The text is presented for informational purposes only. We urge you not to self-medicate. When the first symptoms appear, consult a doctor. Recommended reading: " Why not self-medicate?". Papillomas are skin neoplasms of a benign nature, the distinguishing feature of which is the base-papilla of connective tissue, covered with epithelium on top. Papillomas occur in humans in various parts of the body (on the skin, mucous membranes, in internal organs and other localizations) and in most animals.
Papillomas develop from transitional or squamous epithelium into the form of soft dense formations on the so-called stalk. The size of these formations usually ranges from 1 to 2 centimeters in diameter, and their outer surface has a white or dirty brown tint. Sometimes papillomas grow in different directions and become like cauliflower or a rooster's comb.
Remove papillomas for the sake of cosmetic effect, if they occur in visible areas of the body - on the neck, hands, face, however, if they occur in many areas of the mucous membrane, for example, in the larynx, patency disorders can be provoked threatening the patient's life. In the case of the larynx, papilloma can block the airways, causing voice problems or the inability to breathe normally; in the case of the bladder, papillomas provoke hematuria. If multiple papillomas form on the body, then this indicates the onset of papillomatosis.
Etiology of papillomas
In most cases, the occurrence of papillomas provokes a viral infection - the human papillomavirus (HPV), although sometimes papillomas can occur congenitally or as complications of inflammatory diseases.
When HPV enters the human body, its activity usually begins to manifest itself after a long time. Often, some provoking factors contribute to the activation of papillomavirus, due to which soft neoplasms begin to appear on the skin or mucous membranes. The main factors provoking papillomas experts include stress, decreased immunity, weakening of the body due to treatment, deficiency of vitamins in the body, injury to the skin.
Basically, people become infected with papillomavirus sexually, but there are also cases of household infection with very reduced immunity or in the presence of damaged areas of the skin on the body that can come into contact with an HPV carrier. The appearance of papillomas indicates the activation of the existing virus, which is equally possible for both women and men. A child can become infected with this virus while passing through the birth canal of an infected mother.
Classification of forms of manifestation of HPV
Human papillomavirus that affects the mucous membrane and skin can be classified into the following forms:
- clinical form that can be detected during routine examination: genital, papular and papillary warts, exophytic condylomas, as well as cervicitis and erosion of the cervix in women;
- a subclinical form in which the lesions are asymptomatic, invisible, and can only be detected by endoscopy : inverted lesions (growing towards the inside of the mucous membranes), flat warts, as well as warts in the cervical canal;
- latent form, characterized by the absence of a clinic and detected solely by the results of analyzes;
- the female form or cervical appearance, manifested by cervical cancer or dysplasia of various stages.
When women are infected with highly oncogenic HPV as a result of sexual contact, the likelihood of malignant neoplasms in the cervical canal sharply increases. When infected with other types of the virus, the likelihood of oncology is not so high, however, a cancerous tumor can occur in the rectum or oral cavity. In men, the likelihood of cancer due to HPV exists in the anus, penis and rectum.
Types and forms of papillomas
It is very important to correctly identify papillomas that appear on the body. Their types are directly dependent on the strain of the resulting virus, which, when it enters the human body, promotes the process of excessive cell division in the skin, resulting in papillomas.
HPV strains can be oncogenic or non-oncogenic. There are much more non-oncogenic varieties and, as a rule, they bring nothing but external aesthetic discomfort to the patient.
Such a manifestation can be easily removed, thereby solving the problem. However, if neoplasms occur in the mucous membranes, this indicates serious pathological processes. Such a dislocation means that a person has become infected with an oncogenic strain of HPV, so complex antiviral therapy in this case is essential. To distinguish between different types of papillomas, it is enough to simply compare them with each other and identify the distinctive features of a particular subspecies.
Simple papillomas or warts are the most common type of papillomavirus, caused by several strains at once. These strains of HPV are transmitted not only sexually, but also through household contact, which leads to statistics indicating that 30% of the world's population has encountered such HPV at least once in their lives.
Simple papillomas or vulgar (common) warts are most often localized on the upper limbs, namely, on the hands, but sometimes they can also occur on the body, soles and feet, palms, fingers on the hands. Their peculiarity is that such warts appear in places with damaged skin due to a decrease in local immunity. Such papillomas develop in the soles or palms due to contact with poor-quality household chemicals, profuse sweating, various skin lesions, and dermatitis.
Wart vulgaris has the appearance of skin papillary neoplasms a couple of millimeters in diameter at the onset of the disease. In this case, the head of the wart has a uniform and soft texture and rises above the surface of the skin. It is poorly pigmented, and its root goes deep into the skin, where it receives nourishment from the vessels. As a result of such nutrition, warts gradually grow, and not only their size changes, but also the degree of pigmentation. Also, hair often grows in the center of such papillomas, which is a variant of the norm and does not indicate a malignancy of the neoplasm.
