VIN Management

Management of VIN depends on several factors.  Observation suffices for VIN1. For patients with VIN 2 or VIN3, treatment usually is recommended, although observation is initially reasonable for women who have recently completed a course of corticosteroids, who are temporarily immunocompromised, or who are pregnant.  Current treatments for VIN, although numerous, have largely resulted in suboptimal outcomes. Response rates have been poor and relapse rates high.  Recurrence rates following many medical or surgical therapies range from 39% following local excision and 70% after laser ablation to 90% in some studies of 5-fluorouracil (Stanley, 2003). Finally, the resultant physical and psychologic morbidity associated with such therapies can be profound. In the end, agents that enhance or induce strong cell mediated immune responses likely hold the greatest promise not only for control of HPV-related disease but also for reduction of future recurrences. Topical 5% imiquimod acts by activating macrophages and dendritic cells to release interferon and other proinflammatory cytokines. These cytokines in turn lead to activation of the appropriate antigen-specific immune response. Imiquimod's efficacy in the treatment of genital warts is well-documented, and in a number of recent trials, its use has been associated with encouraging results in the treatment of VIN2 and VIN3 with a greater than 90% response rate (Mathiesen, 2007).