Professional Documents
Culture Documents
Disease Associated HPV Types
Disease Associated HPV Types
Disease
Plantar warts
1,* 2, 4, 63
Myrmecia
60
Common warts
Flat warts
Intermediate warts
10,* 26, 28
Epidermodysplasia
verruciformis
2,* 3,* 5,* 8,* 9,* 10,* 12,* 14,* 15,* 17,* 19, 20, 21, 22, 23, 24,
25, 36, 37, 38, 47, 50
Condyloma acuminatum
6,* 11,* 30, 42, 43, 44, 45, 51, 54, 55, 70
Intraepithelial neoplasias
Unspecified
30, 34, 39, 40, 53, 57, 59, 61, 62, 64, 66, 67, 69, 71
Low-grade
6,* 11,* 16, 18, 31, 33, 35, 42, 43, 44, 45, 51, 52, 74
High-grade
6, 11, 16,* 18,* 31, 33, 34, 35, 39, 42, 44, 45, 51, 52, 56, 58,
66,
Bowen's disease
16,* 31, 34
Bowenoid papulosis
Disease
Cervical carcinoma
16,* 18,* 31, 33, 35, 39, 45, 51, 52, 56, 58, 66, 68, 70
Laryngeal papillomas
6,* 11*
Others
6, 11, 16, 30, 33, 36, 37, 38, 41, 48, 60, 72, 73
information on new HPV types can be found on the HPV Sequence Data
Base through the Internet (http://hpv-web.lanl.gov).
SOURCE: From RC
pathologic associations and tissue specificityeither cutaneous or mucosal. The 23 mucosalassociated HPV can be further subgrouped according to their risk of malignant
transformation. New types of HPV are defined as possessing <90% homology to known types
in six specified early and late genes.
Human Papillomavirus: Cutaneous Infections
Certain human HPV types commonly infect keratinized skin. Cutaneous warts are a discrete
benign epithelial hyperplasia with varying degrees of surface hyperkeratosis manifested as
minute papules to large plaques; lesions may become confluent, forming a mosaic. The extent
of lesions is determined by the immune status of the host.
Synonym: Verruca, myrmecia.
Epidemiology and Etiology
Etiology
See Table 25-2.
Transmission
Skin-to-skin contact. Minor trauma with breaks in stratum corneum facilitates epidermal
infection. Contagion occurs in groupssmall (home) or large (school gymnasium).
Other Factors
Immunocompromise, such as occurs in HIV disease or after iatrogenic immunosuppression
with solid organ transplantation, is associated with an increased incidence of and more
widespread cutaneous warts. Occupational risk associated with meat handling.
Inheritance
EDV: most commonly autosomal recessive.
History
Duration of Lesions
Warts often persist for several years if not treated.
Symptoms
Cosmetic disfigurement. Plantar warts act as a foreign body and can be quite painful during
normal daily activities such as walking if located over pressure points. More aggressive
therapies such as cryosurgery often result in much more pain than that caused by the wart
itself. Bleeding, especially after shaving.
Physical Examination
Skin Lesions
Verruca Vulgaris (Common Warts)
Firm papules, 1 to 10 mm or rarely larger (Fig. 25-9), hyperkeratotic, clefted surface, with
vegetations (Fig. 25-10). Palmar lesions disrupt the normal line of fingerprints. Return of
fingerprints is a sign of resolution of the wart. Characteristic "red or brown dots" (Figs. 25-9
and 25-10) are better seen with hand lens and are pathognomonic, representing thrombosed
capillary loops. Isolated lesion, scattered discrete lesions. Annular at sites of prior therapy.
Occur at sites of trauma: hands, fingers, knees. Butcher's warts: large cauliflower-like lesions
on hands of meat handlers. Filiform warts have relatively small bases, extending out with
elongated cap (Fig. 25-11).
Figure 25-9
Figure 25-10
Figure 25-11
Filiform warts Multiple, elongated keratotic papules on the face of a child; note the
Figure 25-12
Figure 25-13
Verruca plana (flat warts) Flat-topped, pink papules with sharp margination and minimal
hyperkeratosis on the dorsa of the hands and fingers.
Epidermodysplasia Verruciformis
individuals with EDV develop malignant cutaneous lesions on areas of skin exposed to
sunlight.
Management
Goal
Patient-initiated
therapy
For small lesions 1020% salicylic acid and lactic acid in collodion.
For large lesions
40% salicylic acid plaster for 1 week, then application of salicylic acid
lactic acid in collodion.
Imiquimod cream At sites that are not thickly keratinized, apply half-strength 3 times per
week. Persistent warts may require occlusion. Hyperkeratotic lesions on
palms/soles should be debrided frequently; Imiquimod used alternately
with a topical retinoid such as tazarotene topical gel may be effective.
Hyperthermia for Hyperthermia with hot water (113F) immersion for 1/2 to 3/4 h two or
verruca plantaris
three times weekly for 16 treatments is effective in some patients.
Clinician-initiated Costly, painful.
therapy
Cryosurgery
Electrosurgery
CO2 laser surgery May be effective for recalcitrant warts, but no better than cryosurgery or
electrosurgery in the hands of an experienced clinician.
Surgery