Papilloma - benign tumor formation of the skin and mucous membranes of viral etiology.It has the appearance of a papilla on a narrow base (leg), soft or dense consistency, from light to dark brown color.Localization of papillomas on the skin leads to the formation of a cosmetic defect, in the larynx - impaired respiration, voice, on the mucous membrane of the internal organs - ulcerations and bleeding.Relapses of the disease are possible, the most formidable complication is malignant degeneration.Papill removal can be carried out by electrocoagulation, cryodestruction, surgical excision, radio wave method or laser exposure.
General information
Papillomas - This is a disease that affects epithelial cells and skin.The cause of papillomas is the human papillomavirus, which belongs to the Papoviridae family, the Papillomavirus group.Among HPV, viruses with high and low oncogenic risk are distinguished.Oncogenicity papillomas is explained by the ability of the virus to integrate its DNA into the human cell genome.
The mechanism of infection with the human papilloma virus
Once in the human body, at the initial stage, HPV affects the basal cells of the epithelium.Microtrauma, scuffs, cracks and other skin damage contribute to the penetration of the papilloma virus into the body.For a long time, the virus can multiply primarily, not manifesting clinically (chronic carriage).If the virus propagates in the surface layers of the skin, then over time, even with chronic carriage of the papilloma virus, cell hyperplasia is observed.
Since the human papilloma virus is nested in the external environment, the infection occurs with direct contacts.Enforced sexual ties lead to infection;Smoking, pregnancy, endometriosis, vitamin deficiency, immunodeficiencies are predisposing factors so that infection occurs when interacting with the virus.The risk of infection increases with frequent contacts with naked human skin, for example, with massage.
Clinical manifestations of papillomas
Papilloma is a neoplasm of the skin or mucous membranes and looks like a papillary growth that protrudes above the surrounding tissue.Papillomas are localized on the skin, mucous membranes, in the inguinal region and on the genitals, in some cases, papillomas are found in renal pelvis and on the mucous membrane of the ureters.
Since papilloma consists of connective tissue covered with skin and contains blood vessels, bleeding is possible during trauma.The neoplasm grows upward in the form of scattered papillae in various directions and looks like cauliflower.
The skin of the skin may not change, but in most cases papillomas have color from white to dirty brown.Favorite localization - the skin of brushes and hands.In patients with immunodeficiencies, papillomatosis is widespread.Primary changes in the skin begin to appear 1-6 months after infection.The concentration of the virus in the affected areas reaches the maximum by the 6th month from the moment of infection, it is this period that is the most contagious.
Depending on the type of virus, the clinical manifestations of papillomas are variable.So, vulgar papillomas look in the form of a solid bump with a diameter of 1 mm with a rough keratinizing surface.Vulgar papillomas are prone to merger, and therefore often affect significant areas of the skin.Simple (vulgar) papillomas are localized everywhere, but more often they are affected by the skin of the fingers and the back of the palms.In children, especially young people are affected by papillomas, this is due to physiological characteristics, since children crawl without clothes.Typically, vulgar papillomas are located in groups, but a prolonged existence of a single element is possible for several years.Immunodeficiency conditions and general diseases contribute to the spread of the process, in isolated cases, vulgar papilloma is malignant.
The causative agents of the papillomas are PAPC 1.2.4.A few months after infection on the skin of the sole, a small brilliant bump appears, which has all the signs of ordinary papilloma and is surrounded by a protruding rim.In some cases, subsidiaries of small sizes appear around one papilloma, which outwardly resemble bubbles.Then mosaic papillomatosis is diagnosed.
Papillomas on the soles are often painful, especially when walking.In approximately 30% of cases, they are self -dissolving, more often self -procurement is observed in young children.They are often confused with corns that appear between the fingers with prolonged compression.However, corns, unlike papillomas, have a smooth surface and retain the skin pattern.
The causative agents of the flat papillomas are HPV 3.10.These papillomas of the unchanged skin color and look in the form of smooth flat cones, sometimes there can be a yellowish or slightly pink shade more often rounded outlines.Multiplant papillomas are also found.The neoplasms cause pain, itching, the affected area is hyperemic.
Film papillomas are diagnosed in half of those who have turned over older than 50 years about neoplasms on the skin, they are also called acrochords.They are localized on the skin around the eyes, in the groin, in the axillary cavities and on the neck.First, a small-sized yellowish shade appear, which further increase and gradually converts into dense elongated elastic formations in size up to 5-6mm.If acrochords are localized in places where trauma is possible, then they become inflamed and hurt.Film papillomas are not prone to spontaneous disappearance.In patients with diagnosed threaded papillomas, the rectum polyps are often observed.
HPV 13, 32 cause local epithelial hyperplasia, which is characterized by the appearance on the mucous membrane of the mouth and on the red border of the lips of small papillary neoplasms, which slightly rise above the skin and are prone to fusion.
