Papillomas: types, manifestations and features of treatment

Papillomas are prevalent in modern society. According to medical statistics, they are seen in one form or another in 80% of people and are small benign tumor-like formations on the skin and mucous membranes of different parts of the body. They are just one manifestation of infection with the human papillomavirus (HPV), the strains of which number more than 190 species. Among them, we distinguish viruses with high, medium and low oncogenic risk. Therefore, in addition to a cosmetic inconvenience, papillomas can be a serious danger to human life and health, as some of them can turn into malignant tumors.

<1_img_centerxx>

What is HPV

The human papillomavirus only infects humans and its primary route of transmission is sexual. Therefore, HPV is more common in sexually active people. This explains the fact that most often the infection occurs at a young age at the time of the onset of sexual activity and at its peak, that is, 15-25 years. In addition, several strains (types) of HPV can be found simultaneously in the human body, causing the appearance of different types of tumor formations on the skin and mucous membranes.

The disease caused by HPV is called papillomatosis.

Infection with the virus occurs when it comes into contact on the skin or mucous membranes with peeling particles from the skin or mucous membranes of an infected person. They attach to the membranes of immature epithelial cells, from where they enter the cytoplasm of the cell and then into the nucleus. DNA is found in the cell nucleus, which HPV damages. As a result, when the affected cell divides, the consequence will be the formation of new cells that are not healthy, but already have altered genetic information, which leads to disturbances in the mechanism of their reproduction and differentiation. This becomes the reason for the appearance of neoplasms on the skin and mucous membranes.

HPV infection can lead not only to papillomas, but also warts, as well as flat and genital warts. However, it can be asymptomatic. In this case, the patient will not show any outward signs of infection with the human papillomavirus, but will act as a carrier and may infect other people during unprotected sex or at home.

Thus, HPV infection does not always lead to the formation of papillomas. It depends on the strength of the person's immunity, but most often the first small papillomas appear 1 to 6 months after infection.

The human papillomavirus is intracellular. Therefore, with sufficient strength of the immune system, the body successfully suppresses its activity and does not allow to provoke cell proliferation. But with a weakening of immunity under the action of certain factors, the body's defenses fall, the virus is activated, which leads to the formation of papillomas.

All strains or types of HPV can be divided into 4 groups:

• non-oncogenic - strains 1-5, 63;
• low oncogenic risk - strains 6, 11, 40, 42-44, 54, 61, 70, 72, 81;
• medium oncogenic risk - strains 26, 31, 33, 35, 51-53, 58, 66;
• high oncogenic risk - strains 16, 18, 39, 45, 56, 59, 68, 73, 82 (types 16 and 18 are considered the most dangerous).

High risk oncogenic HPV strains have special genes in their DNA that are responsible for the synthesis of specific proteins, oncoproteins (E6 and E7). Thus, when it is incorporated into the DNA of a human cell, its anti-cancer protection decreases. Oncoproteins destabilize the genome of the skin cell, cause its active reproduction and suppress the ability to differentiate. Therefore, it presents a high risk of developing cancer when infected with strains of human papillomavirus with high oncogenic risk.

The extent of the danger posed by papillomas depends directly on the type of HPV. Infection with high risk oncogenic strains is dangerous for development:

• Cervical cancer;
• malignant tumors of the anus, vulva, penis;
• oropharyngeal cancer, etc.

70% of cervical cancer cases are due to infection with HPV types 16 and 18.

But even when infected with strains with low risk of cancer and papilloma formation, they should be treated with care. Convex neoplasms are often injured by clothing, bleed, and tend to inflame. At the same time, perhaps the greatest discomfort is caused by the formations on the genitals, which cause severe discomfort and complicate the conduct of an intimate life. In such cases, it is possible to attach a secondary infection, which can provoke the development of purulent-septic complications. In addition, papillomas can form on the mucous membranes of almost any internal organ, disrupting their work. Thus, papillomatosis of the upper respiratory tract is often found, which causes breathing difficulties.

Causes of papilloma formation and risk factors

HPV can be transmitted sexually, as well as from an infected mother to her baby during childbirth. The contact-household route of transmission of the virus is not excluded, i. e. with the joint use of towels, clothing, etc. This explains the high prevalence of HPV in the world. Self-infection is also possible. In this case, if a papilloma is injured, the virus can be transferred to healthy areas of the skin and affect them.

The main causes of HPV infection are frequent changes of sex partners and unprotected sex.

