PAPILLOMAS

PAPILLOMAS

Considering that one of the most common reasons for turning to a dermatovenerologist is papillomas, which, in addition to causing harm to human health, also cause discomfort of an aesthetic nature, in this article, a dermatovenereologist at the VITAMED MEDICAL clinic, Rikhsieva Mavlyuda Tokhirzhanovna, will talk about their possible symptoms, manifestations and treatment.

What is papilloma?

Papilloma is a benign tumor-like formation of the skin and mucous membranes of viral etiology. It looks like a papilla on a narrow base (pedicle), 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 - breathing and voice disturbances, on the mucous membrane of internal organs - ulcerations and bleeding. Relapses of the disease are possible, the most dangerous complication being malignant degeneration.

Papillomas are a disease that affects epithelial cells and skin. Among HPV, viruses with high and low oncogenic risk are distinguished. The oncogenicity of papillomas is explained by the ability of the virus to integrate its DNA into the genome of human cells.

Mechanism of human papillomavirus infection

When HPV enters the human body, it initially infects the basal cells of the epithelium. Microtraumas, abrasions, cracks and other damage to the skin contribute to the penetration of the papilloma virus into the body. For a long time, the virus can reproduce initially without manifesting itself clinically (chronic carriage).

Since the human papillomavirus is unstable in the external environment, infection occurs through direct contact. Promiscuous sexual intercourse leads to infection; smoking, pregnancy, endometriosis, vitamin deficiency, and immunodeficiencies are predisposing factors for infection to occur when interacting with the virus. The risk of infection increases with frequent contact with bare human skin, for example during massage.

Clinical manifestations of papillomas

Papilloma is a neoplasm of the skin or mucous membranes and looks like a papillary growth that protrudes above the surrounding tissue. Papillomas are localized on the skin, mucous membranes, in the groin area and on the genitals; in some cases, papillomas are found in the renal pelvis and on the mucous membrane of the ureters.

Skin color may not change, but in most cases, papillomas are white to dirty brown in color. Favorite localization is the skin of the hands and arms. In patients with immunodeficiencies, papillomatosis becomes widespread. Primary skin changes begin to appear 1-6 months after infection.

Depending on the type of virus, the clinical manifestations of papillomas are variable. Thus, vulgar papillomas (warts) look like a hard lump with a diameter of 1 mm with a rough keratinizing surface. Simple (vulgar) papillomas are localized everywhere, but more often they affect the skin of the fingers and the backs of the palms. In children, especially younger children, papillomas affect the knees; this is due to physiological characteristics, since children crawl without clothes. Immunodeficiency conditions and general diseases contribute to the spread of the process; in isolated cases, vulgar papilloma becomes malignant.

The causative agents of plantar papillomas are HPV 1,2,4. A few months after infection, a small shiny bump appears on the skin of the sole, which has all the signs of a regular papilloma and is surrounded by a protruding rim. In some cases, small daughter neoplasms appear around one papilloma, which in appearance resemble vesicles. Then mosaic papillomatosis is diagnosed.

Papillomas on the soles are often painful, especially when walking. In approximately 30% of cases, they resolve themselves; self-recovery is more often observed in young children. They are often confused with calluses, which appear between the fingers with prolonged pressure. However, calluses, unlike papillomas, have a smooth surface and retain their skin pattern.

The causative agents of flat papillomas are HPV 3.10. These papillomas are of unchanged skin color and look like smooth, flat lumps, sometimes they can be yellowish or slightly pink in color, often with rounded outlines. There are also polygonal plantar papillomas. The neoplasms cause pain, itching, and the affected area is hyperemic.

Filiform papillomas are diagnosed in half of those over the age of 50 who apply for skin tumors; they are also called acrochords. They are localized on the skin around the eyes, in the groin area, in the armpits and on the neck. First, small bumps of a yellowish tint appear, which subsequently increase and gradually transform into dense, elongated elastic formations up to 5-6 mm in size. In patients with diagnosed filamentous papillomas, rectal polyps are quite often observed.

