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 benign small tumors on the skin and mucous membranes of various parts of the body. They are just one of the manifestations of human papillomavirus (HPV) infection, of which there are more than 190 strains. Among them are viruses with high, medium and low oncogenic risk. Therefore, in addition to an aesthetic defect, papillomas can pose a serious threat to human life and health, as some of them can transform into malignant tumors.

What is HPV

The human papillomavirus only infects humans and its main route of transmission is sexual. Therefore, HPV is most common among sexually active people. This explains the fact that the infection most often occurs at a young age during the onset of sexual activity and at its peak, ie 15-25 years. In addition, several strains (types) of HPV can be present in the human body at the same time, provoking the appearance of different types of tumors 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 particles of ruffled skin or mucous membranes of an infected person. They attach to the membranes of immature epithelial cells, from where they penetrate the cytoplasm of the cell and subsequently into the nucleus. It is in the cell nucleus that DNA is contained, which damages HPV. As a result, when the affected cell divides, the consequence will be the formation of unhealthy new cells, but with altered genetic information, which leads to disorders in the mechanism of their proliferation and differentiation. This causes the appearance of tumors on the skin and mucous membranes.

HPV infection can lead not only to the formation of papillomas, but also warts, as well as flat and genital warts. 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 may infect others 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 more often the first small papillomas appear 1-6 months after the infection.

The human papillomavirus is intracellular. Therefore, with sufficient strength of the immune system, the body successfully suppresses its activity and does not provide an opportunity to provoke cell proliferation. But with the weakening of immunity as a result of 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 (species 16 and 18 are considered the most dangerous).

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

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

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

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

But even when infected with low-risk oncogenic strains and papilloma formation, they must be treated carefully. Protruding neoplasms are often injured by clothing, bleed, and tend to become inflamed. At the same time, perhaps the greatest discomfort is caused by formations of the genitals, which cause severe discomfort and complicate the conduct of 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 all internal organs, which leads to disruption of their work. So papillomatosis of the upper respiratory tract is often found, causing difficulty breathing.

Causes of papilloma formation and risk factors

HPV can be sexually transmitted as well as from an infected mother to her baby during birth. The contact-household route of transmission of the virus is not excluded, ie 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 transmitted to healthy areas of the skin and affect them.

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

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

• immunodeficiency of any origin, including the use of drugs that suppress immunity (immunosuppressants, cytostatics, etc. ), the presence of HIV infection, radiation damage;
• reduction of 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;
• microtraumas of the skin and mucous membranes;
• infection with highly oncogenic strains of HPV;
• the presence in the body of several types of HPV simultaneously;
• 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;
• body exhaustion, hypovitaminosis, chronic fatigue and severe stress;
• multiple births and abortions;
• the presence of severe chronic diseases, in particular diabetes mellitus;
• leading an unhealthy lifestyle, having bad habits;
• poor living conditions.

Elderly people and overweight people are more prone to papillomas. Moreover, 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 major, vulva, vagina, cervix, penis, especially along the coronal sulcus and frenulum. Damage to the mucous membranes of the mouth, tongue, nasopharynx, esophagus, bladder, conjunctiva, trachea and other internal organs is not excluded.

Human papillomavirus can cause tumors of various natures. In general, they can be divided into 3 groups, although in all cases the reason for their appearance is the same - infection with human papillomavirus.

• Papillomas are benign neoplasms with pink, white, pearl or light brown color, most often formed on the eyelids, lips, chest, armpits, neck. They are located alone and usually do not tend to merge, even with multiple lesions. Papillomas are usually round or uneven, look like a cauliflower head, more often have a leg.
• Warts are benign formations of dirty brown or paler color in the form of a rooster or a set of forks united by a common base. They are most often found in the genitals, 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 infection with HPV types 6 and 11. They distinguish between pointed, flat and intraepithelial warts.
• Warts are uneven, light, benign tumor-like formations in the form of plaque or a small nodule on the surface of the skin of the hands, nails, feet, face and front of the body. Warts may look like papillomas, but differ from them in a broad way. They are usually found in HPV infection of 1-5, 7-10, 12, 14, 15, 17, 19-24 types.

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

Also, 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 often - bumps with a thick 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 edge. A characteristic feature is the lack of a leather model. Their formation is provoked by HPV types 1, 2, 4.
• Flat papillomas are soft, smooth, flat, usually rounded growths that have a normal skin color or a slightly yellowish, pink. They can provoke itching, so they are often injured, painful and inflamed. The reason for their formation are HPV strains 3 and 10.
• Filiforms (acrochords) are one of the most common papillomas, especially in the elderly. It is most common on the face, around the eyes, in the groin, armpits, neck. They are yellowish in color and tend to grow gradually, turning into bumps with a dense but elastic texture.
• Genital warts in the perineum, genitals.

Papillomas can be seen with the naked eye or are located in the thickness of the skin or mucous membranes. In the latter case, they are called endophytic and one of their manifestations is cervical dysplasia. Damage to the female internal genitals by papillomatosis may indicate:

• itching, burning, crying in the perineum;
• abundant leukorrhea;
• bloody discharge, in particular after sexual intercourse;
• discomfort during intimacy.

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

Diagnosis

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 monitor changes in existing ones.

It is especially important not to hesitate to see a doctor if there are signs of growth, discoloration of the papilloma, an unpleasant odor or pain in the area of its localization.

