Papilloma is a benign tumor formation of the skin and mucous membranes of viral etiology. It has the appearance of a papilla on a narrow base (stem), of a soft or dense consistency, from light to dark brown. Localization of papillomas on the skin leads to the formation of a cosmetic defect, in the larynx – a violation of breathing, voice, on the mucous membrane of internal organs – ulceration and bleeding. Possible recurrence of the disease, the most terrible complication – malignant degeneration. Removal of papillomas can be carried out by electrocoagulation, cryodestruction, surgical excision, radio wave or laser exposure.
Papillomas are a disease that affects epithelial cells and skin. The cause of papillomas is the human papillomavirus, which belongs to the Papoviridae family, the Papillomavirus group. Among HPV viruses isolated with high and low oncogenic risk. The oncogenicity of papillomas is explained by the ability of the virus to integrate its DNA into the genome of human cells.
The mechanism of infection with human papillomavirus
Once in the human body, at the initial stage, HPV infects basal epithelial cells. Microtraumas, abrasions, cracks and other skin lesions contribute to the penetration of papillomavirus into the body. For a long time, the virus can multiply initially without manifesting itself clinically (chronic carriage). If the virus multiplies in the surface layers of the skin, then over time, even with chronic carrier papillomavirus hyperplasia of cells is observed.
Since the human papillomavirus is unstable in the external environment, infection occurs through direct contact. Indiscriminate sexual relationships lead to infection; smoking, pregnancy, endometriosis, avitaminosis, immunodeficiencies are predisposing factors for infection to occur when interacting with a virus. The risk of infection increases with frequent contact with the bare skin of a person, for example during a massage.
Clinical manifestations of papillomas
Papilloma is a neoplasm of the skin or mucous membranes and externally looks like papillary growth that protrudes above the surrounding tissue. Papillomas are localized on the skin, mucous membranes, in the inguinal region and on the genitals, in some cases papillomas are found in the renal pelvis and on the mucous membrane of the ureters.
Since papilloma consists of connective tissue, covered with skin and contains blood vessels, bleeding is possible when traumatized. The neoplasm grows up outwards in the form of scattered papillae in different directions and looks like a cauliflower.
Skin color can not change, but in most cases papillomas have color from white to dirty brown. Favorite localization – the skin of the hands and hands. In patients with immunodeficiencies, papillomatosis becomes widespread. Primary changes in the skin begin to appear in 1-6 months after infection. The concentration of the virus in the affected areas reaches a maximum by the 6th month from the moment of infection, it is this period that is most contagious.
Depending on the type of virus, the clinical manifestations of papillomas are variable. Thus, vulgar papillomas appear as a solid bump with a diameter of 1 mm and a coarse keratinizing surface. Vulgar papillomas are prone to fusion, and therefore often affect significant areas of the skin. Simple (vulgar) papillomas are localized everywhere, but more often they affect the skin of the fingers and the back of the palms. In children, especially younger ones, papillomas affect the knees, this is due to physiological features, since children crawl without clothes. Vulgar papillomas are usually located in small groups, however, a single element may last for several years. Immunodeficiency states and general diseases contribute to the spread of the process, in isolated cases the vulgar papilloma is malignant.
Pathogens of plantar papillomas are HPV 1,2,4. A few months after infection, a small shiny nipple appears on the skin of the sole, which has all the signs of normal papilloma and is surrounded by a prominent rim. In some cases, around one papilloma appear small new-sized neoplasms that look like bubbles. Then, mosaic papillomatosis is diagnosed.
Papillomas on the soles are often painful, especially when walking. In about 30% of cases they are self-resolved, more often self-healing is observed in young children. They are often confused with calluses that appear between the fingers during prolonged squeezing. However, corns, unlike papillomas, have a smooth surface and retain a skin pattern.
The causative agents of flat papillomas are HPV 3,10. These papillomas of unchanged skin color look like smooth flat lumps, sometimes they can be yellowish or slightly pink in color more often than rounded outlines. There are also polygonal plantar papillomas. Neoplasms cause pain, itching, the affected area is hyperemic.
Filamentous papillomas are diagnosed in half of those who applied over the age of 50 years for skin neoplasms, they are also called acrochords. They are located on the skin around the eyes, in the groin area, in the armpits and on the neck. First, small-sized, yellowish bumps appear, which further increase and gradually transform into dense elongated elastic formations up to 5-6 mm in size. If the acrochords are located in places where trauma is possible, they become inflamed and cause pain. Filamentous papillomas are not prone to spontaneous disappearance. In patients with diagnosed filiform papillomas, polyps of the rectum are often observed.
HPV 13, 32 cause local epithelial hyperplasia, which is characterized by the appearance on the mucous membrane of the mouth and on the red border of the lips of small papillary tumors that slightly rise above the skin and are prone to fusion.
