evaluation of treatment progress, especially when invisible to unaided eye.