These skin lesions look like small yellowish flat plaques that rise slightly above the surface of the skin. Their structure is dense, with a deep subcutaneous root, as evidenced by frequent soreness when pressing on the wart or when it is damaged at home. Such papillomas are localized most often on the face and hands. Sometimes they can occur in the anus or on the labia majora in women and in the scrotum in men. Thanks to an active blood supply, they have an active tendency to grow.
The main feature of flat papillomas is the difficulty of their treatment. After surgical treatment of these neoplasms, scars and scars usually remain in their place.
Genital warts occur in the groin area or on mucous membranes. Outwardly, these are thin papillary neoplasms 2-3 mm in diameter. Such warts grow rapidly, forming a large skin growth from a small single papilla, resembling a cauliflower or a cockscomb.
The main danger of genital warts is a high risk of infection, inflammation of neoplasms in the vagina or labia minora in women. They can easily be injured, after which the infection penetrates at a high speed into the body. Also a big problem associated with genital warts is a high risk of recurrence, which does not decrease even with the use of antiviral treatment and removal of neoplasms. Several strains of the virus can cause genital warts, some of which can be dangerous for women in terms of the malignant process.
Filiform papillomas are called with a thin stalk, the top of which is crowned by the head of the neoplasm. They are very difficult to confuse with other species due to their special appearance, therefore, by looking at the photo of filiform papillomas, they can be differentiated from other varieties.
Such neoplasms occur most often after the age of 45 in areas where thin skin prevails - on the chest, armpits, and neck. An increase in the size of such neoplasms is their even greater elongation. The head of filiform papillomas is usually yellowish or pinkish in color, pigmentation is not pronounced, most often very weak.
Internal moles include any neoplasms on the surface of human internal organs. These are intragastric warts, papillomas in the rectum, neoplasms in the throat and mouth, neoplasms on the walls of the bladder. A distinctive feature of these papillomas is the impossibility of their recognition without appropriate medical manipulations and diagnostics. However, the disease can be suspected by special symptoms. The danger of such neoplasms is revealed in each case.
Papillomas in the bladder may bleed or develop cancer over time.
If the papilloma is located in the region of the larynx, then it contributes to the blocking of breathing and interferes with the speaking function of a person.
Epidermodysplasia verrucous or Lewandowski-Lutz papillomas is a very rare pathology that mainly affects only children or adolescents. It happens that such a disease can be inherited and be of a family nature of distribution.
Clinical manifestations of the disease are numerous red-brown spotted warts on the feet and hands. A feature of the pathology is the fact that when papillomas are located on areas of the body that are exposed to ultraviolet radiation, in a third of all cases they degenerate into malignant neoplasms and grow into the region of neighboring tissues.
Sites of localization of papillomas
The most frequent in the practice of physicians are filiform, vulgar or pointed papillomas, as well as condylomas. The place of localization of filiform warts is the face, vulgar ones are more often located in the area of the feet or hands, and condylomas - exclusively on the mucous membranes (the glans penis and in the urethra in men, in the region of the labia minora and vagina in women), but it happens that any of these warts may occur in an unusual place.
It is not difficult to remove such papillomas in modern conditions, but the danger is the fact that with a decrease in immunity, new papillomas may reappear, which will lead to more serious health consequences, for example, the subsequent occurrence of warts fraught with the development of cervical cancer in women. Plantar warts are most common on rough soles and the balls of the toes. Occasionally, a spike can develop on the thumb after a severe injury to the skin in the area.
In general, papillomatosis is a generalized form of pathology in which neoplasms form throughout the human body. These growths have a characteristic appearance, therefore, having seen the manifestations of the disease once, it can no longer be confused with any other disease.
Symptoms of HPV
The most common symptom of the presence of papillomavirus in the human body is the appearance of papillomas on the skin.
Other symptoms directly depend on the place of dislocation and the type of disease. Depending on the above signs, the symptoms of HPV can be as follows:
- Genital warts occur on the mucous membranes of the genitals, mouth, larynx, rectum and on the inner surface of the stomach. Symptoms of the onset of pathology in the genital area are itching and an unpleasant odor. If such a symptomatology began to disturb, in no case should it be ignored, since very often the cause of its occurrence can be of an oncogenic nature.
- Intraductal papillomas in the area of the ducts of the mammary glands, the signs of which are redness in the area of the nipples, slight itching and burning. Also, if you press on the nipple with such a papilloma, then ichor or green discharge begins to ooze from it. The danger of intraductal papilloma is its gradual and possible degeneration into breast cancer.
- Plantar warts are expressed in an active corn formation in the area of the soles, which, when walking or pressing on it, causes pain in a sharp form.