First of all, the doctor will perform a dermatoscopy, ie examination of the neoplasms using a special magnifying device. This will make it possible to determine their nature, as well as to notice dangerous signs showing 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.

Patients should be advised to be tested for sexually transmitted diseases, especially if genital warts are found. Also, 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 and others. And, if necessary, prescribe appropriate treatment.

To confirm papillomatous infection, patients usually receive a PCR analysis. With its help it is possible not only to confirm or deny the infection with the human papilloma virus, but also to accurately identify the strains.

Treatment and removal of papillomas

The treatment of human papillomavirus infection is always complicated. 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 the reduction of the body's own defenses, which allows the latent HPV in the body to become active, in the first place, patients with papillomatosis are prescribed drug therapy. Includes intake of immunomodulators and antivirals. Cytotoxic drugs may also be prescribed for extensive lesions of the skin and mucous membranes with papillomas. But they are taken under the supervision of a doctor, as they can cause serious side effects.

If the patient is diagnosed with concomitant infections or diseases, appropriate treatment for the situation should be prescribed, and sometimes additional consultation with a specialist and treatment under his supervision is required.

Warts of any kind must be removed, as well as papillomas, which are often injured and inflamed. In other cases, removal is performed at the request of the patient. However, it is possible to start eliminating the visible manifestations of HPV infection only after the end of the treatment of concomitant diseases, if any, and against the background of continuing antiviral therapy.

In general, all modern methods of destruction or removal of papillomas can be divided into 2 major 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, radiowave or plasma coagulation.

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

The success of 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 of infection, HPV is suppressed or even completely destroyed. But this is not a guarantee that there is no risk of re-infection or the formation of new papillomas. If the immunity is reduced due to the action of certain factors, papillomatosis becomes chronic, recurs periodically and can lead to serious complications.

To prevent infection with dangerous strains of HPV and the development of severe complications, especially for girls it is recommended 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 increase the healing time. 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, as it is assumed the formation of malignant cells in it.

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 recurrence of the papilloma at the same site. If there is a leg, it is dissected with surgical scissors and with the help of an electrocoagulator the blood vessel feeding the tumor is "sealed". The remaining wound is sutured, treated with antiseptic and covered with a sterile bandage.

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

Cryodestruction

The method involves the use of low temperatures to kill papilloma cells. This is done by using liquid nitrogen, whose temperature is -196 ° C. The essence of the procedure is to use a special nozzle or to touch the papilloma with a cotton swab dipped in liquid nitrogen. Under its action, the water contained in the cells instantly turns into ice crystals, which destroy them from within. The procedure is performed under local anesthesia or without it, as the exposure time to liquid nitrogen does not exceed 5-20 seconds.

The complexity of the method consists in choosing the correct duration of exposure in order to remove the papilloma to its full depth and not to 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 pink 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 balloon bursts and a crust forms in its place, which disappears after a few days, exposing healthy young skin. Under no circumstances should you puncture the bladder, injure it or the cortex in any other way.

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

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

Laser papilloma removal

The use of a laser to remove papillomas is also possible only in cases where their malignancy is completely ruled out. The procedure is performed under local anesthesia and consists of evaporating the moisture in the papilloma cells with the heat of a laser. In this way, a focused laser beam is aimed at the neoplasm. The duration of the 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 bark will disappear on its own within a week. It cannot be soaked and steamed for 3 days, nor can it be torn off and injured, as this is fraught with scars. In addition, within 2 weeks after removal of the papilloma, it is worth protecting the treatment area from sunlight. Otherwise, there is a high probability of hyperpigmentation in this area.

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

After the peel falls off, healthy pink skin is found, which gradually acquires a normal shade. This is the main advantage of laser papilloma removal, 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 in the postoperative period are violated. Also, laser removal completely eliminates the risk of wound infection and is an absolutely bloodless method, because under the influence of heat energy occurs instantaneous coagulation of small blood vessels.

With the help of laser papillomas are removed mainly on:

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

The laser is the only reliable way to remove plantar warts, as their roots can go 1 cm or more into the tissue.

Electrocoagulation of papillomas

The essence of the method is to use electric current to remove papillomas. Using a special device called an electrocoagulator, the doctor captures the papilloma and cuts it into healthy tissue. In this case, the bleeding is completely absent, as the heat energy of the current is sufficient for 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 is formed. And the whole recovery period takes 7-10 days. Once the bark falls off, the skin beneath it must 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 be used in cases where it is necessary to perform histological examination of the tumor and to accurately determine its nature. However, the outcome of the procedure depends entirely on the qualifications and experience of the doctor, however, as in other cases, because if the removal is not deep enough, the papilloma can form again in the same area.

Radiowave 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 to do with laser papilloma removal. The procedure is performed under local anesthesia and the removal occurs directly due to exposure to the new formation of radio waves. Thanks to them, it is possible to completely cut the papilloma of any size and location, as well as to avoid the formation of scars.

Chemical removal of papillomas

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

In this way, anyone can face the formation of papillomas. There is no effective prevention of HPV infection and vaccines protect only against the most dangerous strains of the virus in terms of cancer risk. However, in most cases, they do not cause significant discomfort to a person, except for genital warts and anus, which need to 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 re-infection or another strain, there is a chance 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 distinguish papillomas from other skin neoplasms and will solve this problem in a matter of minutes.