Papillomas: types, manifestations and features of treatment

Papillomas are widespread in modern society. According to medical statistics, they are observed 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 of the manifestations of human papillomavirus (HPV) infection, the strains of which are more than 190 species. Among these are distinguished viruses with high, medium and low oncogenic risk. Therefore, in addition to an aesthetic drawback, papillomas can pose a serious danger to human life and health, as some of them can turn into malignant tumors.

What is HPV?

The human papillomavirus infects only humans and its main route of transmission is sexual. Therefore, HPV is more common among 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, different strains (types) of HPV can be in the human body at the same time, causing different types of tumor-like formations to appear on the skin and mucous membranes.

The disease caused by HPV is called papillomatosis.

Infection with the virus occurs when it comes in contact with the skin or mucous membranes with exfoliating skin particles or mucous membranes of an infected person. They attach themselves to the membranes of immature epithelial cells, from where they penetrate into the cytoplasm of the cell and subsequently into the nucleus. It is in the cell nucleus that DNA is contained, which damages HPV. Consequently, when the affected cell divides, the consequence of this will be the formation of new cells that are not healthy, but with already altered genetic information, which leads to disruptions 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 the formation of papillomas, but also warts, flat warts and genitals. However, it can be asymptomatic. In this case, the patient will not show external signs of human papillomavirus infection, but will act as a carrier and can infect others during unprotected intercourse or at home.

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

The human papillomavirus is intracellular. Therefore, with a sufficient strength of the immune system, the body successfully suppresses its activity and does not provide the opportunity to provoke cell proliferation. But with a weakening of immunity due to the action of some 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).

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

The extent of the danger posed by papillomas directly depends 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.

Seventy percent of cervical cancer cases are due to HPV types 16 and 18 infection.

But even if infected with low oncogenic risk strains and papilloma formation, they should be treated carefully. Convex tumors are often injured by clothing, bleed and tend to become inflamed. At the same time, perhaps the greatest discomfort is brought by 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 cause the development of purulent-septic complications. In addition, papillomas can form on the mucous membranes of almost any internal organ, which leads to the disruption of their work. Thus, papillomatosis of the upper respiratory tract is often found, which causes difficulty in breathing.

Causes of the formation of papillomas and risk factors

HPV can be transmitted sexually, as well as from an infected mother to her baby during childbirth. The contact-family route of transmission of the virus is not excluded, that is, with the joint use of towels, clothes, 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 sexual 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 HPV strains;
• the presence in the body at the same time of several types of HPV;
• the presence of other sexually transmitted diseases (STDs), in particular 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 miscarriages;
• the presence of severe chronic diseases, in particular diabetes mellitus;
• lead an unhealthy lifestyle, the presence of bad habits;
• poor living conditions.

Older and overweight people are more prone to papilloma formation. In addition, their neoplasms often form in skin folds, which contributes to their injury and inflammation.

Types and symptoms

Cancers 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 along the coronal sulcus and frenum. 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 all cases the reason for their appearance is the same - human papillomavirus infection.

• Papillomas are benign neoplasms of pink, white, pearl or light brown color, which most often form on the eyelids, lips, chest, armpits, neck. They lie on their own and do not usually tend to merge, even with multiple injuries. Papillomas are usually round or irregular, resemble the head of cauliflower, more often they have a leg.
• Warts are benign formations of a dirty brown or lighter color in the form of a cockscomb or set of villi joined by a common base. Most often they are found in the genital area, in the anus and around the mouth. They tend to merge with each other and, as a result, cover large areas of the body. Their appearance is due to HPV type 6 and 11 infection. Distinguish between pointed, flat and intraepithelial warts.
• Warts are irregular, light and benign tumor formations in the form of a plaque or small lump on the surface of the skin of the hands, nails, feet, face and front of the body. Warts may look like papillomas, but they differ from them on a broad basis. They usually occur with HPV infection of 1-5, 7-10, 12, 14, 15, 17, 19-24 types.

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

In addition, neoplasms can 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 cluster.
• Plantar warts are raised above the surface of the skin, often painful bumps with a shiny surface and edge. One feature is the absence of a skin pattern. Their formation is provoked by HPV types 1, 2, 4.
• Flat papillomas are soft, smooth, flat, generally 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 are HPV 3 and 10 strains.
• Filiform (acrocord) are one of the most common papillomas, especially among elderly patients. Most often it is found on the face, around the eyes, in the groin, in the armpits, on the neck. They are yellowish in color and tend to grow gradually, turning into bumps with a dense but elastic consistency.
• Genital warts in the perineum, genitals.

Papillomas can 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 genital organs by papillomatosis can indicate:

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

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

Diagnostics

If papillomas form on the body, face or genitals, you should consult a dermatologist. This will allow not only to diagnose human papillomavirus infection in the early stages, 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 visit a doctor if there are signs of growth, discoloration of the papilloma, unpleasant smell or pain in the area of its localization.

