Human papillomavirus ( HPV ) - Causes, Symptoms and Treatment .MF .
C problem diagnosis and treatment of human papillomavirus (HPV) face dermatovenereologists, urologists, oncologists, beauticians, pathologists, immunologists, virologists.This question has always stood and stands sharply due to the high transmissibility of the virus and HPV ability to induce tumor processes.
HPV tropic to epithelial cells, so they are found in the skin, conjunctiva, the mucous membranes of the mouth, esophagus, bronchi and rectum.As a result, the cells start to proliferate, but the full viral replication occurs in the highly specialized cells.HPV virus is the only one capable of producing a tumor in vivo.
Types of Human Papilloma Virus
HPV for carcinogenicity Division
At the moment, there are about 100 types of HPV, and besides the fact that almost every one of them causes neoplastic processes specific localization of their more conventionally divided into two groups - high and low oncogenicrisk.By oncogenic HPV high risk include: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 68. on
Symptoms of HPV
Education on the skin caused by HPV:
• Common warts on the skin caused by the following HPV types: 1-4 (plantar warts or the people "shipitsy"), 26-29, 38, 41, 49, 57, 63, 65, 75-77.Common warts - the most common benign epidermal proliferative education.First, they are formed as a dome-shaped papules, the size of a pinhead, and as they grow, they darken and become rough shape.They may be arranged singly or in groups, but in any case initially formed parent wart, which are formed around the child.The location of the warts may feel pain, a slight burning sensation, but it is possible and no abnormal sensitivity.The most frequent localization - on the back surface of the upper and lower limbs, eyelids as filamentous warts in the beard area in the scalp, in the interdigital spaces, on the palm and the inner surfaces of the fingers on the red border of lips, on the plantar surface (this localizationIt tends to increase in skin depth).
Plantar warts are located in areas of compression (metadorsalnoy sole and heel region), they are presented gross keratotic papules with a growth trend in the depth of tissue and rapid spread.This type of wart is sufficiently resistant to treatment.They look like calluses and walking pain.
plantar warts (shipitsa)
• Warts Butcher 2, 7. This type of wart resembles a cutaneous horn is long threadlike papules, often localized in the upper limbs, and can occur after a cut on his finger.
• Flat warts are caused by 10, 49, 28 HPV type, they are slightly raised above the surface of the skin, with a tendency to group.They corporal or pale brown color, often localized on the forehead and shoulders in the form of keratitis, or nevi, also exhibit this type of warts on the penis, cervix, vulva, and rectum.
• Verrutsiformnaya epidermodysplasia: 2, 3, 5, 8-10, 12, 14, 15, 17, 19, 20-25, 37, 47, 50. This is a rare life dermatosis characterizedlong-term persistence and refractory virus manifests itself in the form of disseminated flat wart lesions or hypo / hyperpigmented spots resembling pityriasis versicolor.The spots are covered with small scales, tend to merge.Inherited is recessive in type, and therefore at risk people who are in blizkorodstennom marriage.Eruptions are located in open areas: face, neck, upper limbs.This type of HPV never regresses and is resistant to treatment, and a high risk of malignancy.
• periungual warts caused by HPV type 16, are located on the sides of the nail bed, with a tendency of growing into the skin and further nail dystrophy.
• Bowen's disease: 16, 34, 35, 55. Otherwise, the disease is called Bouenalny pappulёz, it is detected in the form of multiple small papules located in the anogenital areas, and more often in young people.Goodness in question, because it is induced by the 16th type of HPV.
• Squamous cell carcinoma: 5,8, 14, 17, 20, 41, 47.
• Keratokantoma 37
• Melanoma: 38
Education genital (anogenital warts):
• Genital warts: 6, 11, 42, 44, 51, 54, 55, 69. These education ironed as cauliflower or cockscomb.The most common injury areas: the foreskin, the glans penis, endouralnaya area peranalnraya area, labia, vagina, cervix, urethra mouth, corners of the mouth.And the presence of genital Kandil always indicative of sexual intercourse, through which infection occurred.The most prominent representative of this group of diseases HPV - a giant condyloma Buschke-Levenshtenna, which is located either on the trunk of the penis, or in the coronal sulcus or in the perianal region.First, there are small papillomas, which then grow rapidly, coalesce and form a lesion with a broad base.The main difference from all other warts - progressive increase in destructive changes in the underlying tissues, and relapsing.Another representative - papillomatosis of the vulva, represented by granular elements in the vulvar area.The greatest danger is posed by HPV associated diseases of the urogenital tract (chlamydia, mycoplasmosis, cytomegalovirus infection).Cervical kandilomy difficult to diagnose and the most dangerous for pregnant women, because in this period they are subject to decay, resulting in open bleeding which is often joined by secondary infection.But this kind of postpartum warts may regress spontaneously, but only if they were stored during pregnancy.
• Anal intraepithelial neoplasia: 16, 18, 30, 31,33, 35, 39, 45, 51, 52, 56, 58, 66, 69.