One of the papillomas rarely found are the papillomas of Lewandovsky-Lutz (warty epidermodisphelia).Mostly children and adolescents are sick.Sometimes warty epidermodisplasia is family character.It looks clinically like multiple red-brown spotted papillomas on the hands and feet.If papillomas are located in skin areas, which are most susceptible to ultraviolet radiation, then in 30% of cases they are malignant and reborn into malignant tumors with germination into neighboring tissues.
HPV, which are the pathogens of pointed condils, can be with a low, medium and high risk of oncological degeneration, therefore, when diagnosing sharp-pointed confectionils, PCR examination always needs to be carried out.The incubation period is from several weeks to several months.Since in some cases the changes are minimal, these papillomas remain unnoticed.The main transmission path is sexual.The risk group includes people with immunodeficiency and often changing sexual partners.Outwardly, they look like pink or pale gray pigmented pointed growths on the leg.
In most cases, pain, burning, itching, irritation when touching and friction with underwear are noted, often injured and bleed.They are localized on the eve of the vagina, on small labia, less often, spicy condylomas are found in the vagina and on the cervix.In men, the hole of the urethra is affected.The damage zone depends on sexual behavior in this way, in people practicing anal contacts, pointed condylomas are found in the perineum and in the perianal zone.In some cases, pointed condylomas are diagnosed on the oral mucosa and on the red border of the lips, which is again associated with the characteristics of the sexual activity.
Juvenile papillomas of larynx rarely record, they are caused by HPV 6.11;For the most part, children under five are sick.Infection occurs during childbirth, when the woman in labor has papillomas in the vagina and the child while passing along the birth canal, takes a premature breath.The disease is characterized by papillary growths on vocal bundles, which leads to the difficulty of air circulation and speech disorders.
Diagnosis of papillomas
Diagnosis of papillomas is carried out by a dermatologist or venereologist.Due to the large number of types of virus, it has its own characteristics.It is possible to make an accurate diagnosis based on a visual inspection only in the classic case of the pointed warts, but this does not give accurate information about the type of virus and its oncogenicity.Therefore, in case of suspicion of the papillomatous nature of neoplasms, they resort to the PCR diagnostics of the DNA of the virus.
PCR diagnostics allows not only to confirm the presence of the human papillomavirus in the body and determine its type, but also to diagnose how many viruses are in the body at the time of analysis.This has a diagnostic value, since, knowing the percentage of the virus content and its type, you can determine the approximate periods of infection and identify contact persons in order to examine and prescribe preventive therapy.PCR diagnostics also gives information about whether papillomas have a chronic course or they are a consequence of a simultaneous decrease in immunity.Thanks to such data, adequate therapy can be prescribed.
If the only treatment method is the removal of papillomas, then in parallel with surgery, a biopsy is carried out for cytological research.A histological examination of the tissue of papillomas gives more accurate results, since the examination is subject to as cells, so the correct location of their layers and the structural features of the tissue.This gives reliable results about the degree of changes in the body and about the probability of malignancy, since long -term and non -unequal papillomas are more often leading to cancer than the detected HPV with a high degree of oncoris.
As a rule, the PCR diagnostics is screening in nature and, if the analysis confirms the presence of the virus, then an additional study is carried out.
Papilloma treatment
The treatment regimen of papillomas in each case is selected individually.If a HPV is detected during the diagnosis, but there are no clinical manifestations yet, then preventive therapy is prescribed by cytostatics.It is quite effective and allows you to "strew" the virus for several years.Patients who are carriers of HPV are recommended to periodically conduct PCR examination and use barrier means of contraception, so as not to danger the human papillomavis infection with their partner.
Inozin pranobex is a drug for the treatment of papillomas from the group of antiviral agents, which suppresses the reproduction of viruses.It is one of the most preferred, as it has immunomodulating properties.Indications for use are diagnosed papillomas with a combination of other viral infections, such as cytomegalovirus infections, measles and mumps.The presence of a herpes virus, chronic viral hepatitis and immunodeficiency also requires the inclusion of isoprinosine in the treatment regimen.Since papilloma therapy is long, the papillo pranobex must only be taken under the supervision of a doctor, since it is necessary to control laboratory indicators.The use of immunomodulators and vitamin courses are shown to all patients with HPV.
If there are manifestations of HPV on the skin and mucous membranes, then, depending on localization and symptoms, resort to cryodestruction of papillomas, electrocoagulation or the removal of Papill Laser.It is possible to use another modern method of surgical treatment -removal of papillomas with radio waves.If papilloma has signs of malignancy, then excision is carried out with a scalpel of the affected area with the capture of healthy tissues.
It should be borne in mind that the removal of papillomas does not lead to a complete recovery, since today there are no drugs that are detailed on HPV.Therefore, patients with previously diagnosed papillomas need to periodically undergo examination and conduct antiviral therapy courses.
Since HPV is mainly transmitted sexually, the only prevention of papillomas is the barrier method of contraception.When planning pregnancy, it is necessary to diagnose and, if required, then the treatment of the virus in order to reduce the likelihood of infection of the child during childbirth and in the first years of life.