| What is HPV? | • Warts are caused by HPV
• HPV infects the skin and mucosal epithelia inducing epithelial hyperplasia leading to a wart
• HPV infects the basal keratinocytes of cutaneous and mucosal epithelium
• Transmission by skin-to-skin contact or surfaces or objects
• There are more than 100 different types of HPV, and around 40 that affect the genital area
• The type of HPV influences the wart morphology:
• Verruca vulgaris: types 2, 4
• verruca plana: types 3, 10
• PP warts: type 1
• Genital warts: types 6-11, 16, 18, 31, 33 |
| How is epidemiology of Verruca Vulgaris? | • One of the top 3 skin problems in children
• Peak prevalence is during adolescence (13-16 y.o)
• About 5 to 20% of teens are affected
• Common in younger and older people
• Males and females are equally affected |
| What is Verruca Vulgaris? | • Hyperkeratotic, exophytic, dome-shaped papules or nodules
• Most common on fingers, dorsal hands, knees, may occur anywhere
• Punctate black dots representing thrombosed capillaries
• May spread with skin trauma
• Due to HPV 2, 4 |
| What is Verruca Plana? | Flat Warts:
• Skin colored or pink
• Smooth-surfaced, slightly elevated, flat-topped papules
• Dorsal hands, arms, face (exposed areas)
• Due to HPV 3, 10 |
| What is palmoplantar verruca? | • Thick, endophytic papules
• Mosaic warts: plantar warts coalescing into large plaques
• Due to HPV 1
• Can accumulate a thick callus over and around the wart
• May be painful when walking |
| How is histology of warts? | . |
| What is the principle of tx of warts? | • Treatments are often destructive and/or stimulate the immune system
• Multiple treatments are almost always needed for any treatment modality: cryotherapy, acids, laser, etc..
• Chance of spontaneous resolution at 2 years is over 75%
• There is no specific anti-HPV therapy (unlike hepatitis and HIV) |
| What are types of tx of warts? | . |
| What are genital warts? | • Papillomatous or sessile papules or large confluent plaques
• Not hard, not hyperkeratotic
• External genitalia, perineum, perianal, inguinal fold
External Genital:
• HPV infection is one of the most common STI’s
• Peak prevalence in women 20-24 y.o, in men 25-29 yo
• Risk factors: sexual intercourse at an early age, numerous partners, unprotected exposure
• HPV infection is linked to genital warts, premalignant lesions of the cervix, vagina, vulva, penis, and oropharynx |
| How is HPV infection? | • Transmitted by sexual contact
• HPV 16-18 are associated with higher malignancy risk
• Immunosuppression (organ transplant, HIV) have more frequent infections, persistent, difficult to treat
• HIV infected patients have a higher risk of perianal squamous cell carcinoma |
| What is differential of warts? | Pearly Penile Papules, Condylomata lata (secondary syphilis) |
| How is tx of EGW? | • Cryotherapy
• Podophyllotoxin
• Imiquimod
• Surgical (destructive) methods can be used to treat EGW:
• Laser CO2
• Electrocautery
(The two above need N95 respirator or local exhaust ventilation (protection of the practitioner)
• In addition it is important to counsel patients about the risk of transmission and malignancy |
| What is imiquimod? | • Topical cream 5%, used 3 times a week, 6 to 10h then rince. Maxi 16 weeks
• 1 bag/20 cm², EGW
• No direct action on the virus but induction of IFN α
• Eradication: 67% in women
• Applied by the patient
• Local tolerated erythema the first 2 weeks
• Relapse sometimes (13% vs 23% at 6 months)
• Indications: EGW in immune competent; HIV on tritherapy and CD4 > 200 |
| How is HPV prevention? | Two vaccines approved (Gardasil and Cervarix against types 16 and 18 |