- Papillomas in the larynx are not initially expressed in any specific symptoms, but gradually this pathology leads to a change in the person's voice, a feeling of a lump in the throat, and impaired respiratory functions. Also, the patient begins to experience difficulty in swallowing.
- Flat warts in adolescents most commonly occur on the outer sides of the hands and lower face. The symptomatology is very blurred and is most often expressed in a light, rarely occurring itching of the neoplasms.
In the presence of HPV in the human body, it is most often possible to draw a conclusion about reduced immunity. Once in the body, viruses begin the process of infecting the basal epithelial layer, making the main bias towards the defeat of the transition area from squamous multilayered epithelium to cylindrical. In infected cells, 2 forms of the virus can exist - episomal (outside cellular chromosomes) with a benign nature and introsomal (integrated into cell genomes) with a malignant nature of parasitism.
The incubation period of papillomavirus can vary from the moment the virus enters the body to the first manifestations of the disease within a period of 14 days to a couple of years. The nature of papillomavirus infection is usually latent, that is, hidden. At the same time, several varieties of pathology can settle in the human body at the same time, and under the influence of certain factors, each of them can at one time begin to manifest itself through active reproduction. In this case, a stage of the disease occurs, at which clinical manifestations begin to be identified.
Very often (up to 90% of all cases of HPV infection) within 6-12 months, the human body heals itself from this pathology, however, in 10% of the remaining cases, the disease can become chronic with a long course, relapses and the possibility of malignancy of the process.
Diagnosis of the disease
Ultrasound for papillomas
Ultrasound in the diagnosis of papillomas is not used as the main method of investigation, but as an additional, confirming the correctness of the proposed diagnosis. Basically, ultrasound is used to diagnose papillomas in internal organs when it comes to their malignant degeneration.
Ultrasound is used among the methods of instrumental verification in the diagnosis of intraductal papilloma.
Ultrasound in this case does not allow the specialist to examine the ducts of the mammary glands, but helps in differentiating intraductal papilloma from suspected breast cancer, makes it possible to exclude galactorrhea in prolactinoma. Ultrasound can also help detect the occurrence of neoplasms in bladder papilloma. However, ultrasound in this case is effective only if the neoplasms exceed 1 centimeter in diameter.
PCR diagnostics at diagnosis
Diagnosis of the disease in question is carried out by doctors dermatologist and venereologist. Since the number of types of the virus is diverse, it is important to accurately determine which type the patient is infected with and whether this strain has an oncogenic character. Visually making an accurate diagnosis is possible only in the case of classic genital warts, which is why, when HPV infection is suspected, specialists always use PCR scraping.
Polymerase chain reaction (PCR) offers researchers not only to determine the presence of HPV in the body, but also demonstrates its type, oncogenicity and the number of viruses at the time of diagnosis. This is very important in terms of diagnostics, since if information is available on the percentage of the virus in the body, it is possible to determine the approximate time of infection and establish the contact persons of the patient in order to conduct etiotropic therapy with them.
According to the results of PCR diagnostics, it is possible to determine the chronic course of the infection or its one-time outbreak due to a decrease in immunity. Such information gives the specialist the opportunity to prescribe an adequate therapy for a particular case. Usually, PCR diagnostics is carried out in the form of screening. When the presence of the virus in the body is confirmed, the patient continues to be examined using other methods. The method is used for all forms and types of HPV.
In medicine, a biopsy is a procedure for taking human tissue samples for subsequent examination using staining with special dyes. Biopsy is very common in cancer cases, as well as when HPV is suspected. On the eve of the treatment of papillomaviruses, doctors necessarily exclude the oncological nature of the neoplasms.
Biopsy is a highly accurate diagnostic technique that, if HPV is suspected, can be expressed in cytological or histological studies.
A cytological study is an examination of body cells under a microscope, designed to demonstrate to specialists the changes that a viral infection has caused in these cells. For the prevention and early detection of cervical cancer, cells for cytological examination in a woman are taken from this organ. If oncogenic types of HPV are detected in women, even in the absence of external manifestations and signs, they are annually assigned cytological studies, which allow them to see signs of cervical dysplasia in a timely manner. The fact is that dysplasia of this organ is completely curable, and if the development of the process is not started, then cervical cancer will not develop in the body at all, even with an oncogenic type of virus.
In order to accurately diagnose HPV, a histological examination is carried out, for which not a superficial cell scraping is taken from the patient for analysis, but a piece of tissue, which allows to consider the correct arrangement of cell layers, tissue features, and identify oncological characteristics. When conducting a histological examination using solutions, the tissue sample taken is dehydrated and embedded in paraffin, after which sections are made using a microtome, allowing to obtain layers with a thickness of 0.1 millimeters. The removed layers are stained with special dyes in order to reveal pathological cells under microscopic examination and determine their nature.