But infection with a virus does not always lead to the formation of papillomas, genital warts, etc. The likelihood of developing papillomatosis depends on various factors:

• immunodeficiency of any origin, including taking drugs that suppress immunity (immunosuppressants, cytostatics, etc. ), the presence of HIV infection, radiation damage;
• decrease in the body's defenses against the background of physiological changes during pregnancy;
• early onset of sexual activity, when the immune system is not yet fully formed and strengthened;
• microtrauma of the skin and mucous membranes;
• infection with highly oncogenic strains of HPV;
• the presence in the body at the same time of several types of HPV;
• the presence of other sexually transmitted diseases (STDs), especially gonorrhea, trichomoniasis, herpes, cytomegalovirus infection, Epstein-Barr virus, hepatitis B and C, etc. ;
• hormonal disorders;
• exhaustion of the body, hypovitaminosis, chronic fatigue and severe stress;
• multiple births and abortions;
• the presence of severe chronic diseases, especially diabetes mellitus;
• lead an unhealthy lifestyle, the presence of bad habits;
• bad life conditions.

The elderly and overweight are more prone to the formation of papillomas. In addition, their neoplasms often form in the folds of the skin, which contributes to their injury and inflammation.

Types and symptoms

Neoplasms caused by HPV infection can form on the skin and mucous membranes of various parts of the body, including the face, neck, and décolleté. They can also form on the arms, legs, back, genitals including the perineum, labia minora and labia majora, vulva, vagina, cervix, penis, especially alongof the coronal furrow and the frenulum. Damage to the mucous membrane of the oral cavity, tongue, nasopharynx, esophagus, bladder, conjunctiva of the eye, trachea and other internal organs is not excluded.

Human papillomavirus can lead to the appearance of neoplasms of a different nature. In general, they can be divided into 3 groups, although in any case the reason for their appearance is the same - infection with the human papillomavirus.

• Papillomas are benign neoplasms that are pink, white, pearly or light brown in color, most often forming on the eyelids, lips, chest, armpits, neck. They are localized alone and generally do not tend to fuse, even with multiple lesions. Papillomas are usually round or bumpy, resemble the head of a cauliflower, more often have a leg.
• Warts are benign formations of a dirty brown or paler color in the form of a rooster crest or set of villi united by a common base. Most often, they are found in the genital area, anus, and around the mouth. They tend to merge together and, therefore, cover large areas of the body. Their onset is due to infection with HPV types 6 and 11. Distinguish between sharp, flat and intraepithelial warts.
• Warts are patchy, mild, benign, tumor-like formations in the form of a plaque or small nodule on the surface of the skin of the hands, nails, feet, face, and the front of the body. body. Warts can look like papillomas, but differ from them in a broad base. They usually occur with HPV infection types 1-5, 7-10, 12, 14, 15, 17, 19-24.

Such tumor-like formations can vary in size from a few millimeters to large growths that cover large areas of the skin or mucous membranes.

Also, neoplasms may differ in appearance, which directly depends on the type of HPV that has entered the body. More often than others, there are:

• Vulgar or common - bulges of dense consistency with a diameter of more than 1 mm. They tend to merge and group together.
• Plantar warts are raised above the surface of the skin, often painful bumps with a shiny surface and rim. A characteristic feature is the absence of a skin pattern. Their formation is caused by HPV types 1, 2, 4.
• Flat papillomas are soft, smooth, flat, usually rounded growths that have a normal or slightly yellowish, pinkish skin color. They can be itchy, so they are often injured, painful, and inflamed. The cause of their formation is HPV strains 3 and 10.
• Filiforms (acrocords) are one of the most common papillomas, especially in elderly patients. Most often found on the face, around the eyes, in the groin, armpits, on the neck. They are yellowish in color and tend to grow gradually, turning into lumps of a dense but elastic consistency.
• Genital warts in the perineum, genitals.

Papillomas may be visible to the naked eye or located in the thickness of the skin or mucous membranes. In the latter case, they are called endophytes and one of their manifestations is cervical dysplasia. The defeat of the female internal genitalia by papillomatosis may indicate:

• itching, burning, crying in the perineum;
• profuse leucorrhea;
• bloody discharge, in particular, occurring after intercourse;
• discomfort during intimacy.

Sometimes papillomatosis can cause back and pelvic pain, weakness, swelling in the legs, and unnecessary weight loss. These signs are among the most alarming, as they can indicate the development of complications from HPV infection.

Diagnostic

If papillomas form on the body, face, or genitals, you should see a dermatologist. This will not only make it possible to diagnose human papillomavirus infection at an early stage, but also to take measures to prevent the formation of new elements, as well as to observe changes in existing ones.