HPV 13, 32 cause local epithelial hyperplasia, which is characterized by the appearance of small papillary neoplasms on the oral mucosa and on the red border of the lips, which slightly rise above the skin and tend to merge.

One of the rare papillomas is Lewandowsky-Lutz papillomas (epidermodysplasia verrucous). Mostly children and adolescents are affected. Sometimes epidermodysplasia verruciformis is familial. Clinically it looks like multiple red-brownish spotted papillomas on the hands and feet. If papillomas are located in areas of the skin that are most susceptible to ultraviolet radiation, then in 30% of cases they become malignant and degenerate into malignant tumors with germination into neighboring tissues.

HPV, which is the causative agent of genital warts, can have a low, medium and high risk of oncological degeneration, therefore, when diagnosing genital warts, a PCR examination should always be performed. The incubation period ranges 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 frequently changing sexual partners. Externally they look like pink or pale gray pigmented pointed growths on a stalk.

In most cases, there is pain, burning, itching, irritation when touched and rubbed by underwear, and they are often injured and bleed. They are localized in the vestibule of the vagina, on the labia minora; less commonly, genital warts are found in the vagina and on the cervix. In men, the opening of the urethra is affected. The affected area depends on sexual behavior; in individuals who practice anal intercourse, genital warts are found 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 is again associated with the characteristics of sexual life.

Juvenile laryngeal papillomas are rarely recorded and are caused by HPV 6.11; Mostly children under five years of age are affected. Infection occurs during childbirth, when a woman in labor 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 difficulty in air circulation and speech impairment.

Diagnostics papillomas

Diagnosis of papillomas is carried out by a dermatovenerologist. Due to the large number of types of virus, it has its own characteristics. An accurate diagnosis based on visual examination 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 oncogenicity. Therefore, if the papillomatous nature of the neoplasms is suspected, they resort to PCR diagnostics of viral DNA.

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 are present in the body at the time of the analysis. This has diagnostic significance, since, knowing the percentage of the virus and its type, it is possible to determine the approximate timing of infection and identify contact persons for the purpose of examination and prescribing preventive therapy. PCR diagnostics also provides information about whether papillomas have a chronic course or are the result of a one-time decrease in immunity.

If the only method of treatment is removal of papillomas, then in parallel with surgery, a biopsy is performed for cytological examination. Histological examination of papillomas tissue gives more accurate results, since both the cells and the correct arrangement of their layers and the structural features of the tissue are subject to examination. This gives reliable results about the degree of changes in the body and the likelihood of malignancy, since long-term and untreated papillomas more often lead to cancer than timely detected HPV with a high degree of cancer risk.

As a rule, PCR diagnostics are screening in nature and, if the analysis confirms the presence of the virus, then additional research is carried out.

Treatment of papillomas

The treatment regimen for papillomas is selected individually in each specific case. If HPV is detected during diagnosis, but there are no clinical manifestations yet, then preventive therapy is prescribed. It is quite effective and allows you to “put to sleep” the virus for several years. Patients who are carriers of HPV are recommended to periodically undergo PCR examinations and use barrier contraceptives so as not to expose their partner to the risk of contracting the human papillomavirus.

Also at this time, drugs have been developed for the treatment of papillomas from the group of antiviral drugs that suppress the reproduction of viruses. Since therapy for papillomas is long-term, treatment is carried out only under the supervision of a physician, since monitoring of laboratory parameters is necessary. 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 laser removal of papillomas. It is possible to use another modern method of surgical treatment - removal of papillomas using radio waves. If the papilloma has signs of malignancy, then excision of the affected area with a scalpel is carried out, capturing healthy tissue.

It should be borne in mind that removal of papillomas does not lead to complete recovery, since today there are no drugs that have a detrimental effect on HPV. Therefore, patients with previously diagnosed papillomas need to undergo periodic examinations and courses of antiviral therapy.

Since HPV is mainly transmitted sexually, the only way to prevent papillomas is a barrier method of contraception. When planning a pregnancy, it is necessary to diagnose and, if necessary, treat the virus in order to reduce the likelihood of infection of the child during childbirth and in the first years of life.

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