Treatment of papillomatosis
Medical products (preparations, medicines, vitamins, medicines) are mentioned for informational purposes only. We do not recommend using them without a doctor's prescription. Recommended reading: " Why can't you take medications without a doctor's prescription?". Treatment of papillomavirus is always carried out on an individual basis. If the virus is detected during the diagnosis, but there are no manifestations yet, the patient is prescribed etiotropic cytostatic therapy, which allows to effectively "lull" the virus for several years.
If a person is a carrier of HPV, then he should regularly undergo PCR diagnostics in order to identify the initial signs of the development of the disease. In addition, the carrier of this virus is required to use barrier contraceptives so as not to infect sexual partners.
When detecting papillomaviruses, it is mandatory to use antiviral agents in treatment, for example, the drug Inosine pranobex, which suppresses the reproduction of viruses with immunomodulatory properties. Use this medicine when diagnosing HPV together with other viral infections (for example, together with cytomegalovirus infections, mumps and measles viruses, as well as herpes, hepatitis, immunodeficiency states). Therapy with this drug is long and requires constant monitoring by a doctor who, depending on the results of laboratory tests at a particular stage of treatment, can adjust the dosage of the drug. In general, immunomodulatory and vitamin preparations are indicated for absolutely all patients with HPV.
When papillomas appear on the mucous membranes or skin, depending on the location and symptoms, they resort to cryodestruction, electrocoagulation and laser removal growths. Sometimes papillomas are removed with a more modern technique - using radio waves. In case of signs of malignancy of the papilloma, it is excised surgically together with the surrounding healthy tissues around the growth. It is also important to know that removing the papilloma does not lead to a complete cure, since the virus remains in the body and can recur.
There are no preparations for the complete elimination of this virus from the body in modern medicine, therefore, if such a diagnosis is detected, even in the absence of manifestations, a person must regularly undergo examinations to detect the development of pathology.
Since papillomavirus is most often transmitted sexually, it is worth preferring a barrier method of contraception, and if a woman is planning a pregnancy, it is important to carry out diagnostic measures in a timely manner and take therapy that will reduce the likelihood of infection of the child with this virus.
Prevention of the disease
It is possible to prevent the occurrence of papillomas on the body by observing elementary rules of personal hygiene and timely disinfection of any wounds. Be sure to use a separate towel, comb, manicure tools, shoes for each family member in everyday life, and intermittent sexual contacts should always be protected with condoms. It is also important to always take a shower after sexual intercourse and treat the contact areas of the skin and mucous membranes, since it takes some time for the virus to enter the human body.
In modern medicine, there is also a vaccine against papillomavirus. It has already been tested in 72 countries around the world, it is effective against 16 and 18 HPV subtypes, which cause cervical cancer in 90% of all diagnosed cases. Vaccination also successfully fights against viruses of subtypes 6 and 11, which provoke the development of genital warts that are difficult to treat. Due to the sexual route of infection with these viruses, it is recommended to vaccinate before the onset of a person's sexual life. Most often, experts recommend three doses of the vaccine for girls aged 11-12 years. There is also a Cervarix vaccine that prevents infection with only two HPV subtypes - 16 and 18. It can be introduced into the body from the age of ten. The World Health Organization recommends that boys also be vaccinated to prevent the possibility of HPV circulating.
Are papillomas dangerous?
Papillomavirus is a risk factor in the development of oncological pathologies. Most often, due to this virus, cervical cancer, cancer of the external genital organs (vulva, glans penis) occurs. However, HPV infection does not always lead to cancer. There are many subtypes of this virus with a low oncogenic index, for example, subtypes 6, 11, 42, 43, 44, which form warts, but there are also highly oncogenic subtypes - 16, 18, 31, 33, which provoke flat warts. From the moment the virus enters the body to the transformation of the neoplasm into a malignant one, it can take from 10 to 20 years.
Acceleration of the pathological process in papillomavirus contributes to obesity, alcoholism, smoking, hormonal shocks in the body, which are the cause of reduced immunity. Also, the resulting papilloma can be pushed to destruction by a sexual infection, neoplasm trauma with inflammation and bleeding.
If there are large papillomas on the body, which can be very easily damaged in everyday life, they must be removed.
If the papillomavirus, which is detected in the body, is not treated, then the risk of contracting other infections increases dramatically. And with the course of parallel infectious processes, papillomas begin to appear in other parts of the body, weakening the immune system. It turns out a vicious circle. In addition, if some papillomas are not removed, they can degenerate into oncological neoplasms, which means that this disease must be approached with all seriousness and never let the course of the disease take its course.
- Bazhukova N. N., Vozovik A. V. A modern view on the pathogenesis of human papillomavirus infection // Bulletin of the Ural medical academic science. -2014. - No. 5. -WITH.116-120
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