It is especially important not to hesitate to consult a doctor if signs of growth, discoloration of the papilloma, an unpleasant smell or pain in the area of its localization appear.

First of all, the doctor will perform a dermatoscopy, that is, an examination of neoplasms using a special magnifying device. This will allow to determine their nature, as well as to notice dangerous signs indicating a high probability of degeneration of a benign formation into a malignant one, not to mention a formed cancer. If detected at an early stage of development, they can be treated successfully and have a favorable prognosis in the future.

It is imperative to recommend patients to be tested for STDs, especially if warts are found in the genital area. In addition, in such situations, it is shown that women receive advice from a gynecologist and men from a urologist. This is important for diagnosing the presence of human papillomavirus lesion of the cervix, urethra, etc. and, if necessary, prescribe appropriate treatment.

To confirm papillomatous infection, patients are usually assigned a PCR analysis. With its help, it is possible not only to confirm or deny infection with the human papillomavirus, but also to accurately determine the strains.

Treatment and removal of papillomas

The treatment of human papillomavirus infection is always complex. Of course, you can simply remove the disturbing papilloma, but in this case there is a high risk that a new one or even several will soon form in its place. Since the main reason for the formation of papillomas is a decrease in the body's own defenses, which allows the dormant HPV in the body to become active, first of all, patients with papillomatosis are prescribed drug therapy. This includes taking immunomodulators and antiviral agents. In case of extensive lesions of the skin and mucous membranes with papillomas, cytotoxic drugs may also be prescribed. But they are taken under the supervision of a doctor, as they can cause serious side effects.

If a patient is diagnosed with concomitant infections or diseases, he should be prescribed the appropriate treatment for the situation, and sometimes it is necessary to additionally consult a specialized specialist and undergo treatment under his supervision.

Warts of all types are subject to forced removal, as well as papillomas, which are often injured and inflamed. In other cases, the withdrawal is carried out at the request of the patient. But it is possible to begin to eliminate the visible manifestations of HPV infection only after the end of treatment of concomitant diseases, if any, and against the background of continued antiviral therapy.

In general, all modern methods of destruction or removal of papillomas can be divided into 2 large groups:

• chemical - consists in the use of various chemical compounds to remove papillomas, including trichloroacetic acid, dermatological preparations;
• physical - involves the removal of papillomas by surgery, using electrocoagulation, cryodestruction, laser, radio waves, or plasma coagulation.

After removing the papilloma by one method or another, it is important to use topical agents prescribed by the doctor to speed healing and eliminate the risk of infection.

The success of the treatment and especially the elimination of papillomas depends on the strength of the immune system. In its normal state, in 90% of cases, within 2 years of infection, HPV is suppressed or even completely destroyed. But this does not guarantee that there is no risk of reinfection or the formation of new papillomas. If immunity is reduced due to the action of certain factors, papillomatosis becomes chronic, periodically gives relapses and can lead to serious complications.

In order to prevent infection with dangerous strains of HPV and the development of serious complications, it is recommended, especially for girls, to be vaccinated between the ages of 9 and 25.

Surgical removal of papillomas

The essence of the method is to remove the neoplasm with a scalpel, which is associated with the formation of scars and increased healing time. Therefore, it is used only when it is necessary to remove a large papilloma or in cases when it is necessary to conduct a histological examination, since the formation of malignant cells is supposed in it.

The operation is performed under local anesthesia, which makes it painless. The doctor removes the neoplasm itself with a scalpel and captures the surrounding healthy tissue. This is necessary to eliminate the risk of reformation of the papilloma in the same place. If he has a leg, he is dissected with surgical scissors and, using an electrocoagulator, the blood vessel that supplied the neoplasm is "sealed". The remaining wound is sutured, treated with an antiseptic and covered with a sterile dressing.

Today, the surgical removal of papillomas is carried out mainly when there is a suspicion of cancer cell formation.

Cryodestruction

The method involves the use of low temperatures to destroy the papilloma cells. This is achieved through the use of liquid nitrogen, the temperature of which is -196 ° C. The essence of the procedure is to use a special nozzle or to touch the papilloma with a cotton swab moistened with liquid nitrogen. . Under its action, the water contained in the cells instantly transforms into ice crystals, which destroy them from the inside. The procedure is performed under local anesthesia or without local anesthesia, since the time of exposure to liquid nitrogen does not exceed 5-20 seconds.

