PAPILLOMA VIRUS OF THE SKIN

Human papillomavirus infections caused by the virus and their diagnosis are not interesting for dermatologists but are of great interest to urologists, oncologists, pathomorphologists, immunologists, and virologists, as the human papilloma virus is widely spread and significantly opens up the possibilities for the development of malignant processes.

Human papillomavirus infection is manifested by various types of warts and condylomatous lesions.

The infectious nature of warts was confirmed in the late 19th century, while their viral etiology was established at the beginning of the 20th century.

Human papillomavirus infects epithelium and multiplies in the squamous epithelium of the skin, mucous membranes of the mouth, genitalia, conjunctiva, perianal area, bronchi, and esophagus. Virus penetration occurs in the basal layer of the epithelium of the skin and squamous epithelium, after which the nuclei begin to proliferate. Human papillomavirus full replication occurs only in the basal and squamous layers of the epithelium and in the upper layers of the stratified squamous epithelium and in the superficial layers of squamous and keratinized epithelium.

For the day, it is known that there are over 100 serotypes of the human papillomavirus (HPV), and what’s most concerning is that new strains are emerging. Some of these strains are associated with high risk (oncogenic or linked to precancerous lesions).

Transmission of the human papillomavirus occurs through close contact, but transmission of the virus can also occur indirectly. Essential factors for HPV infection include minimal skin damage, which facilitates the virus’s localization in mucous membranes such as the genitals, mouth, and throat.

Significant factors for HPV infection also include the number of viruses present at the site of contact, the quality of exposure to the skin, and the response of the immune system to the virus. Since the quantity and activity of viruses in an organism are directly related to the condition and functioning of the organism’s immune system.

A weakened immune system predisposes to HPV proliferation and the development of papillomas. During certain conditions like immunosuppression, prolonged intake of medications, and during periods of intense stress and exhaustion, immunity decreases and viruses multiply rapidly. Under certain conditions (immunosuppression, aging, stress), the size and number of papillomas rapidly increase. If the papilloma’s growth is disturbed, it can lead to an inflammatory process. At this time, as a medical and aesthetic measure, the removal of papillomas is desirable.

Human papillomavirus infection can manifest as various lesions on the skin: warts, plantar warts, common warts, filiform warts, anogenital warts, and others.

Human papillomavirus infection can manifest as various lesions on the mucous membranes: condylomas acuminata in the genital area and anus, condylomas acuminata on the oral mucosa, focal papillomatosis, condylomatosis of the urethra, cervix, and rectum.

Human papillomavirus infection is the most common type of viral infection in humans, caused by the human papillomavirus (HPV) – usually benign epidermal proliferative lesions. Initially, a correctly round lesion develops, the papules of which, with growth, hyperkeratosis, exfoliation, and keratinization on the surface occur. HPV papules may be solitary and more often multiple, predominantly located on skin folds. The primary papule is larger than its descendants, the filiform papules.

The specific localization of HPV papules often includes:

• Papular type warts – the outer surface of the cluster, fingers and flexion areas of the upper limbs
• Long filiform warts – eyelids, face, neck, beard area
• Flat warts – chin, beard area and less often the shins, because shaving traumatizes and the elements spread to the surface of the skin
• Large warts prone to exophytic growth – hairy scalp
• Papillomatosis, which develops due to constant friction between the fingers
• Flat warts with sharply defined borders – palm area and inner surface of fingers
• Whitish papules, papillomatous or filamentous warts – on the red lip
• Flat warts that are embedded deep in the skin – ankle warts, the most common and annoying because they are located in pressure areas – on the ankle
• Warts in the nail area – located around the nail plate, often damage the nail bed, hyponychia and cause local dystrophy of the nail

Clinical diagnosis of human papillomavirus infection does not always determine it with high accuracy since papules are sometimes barely visible even with a magnifying glass. Patients should consult a physician with any manifestation of papules to determine the possibilities for their treatment.

For effective treatment of human papillomavirus infection, the approach should be individualized and respond to the patient’s needs. In most cases, the removal is preferred since specific antiviral drugs are not available daily. However, vaccination against human papillomavirus infection is already available for prevention (this applies only to 4 serotypes).

In contemporary medicine, there are several destructive methods for treating skin lesions:

• Surgical excision – preferably performed when there is concern about malignization.
• Electrosurgery – removal of individual papules with an electrocoagulator.
• Cryodestruction – cryodestruction with various cryogens, preferably with liquid nitrogen.
• Chemical – removal with chemical preparations – special chemical peelings.
• Laser – removal of papules using laser apparatuses.
• Radiotherapy – removal of papules using radiotherapy equipment.

Each of these methods has its advantages and disadvantages. Surgical methods usually provide more pronounced scarring, especially in the case of cryodestruction, electrocoagulation, and chemical peeling, as the process of healing is more complicated. Apart from that, there is a chance that complete removal of papules cannot be achieved.

The decision on which method to use is made by a dermatologist, based on the examination of the skin lesion and using digital dermatoscopy.

“Marjani Clinic” offers various methods for the treatment of papillomas, warts, skin tags, and other skin lesions (condylomas, fibromas, atheromas, keratomas, keratoacanthomas, “skin horns,” etc.), and the procedure is performed by electrosurgery. The procedure is performed under local anesthesia, and after the procedure, the wound is treated with a solution of iodine and a small adhesive plaster, which is removed in 1-2 weeks.