Efi.

Gelerstein 2011

Topic 8. Skin diseases caused by human papilloma virus (HPV) Warts: Most people have warts at some point of their lives HPV 1, 2 and 4 - found in common warts HPV 3 - found in plane warts HPV 6, 11, 16 and 18 - common in genital warts Common Warts = Verruca vulgaris. Definition Hyperplastic tumors induced by HPV Incubation: weeks, months Benign infectious epithelioma Most frequent form, certain localization Histology: acanthosis, papillomatosis, balloon cells, vegetative hyperkeratosis Clinical features: Hyperkeratotic papillomatous tumors, usually 2-6mm in diameter. Loss of skin markings and intra-lesional hemorrhagic dots or streaks Most common sites are acral - hands, feet. On fingers, frequently periungual HPV 1, 2, 4, 7 most common Important: pseudo-Kbner phenomenon, autoinoculation Diagnostic approach: Clinical findings (punctate bleeding when cut off) Histology; identification of HPV type only essential for genital lesions with infected female or partner. Differential diagnosis: In children, molluscum contagiosum. In adults, actinic keratosis, seborrheic keratosis, stucco keratosis, keratoacanthoma. Therapy: Cave: Do no harm! Most common warts, especially in children, resolve spontaneously. Procedures that are extremely painful or cause scarring should therefore be avoided. All forms of therapy have at least a 50% recurrence rate. Small, not extremely hyperkeratotic lesions can be treated with Cryotherapy; usually 2 freez-spray cycles employed: repeated weekly. Application of salicylic acid plasters (every 23days) or flexible gels (daily) followed by paring or curettage (12 weekly by physician or aide). As the number of warts , the more painful the treatment becomes and the success rate drops. Laser destruction of individual resistant or painful lesions (especially periungual) may be useful. In resistant cases, imiquimod with aggressive removal of scale and occlusion

Efi. Gelerstein 2011

Plane warts = Verrucae planae juvenile Definition: Small HPV-induced papules (plane as in flat). Involves HPV 3, 10, 29 Clinical features: 1-2mm, skin-colored subtle papules, often not recognized as warts by patient Most common sites are face and hands. Frequently spread by autoinoculation, especially on face of men (less often legs of women) by shaving. Most patients are children or young adults. Plane warts in older patients raise the question of immunosuppression. Diagnostic approach: Clinical findings, histology; HPV typing rarely needed. Differential diagnosis: On face, syringomas, xanthelasma; On chest, popular granuloma annulare and eruptive vellus hair cysts. Lichen ruber planus Therapy: Therapy can easily cause lesions to spread; so slow and gentle are the magic words! Try imiquimod, topical retinoids, light Cryotherapy, laser destruction Resistance, diathermy, keratolysis, cryosurgery, Podophyllin Condyloma acuminatum = Genital warts Definition Sexually transmitted HPV infection of genital and perianal transition mucosa; most common STD. Pathogenesis: HPV 6, 11 (not oncogenic), 16, 18 (oncogenic). Predisposing factors: Phimosis Vaginal discharge Intertrigo Chronic eczema Proctitis Homosexuals, HIV Clinical features: Incubation period 4 weeks to 6 months. Tiny white papules, which rapidly both spread and enlarge. Larger lesions often macerated. May be genital or perianal Infections in children: Vertical transmission in uterus or during birth can lead to infections which may appear with considerable time delay. Laryngeal papillomatosis is caused by HPV in infants larynx.

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Diagnostic approach: Examine sexual partner, exclude other STDs. Painting with 5% acetic acid will unmask discrete lesions by turning them white. Be sure affected women have cervical examination. If lesions are recalcitrant, consider HPV typing. Differential diagnosis: Condylomata lata (secondary syphilis) sound similar, but are large broad-based moist lesions. Therapy: Application of podophyllotoxin 0.5% solution by patient using various regimens 520% tincture of podophyllin is used; it must be applied by physician 12 weekly until clear. Caution: podophyllin should not be applied to the urethra, internally, or during pregnancy. It also contains mutagenic and carcinogenic compounds and is, in our opinion, best avoided. Physical destruction of infected cells Cryotherapy Electrodesiccation Local chemotherapy (5-FU, podophyllin) Curettage HPV vaccines Protective Bivalent (Cervarix) HPV 16/18 Cervix cc (CIN2/3) Quadrivalent (Silgard, Gardasil) HPV 6/11/16/18 Cervix cc (CIN2/3) Vulvar cc (VIN2/3) Kls nemi szervi condyloma acuminatum 926 years IM. 3 dosages

Ages Mode

1025 years IM. 3 dosages