The complexity of the method lies in choosing the right duration of exposure in order to remove the papilloma in all its depth and not to damage healthy tissue, which will lead to the formation of scars.

Immediately after treatment with liquid nitrogen, a white spot forms at the site of the papilloma. Subsequently, a small bubble with a transparent or pinkish liquid content forms on it and the surrounding skin turns red and may swell a little. This may be accompanied by mild discomfort in the form of a burning or tingling sensation.

After 3-4 days, the bubble bursts and a crust forms in its place, which itself disappears after a few days, exposing young and healthy skin. In no case should you independently pierce the bladder, injure it or crust in any other way.

Cauterization of papillomas with liquid nitrogen is possible only in cases where the possibility of the formation of malignant cells is completely excluded. This method is most often used to remove papillomas and genital warts on:

• centuries;
• face;
• small joints;
• genitals.

Removal of papillomas with a laser

The use of a laser to remove papillomas is also possible only in cases where their malignancy is completely excluded. The procedure is performed under local anesthesia and involves the evaporation of moisture from the papilloma cells with thermal energy from a laser. Thus, a focused laser beam is directed towards the neoplasm. The exposure time does not exceed 1 minute.

As a result, a scab forms at the site of the papilloma, and the skin around it turns red and swells. The crust will disappear on its own within a week. It cannot be soaked and steamed for 3 days, nor can it be torn off and hurt, because it is heavy with scars. In addition, within 2 weeks of removing the papilloma, the treatment area should be protected from the sun. Otherwise, there is a high probability of hyperpigmentation of this area.

When removing papillomas on the face with a laser, do not apply decorative cosmetics to the affected area until complete healing.

After the scab falls, healthy pink skin is exposed, which gradually takes on a normal shade. This is the main advantage of laser removal of papillomas, as it does not involve the formation of scars and scars. They can be formed only when large neoplasms are removed and the rules of care of the postoperative period are violated. In addition, laser removal completely eliminates the risk of infection of the wound and is an absolutely bloodless method, since under the influence of heat energy instant coagulation of small blood vessels occurs.

With the help of a laser, papillomas are mainly removed on:

• hands;
• legs and feet;
• face;
• centuries;
• neck;
• genitals.

Laser is the only reliable way to remove plantar warts, as their roots can penetrate tissue up to 1 cm or more.

Electrocoagulation of papillomas

The essence of the method is to use an electric current to remove papillomas. Using a special device called an electrocoagulator, the doctor captures the papilloma and cuts it from healthy tissue. In this case, the bleeding is completely absent, since the thermal energy of the current is sufficient for the coagulation of small blood vessels. But the procedure can be painful, especially if it is necessary to remove the growth in areas of the body with delicate skin.

After electrocoagulation, a crust also forms. And the whole recovery period takes 7-10 days. After the scab has fallen, the skin underneath must be protected from damage and exposure to ultraviolet rays.

The method is used to remove papillomas in different parts of the body. In addition, electrocoagulation can also be used in cases when it is necessary to conduct a histological examination of a neoplasm and accurately establish its nature. But the result of the procedure depends entirely on the qualifications and experience of the doctor, however, as in other cases, because if the ablation is not deep enough, the papilloma can re-form in the same area.

Radio wave surgery

This method is one of the most advanced in the removal of papillomas of any kind. It involves the use of a special device. But at the same time, it has a lot in common with laser removal of papillomas. The procedure is performed under local anesthesia and the removal occurs directly due to exposure of the neoplasm to radio waves. Thanks to them, it is possible to completely cut the papilloma of any size and location, as well as to avoid scarring.

Chemical removal of papillomas

The method involves the regular application of special compounds to the papilloma, which destroys their cells, which leads to the subsequent disappearance of the neoplasm. But when using such drugs, it is important to be extremely careful not to allow the substance to come into contact with healthy skin.

So, everyone can cope with the formation of papillomas. There is no effective prevention of HPV infection, and vaccines only protect against the most dangerous strains of the virus in terms of cancer risk. Nevertheless, in most cases, they do not cause any significant inconvenience to a person, with the exception of genital and anus warts, which must be removed. In any case, you can get rid of any papilloma quickly and effectively, but since it is impossible to completely destroy HPV in the body with drugs, and there is always a risk of getting infected again or with aother strain, it is possible that the problem will return. The only reliable way to minimize the likelihood of papilloma formation is to strengthen the immune system. And if they appear and represent a cosmetic defect or interfere with a person's daily life, contact a dermatologist. The doctor will be able to accurately differentiate papillomas from other skin neoplasms and resolve this problem within a few minutes.