First of all, the doctor will carry out a dermatoscopy, that is, an examination of the neoplasms using a special magnifying device. This will allow to determine their nature, as well as to notice dangerous signs that indicate 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 are successfully treatable and have a favorable prognosis in the future.

It is imperative that patients be recommended to be tested for sexually transmitted diseases, especially if warts are found in the genital area. Also, in such situations, women have been shown to receive advice from a gynecologist, and men from a urologist. This is important for diagnosing the presence of a human papillomavirus lesion of the cervix, urethra, etc. and, if necessary, to 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 human papillomavirus infection, but also to accurately determine the strains.

Treatment and removal of papillomas

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 defenses, which allows dormant HPV in the body to become active, first of all, drug therapy is prescribed to patients with papillomatosis. Includes the intake of immunomodulators and antiviral agents. With extensive lesions of the skin and mucous membranes with papillomas, cytotoxic drugs can 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 illnesses, the appropriate treatment should be prescribed for the situation and sometimes it is also necessary to consult a specialist specialist and undergo therapy under her supervision.

Warts of all types are subject to mandatory removal, as are papillomas, which are often injured and inflamed. In other cases, removal 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 the treatment of any concomitant diseases and against the background of the continuation of 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, by electrocoagulation, cryodestruction, laser, radio wave or plasma coagulation.

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

The success of the treatment and especially the removal of papillomas depends on the strength of the immune system. In its normal state, in 90% of cases, within 2 years from the moment of infection, HPV is suppressed or even completely destroyed. But this is not a 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 HPV strains and the development of serious complications, it is recommended, especially for girls, to be vaccinated between 9 and 25 years of age.

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 an increase in healing times. Therefore, it is used only when it is necessary to remove a large papilloma or in those cases when it is necessary to conduct a histological examination, since the formation of malignant cells is assumed.

The procedure 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 papilloma reformation in the same place. If it has a leg, it is dissected with surgical scissors and with the help of an electrocoagulator, the blood vessel that fed the neoplasm is "sealed". The remaining wound is sutured, treated with an antiseptic and covered with a sterile bandage.

Today, surgical removal of papillomas is mainly performed when the formation of cancer cells is suspected.

cryodestruction

The method involves the use of low temperatures to destroy 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 touch the papilloma with a cotton swab dipped in 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 it, since the time of exposure to liquid nitrogen does not exceed 5-20 seconds.

The complexity of the method lies in choosing the correct duration of exposure in order to remove the papilloma in all its depth and not damage healthy tissues, 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 clear or pinkish liquid content forms on it, and the surrounding skin becomes red and may swell slightly. This may be accompanied by mild discomfort in the form of a burning or tingling sensation.

After 3-4 days, the blister bursts and a crust forms in its place, which in turn disappears after a few days, exposing the young and healthy skin. In no case should you independently puncture the blister, injure it or scab in another way.

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

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

Removal of papillomas with a laser

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

As a result, a crust forms at the site of the papilloma, and the skin around it becomes red and swollen. The scab will go away on its own within a week. It cannot be soaked and steamed for 3 days, as well as torn and injured, as it is fraught with scars. In addition, within 2 weeks of papilloma removal, it is worth protecting the area to be treated from sunlight. 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 off, healthy pink skin is exposed, which gradually takes on a normal hue. This is the main advantage of laser papilloma removal, as it does not involve the formation of scars and scars. They can form only when large neoplasms are removed and the rules of care are violated in the postoperative period. In addition, laser removal completely eliminates the risk of wound infection and is an absolutely bloodless method, since under the influence of thermal 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 1 cm or more into the tissue.

Electrocoagulation of papillomas

The essence of the method is to use an electric current to remove papillomas. Using a special apparatus called an electrocoagulator, the doctor captures the papilloma and cuts it into healthy tissue. In this case, 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 you need to remove the growth in areas of the body with delicate skin.

After electrocoagulation, a crust also forms. And the entire recovery period takes 7-10 days. After the scab falls off, the skin under it should be protected from damage and exposure to ultraviolet radiation.

The method is used to remove papillomas in different parts of the body. In addition, electrocoagulation can also be used in cases where 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, since if the removal is not deep enough, the papilloma can form again in the same area.

Radio wave surgery

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

Chemical removal of papillomas

The method involves the regular application of special compounds to the papilloma, which destroy 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.

Therefore, 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. However, in most cases, they do not cause significant inconvenience to a person, with the exception of genital and anus warts, which must be removed. In any case, you can quickly and effectively get rid of any papillomas, 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 another strain, there is a possibility that the problem will recur. 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 solve this problem in minutes.