One of the rarely encountered papillomas is the Lewand-Lutz papilloma (warty epidermodysplasia). Mainly children and teenagers are ill. Sometimes the warty epidermodisplasia is family-like. Clinically looks like multiple red-brownish spotted papillomas on the hands and feet. If the papillomas are located on the skin areas that are most susceptible to ultraviolet radiation, then in 30% of cases they are malignant and degenerate into malignant tumors with germination in neighboring tissues.
HPV, which are causative agents of genital warts, can be with low, medium and high risk of oncological degeneration, therefore, when diagnosing genital warts, you always need to undergo PCR examination. The incubation period is from several weeks to several months. Since in some cases the changes are minimal, these papillomas go unnoticed. The main route of transmission is sexual. The risk group includes people with immunodeficiencies and often changing sexual partners. Externally, they look like pink or pale gray pigmented pointed growths on the stem.
In most cases, there is pain, burning, itching, irritation when touched and rubbed with underwear, often injured and bleeding. They are localized on the threshold of the vagina, on the labia minora, less often peaked condylomas occur in the vagina and on the cervix. In men, the urethral opening is affected. The affected area depends on sexual behavior, so in individuals practicing anal contact, genital warts occur in the perineal area and in the perianal area. In some cases, genital warts are diagnosed on the oral mucosa and on the red border of the lips, which again is associated with the characteristics of sexuality.
Juvenile laryngeal papillomas are rarely recorded, they are caused by HPV 6.11; children under five are ill for the most part. Infection occurs during childbirth, when the woman has papillomas in the vagina and the child, while passing through the birth canal, takes a premature breath. The disease is characterized by papilloma growths on the vocal cords, which leads to obstruction of air circulation and speech disorders.
Diagnosis of papillomas
Diagnosis of papillomas is carried out by a dermatologist or venereologist. Due to the large number of virus types, it has its own characteristics. An accurate diagnosis based on a visual inspection can only be made in the classic case of genital warts, but this does not provide accurate information about the type of virus and its carcinogenicity. Therefore, in case of suspicion of the papillomatous nature of the neoplasms, PCR diagnosis of the virus DNA is resorted to.
PCR diagnostics allows not only to confirm the presence of human papillomavirus in the body and determine its type, but also to diagnose how many viruses exist in the body at the time of the analysis. This has a diagnostic value, since, knowing the percentage of the virus and its type, it is possible to determine the approximate dates of infection and identify contact persons for the purpose of examination and prescription of preventive therapy. PCR-diagnostics also gives information about whether papillomas have a chronic course or whether they are the result of a single-step decrease in immunity. Thanks to such data, adequate therapy can be prescribed.
If the only method of treatment is the removal of papillomas, then in parallel with surgery, a biopsy is performed to conduct a cytological examination. Histological examination of papilloma tissue gives more accurate results, since both cells are to be examined, as well as the correctness of the arrangement of their layers and the structural features of the tissue. This gives reliable results on the degree of changes in the body and on the likelihood of malignancy, as long-term and untreated papillomas often lead to oncological diseases than timely detected HPV with a high degree of oncological risk.
As a rule, PCR diagnostics is of a screening nature and, if the analysis confirms the presence of a virus, then conduct additional research.
The scheme of treatment of papillomas in each case is selected individually. If HPV is detected during the diagnosis, but there are no clinical manifestations yet, then preventive cytostatic therapy is prescribed. It is quite effective and allows you to “put down” the virus for several years. Patients who are carriers of HPV are recommended to periodically conduct PCR examinations and use barrier contraceptives in order not to endanger the human papillomavirus of his partner.
Inosine pranobex – a drug for the treatment of papillomas from the group of antiviral drugs, which suppresses the multiplication of viruses. It is one of the most preferred, since it has immunomodulating properties. The indications for use are diagnosed papillomas with a combination of other viral infections, such as cytomegalovirus infections, measles and mumps viruses. The presence of the herpes virus, chronic viral hepatitis and immunodeficiency also requires the inclusion of Isoprinosine in the treatment regimen. Since papilloma therapy is long, inosine pranobex should be taken only under the supervision of a physician, since control of laboratory parameters is necessary. The use of immunomodulators and courses of vitamins are shown to all patients with HPV.
If there are manifestations of HPV on the skin and mucous membranes, then, depending on the location and symptoms, they resort to cryodestruction of papillomas, electrocoagulation or removal of papillomas by a laser. Perhaps the use of another modern method of surgical treatment – removal of papillomas by radio waves. If the papilloma has signs of malignancy, then the excision of the affected area with a scalpel with the capture of healthy tissue is performed.
It should be borne in mind that the removal of papillomas does not lead to complete recovery, as to date there are no drugs that are detrimental to HPV. Therefore, patients with previously diagnosed papillomas should be periodically examined and conducted courses of antiviral therapy.
Since HPV is mainly transmitted sexually, the only prevention of papillomas is a barrier method of contraception. When planning pregnancy, it is necessary to carry out diagnostics and, if necessary, the treatment of the virus, in order to reduce the likelihood of infection of the child during delivery and in the first years of life.