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Cutaneous Manifestations of Human Papillomaviruses: A Review
Cutaneous Manifestations of Human Papillomaviruses: A Review
Cutaneous manifestations
of human papillomaviruses:
A review
J. C. Cardoso, E. Calonje
K E Y
WORDS
human
papillomavirus,
common warts,
plantar warts,
plane warts,
condyloma
acuminatum,
Bowenoid
papulosis,
epidermodysplasia verruciformis
B S T R A C T
Human papillomaviruses (HPVs) are small DNA viruses of the papovavirus family, with more than 100
types already described. Their importance in human disease cannot be overemphasized because
these agents are among the most common pathogens in cutaneous infectious diseases and are
very important in a subset of predominantly, but not exclusively, genital squamous-cell carcinomas.
HPVs can be associated with a variety of cutaneous as well as mucosal manifestations. Some types
of HPVs are associated with increased risk of epithelial malignancies; these have been divided into
low-risk and high-risk types based on their oncogenic potential. Clinical and histological features of
HPV infection vary according to individual susceptibility (e.g., immunosuppressed patients), site of
involvement, and type of HPV implicated. The histological features of HPV infection are very easy to
identify on sections stained with hematoxylin and eosin. However, many findings usually associated
with HPV infection are entirely non-specific. Additional current diagnostic methods for identification
of HPV in tissues include techniques based on the detection of viral DNA; namely, in-situ hybridization and polymerase chain reaction (PCR). This article reviews the main clinical and histopathological
cutaneous manifestations of HPV infection, including common warts, plantar warts, plane warts, condyloma acuminatum, Bowenoid papulosis, and epidermodysplasia verruciformis. Emphasis is placed
on the clinical and histological features of these various manifestations, including a brief discussion
about the routinely used laboratory methods for detecting HPV in tissues.
Introduction
Human papillomaviruses (HPVs) are small DNA
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Review
Common warts
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Figure 4. Plantar wart. Similar histological features to those of a common wart but with endophytic growth and prominent clumps of eosinophilic material are seen in the stratum corneum
and within the cytoplasm of keratinocytes
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the epithelium of hair follicles may result in changes
reminiscent of trichilemmoma or inverted follicular
keratosis, which led some researchers in the past to
conclude that the latter lesions were induced by HPV
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demonstrate the presence of HPV DNA in a group of
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is a very rare phenomenon (1) and has been described
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acanthosis and papillomatosis, and typically have an
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sion of the intercommunicating rete ridges has been
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the vacuolation common to other viral warts, also
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philic cytoplasmic inclusions, which represent altered
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Plantar warts
Plantar warts occur on the sole of the foot and are
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epidermoid cysts occurring on the sole of the foot in
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that present as a keratotic plug surrounded by a hyper
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black dots scattered over the surface, which represent
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taining melanin granules in the cytoplasm of kerati
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plantar warts, papillomatosis is only mild or absent
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be ulcerated, and more commonly involves the penis
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authors as a variant of verrucous carcinoma, although
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parakeratosis, papillomatosis, and marked acanthosis
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coarse keratohyaline granules are characteristic fea
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hyperkeratotic surface and few or no koilocytic chang
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consists of cells with little or no atypia, which typically
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deep structures like the corpora cavernosa character
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in the deep portion of the lesion are particularly im
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Bowenoid papulosis/
undifferentiated intraepithelial
neoplasia
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the presence of usually multiple papules, which may
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have been described occasionally in other locations
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should only be regarded as a form of intraepithelial
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distinguishing it from other entities based only on the
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associated with HPV infection, but with other condi
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usually associated with HPV infection, and is further
subdivided into warty and basaloid types, based on
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Acta Dermatoven APA Vol 20, 2011, No 3
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Figure 10. Undifferentiated intraepithelial neoplasia. Full thickness epidermal dysplasia with
basaloid atypical cells and frequent mitotic
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Figure 11. Undifferentiated intraepithelial neoplasia. In-situ hybridization for high-risk HPV
shows prominent nuclear positivity in most cells.
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mis (EV) is a rare genodermatosis with an autosomal
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Conclusions
HPVs are among the most common infectious
agents in humans, and can be associated with a variety
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tean spectrum of clinical manifestations, of the possi
ble complications associated with them (especially the
risk of malignant transformation in some settings),
and basic knowledge about the currently available di
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