• Cancer: 6,11, 16, 18, 31, 33, 35, 39, 45, 51, 52, 54. 56, 66, 69.
• Papilloma: 6, 7, 11, 32, 57, 72, 73. One of the representatives of this type is blooming papillomatosis, in the mouth it looks like a cauliflower - white vegetating plaque in the mouth.Most often it occurs in older people.On this form of human papillomavirus infection, little is known, so we can not clearly answer the question about her malignancy.Laryngeal papillomatosis can spread to the trachea, bronchi and lung tissue.It is a disease predominantly 6 and 1 type, he often exposed to kids and adults.As a result of the defeat of the larynx, the first symptoms is hoarseness and aphonia, hoarseness, difficulty in breathing.
• The focal epithelial hyperplasia: 13-32
• Cancer: 2, 6, 11, 16, 18, 30.
Clinical manifestations may be skin and ekstrakutannymi (mucous in okolonogtevoy areas on the cervix and so on.d).
Diagnosis of human papillomavirus
• Objective inspection
• Histological study that helps to see cell atypia, the presence koylotsitov helps differentiate HPV high and low oncogenic risk (low oncogenic risk detect diploid or polidiploidnuyu DNA, while high - aneuploidDNA), and, without missing malignancy.
• The PCR method is highly specific and highly sensitive method, this method helps to predict the course of disease.
Despite many treatments, it is believed that HPV can not be eliminated completely, so all treatment is to remove the clinical and subclinical manifestations.The approach in the treatment must be strictly individual.For successful treatment is necessary to observe a few guidelines:
• Periodic examination for early detection and treatment of anogenital warts, because it is the main route of transmission - sexual (but may be household - is extremely rare).
• Upon detection of HPV foci need to constantly monitor them to prevent the development of malignancy and metastasis.
• Patients should be advised to use condoms or avoid casual sex.
1. Destructive methods: surgical excision, curettage, electrosurgery, cryosurgery, laser surgery.
- Surgical treatment is carried out in cases of suspected malignancy.It is used not so often, because when you remove the warts can be opened to bleed heavily.During this manipulation excised wart sent for biopsy, and the wound is sutured.
- Curettage - removal of warts using a curette, ie by scraping.After that produce electrocoagulation, and the wound is laid dry bandage.
- Electrosurgery is used for small warts department.But even in this case there are relapses.This method can also be used and large warts, but before they have to be soaked in or administered warts electrode thickness, thus uncoupling between becomes less durable cells.
- Cryodestruction made with liquid nitrogen.
- Laser Surgery currently occupies a leading position in the surgical treatment, ie in addition to the destruction carried out in parallel hemostasis.In addition, the laser vaporizes the wart, it exerts a direct toxic effect on HPV, so this method of treatment is in first place on the choice of the treatment of cervical intraepithelial neoplasia, also yavlyaetsmya dominant in the treatment of genital warts in pregnant women (even in the last stages of development).
2. Chemicals with cauterizing effect: solitsilovaya acid, trichloroacetic acid, solkoderm.The main advantage of this method is relatively safe.
- Salicylic acid has a pronounced keratolytic effect, but for a better penetration of salicylic acid into the interior of the warts, they should soak in warm water, and at the end of the procedure to remove these pathological obrazoaniya via Penza, and then seal the plaster.
- Trichloroacetic acid working concentration of 50-90% provides chemical destruction of tissue, but after using it on the site of pain or ulcers are formed.
- Kontaridin no direct antiviral effect but inhibits mitochondrial infected epithelial cells leads to their death, acanthosis and bubble formation.Administration is allowed to stand for 24 hours, and waiting for the formation of a bubble in the past 2 days.Thereafter, healing occurs within 1 week, while leaving no scar.
- Solkoderm, unlike other drugs, has only a strictly limited action, without damaging surrounding tissue.This method is one of the leading chemical.
3. cytostatic drugs: podofilin, podophylotoxins, 5-fluorouracil, kleomitsin.
- Podophyllin - cytostatic drug is a substance from a plant and is used for the treatment of anogenital warts in the form of a 10-25% alcohol solution.Cell death occurs through inhibition of DNA synthesis mediated by.
- toxic 5-fluorouracil for the viral DNA.This drug is used in the anogenital stability, flat and vulgar warts to other therapies.
- Bleomycin - sulfur-containing glycopeptide cytostatic agent with antitumor, antibacterial and antiviral activity!This preparation is injected directly into the wart tissue, where it binds to the viral DNA and blocking its synthesis.The injection is painful, so before the procedure is necessary to anesthetize the place EMLA cream, and dilute the drug with anesthetic.The procedure is carried out every 2-3 weeks.
4. Immunotherapy: interferon imikvilod, izoprinozin.This method of treatment is only applicable in combination with other techniques, because it does not have any specific effect and only activates the immune system components.
5. Combination treatments include a combination of the mentioned methods.
therapists Shabanova IE