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 formations similar to tumors in 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 species. Among them, viruses with high, medium and low oncogenic risk are distinguished. Therefore, in addition to an aesthetic barrier, papillomas can pose a serious risk to human life and health, as some of them can turn into malignant tumors.

What is HPV?

The human virus papyrus infects only humans, and its main 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 onset of sexual activity and at its peak, namely 15-25 years. Moreover, several types (types) of HPV can be present simultaneously in the human body, provoking the appearance of different types of formations similar to tumors in the skin and mucosa.

The disease caused by HPV is called papillomatosis.

Virus infection occurs when it comes in contact with the skin or mucosa with particles of weakened skin or mucosa of an infected person. They attach to immature epithelial cell membranes, from where they penetrate into the cell cytoplasm, and then into the nucleus. Deep in the cell nucleus that contains DNA, which damages HPV. As a result, when the affected cell divides, the consequence of this will be the formation of new cells that are not healthy, but already have genetically altered information, which leads to disruption of 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, as well as flat warts and genitals. However, it can be asymptomatic. In this case, the patient will not show external signs of human papillomavirus infection, but he will act as a carrier and may infect others during unprotected intercourse 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 1-6 months after infection.

Human papillomavirus is intracellular. Therefore, with a sufficient strength of the immune system, the body successfully suppresses its activity and does not offer an opportunity to provoke cell proliferation. But with a weakening of immunity as a result of the action of several factors, the body's defenses fall, the virus is activated, which leads to the formation of papillomas.

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

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

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

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

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

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

But even when infected with strains with low oncogenic risk and papilloma formation, they must be treated with caution. Convex neoplasms are often injured by clothing items, bleed, and tend to become inflamed. At the same time, perhaps the greatest concern has been brought about by formations in the genitals, which cause strong disturbances 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 mucosa of almost any internal organ, leading to disruption of their work. So, papillomatosis of the upper respiratory tract is often found, which causes difficulty in breathing.

Causes of papilloma formation and risk factors

HPV can be transmitted sexually as well as from an infected mother to her baby at birth. The contact-home route of transmission of the virus is not excluded, that is, with the shared 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 damaged, 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 partner and unprotected sex.

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

• lack of immunity of any origin, including taking immunosuppressive drugs (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 simultaneous presence in the body 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;
• body depletion, hypovitaminosis, chronic fatigue and severe stress;
• multiple births and abortions;
• the presence of severe chronic diseases, in particular diabetes mellitus;
• leading an unhealthy lifestyle, the presence of bad habits;
• poor living conditions.

Elderly and overweight people are more prone to papilloma formation. Moreover, their neoplasms often form in the folds of the skin, which contributes to their damage 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 hands, feet, spine, genitals, including the perineum, labia minora and majora, vulva, vagina, cervix, penis, especially along the coronal groove and frenula. Damage to the mucosa of the oral cavity, tongue, nasopharynx, esophagus, bladder, conjunctiva, trachea and other internal organs is not excluded.

The human papilloma virus 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 - infection with the human papillomavirus.

• Papillomas are benign neoplasms of pink, white, pearly or light brown color, most often form on the eyelids, lips, chest, armpits, neck. They are solitary and usually do not tend to coalesce, even with multiple lesions. Papillomas are usually round or bumpy, resembling cauliflower head, most often have one leg.
• Warts are benign formations of a faint or paler brown color in the form of a cliff or a group of clumps joined by a common base. Most often they are found in the genital area, 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 types 6 and 11 of HPV. Distinguish between prominent, flat and intraepithelial warts.
• Warts are uneven, light, benign formations, like a tumor, in the form of a 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 on a broad basis. They usually occur with HPV infection of types 1-5, 7-10, 12, 14, 15, 17, 19-24.

Formations such as tumors can vary in size from a few millimeters to large growths covering large areas of skin or mucous membranes.

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

• Vulgar or ordinary - bulge of dense consistency with a diameter of more than 1 mm. They tend to come together and group together.
• Plantar warts rise above the surface of the skin, often painful bumps with a shiny surface and edge. A characteristic feature is the lack of a skin pattern. 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 are slightly yellowish-pink. They can provoke itching, so they are often damaged, painful and inflamed. The cause of their formation are HPV voltages 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, neck. They are yellow in color and tend to grow gradually, turning into lumps with 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 endophytic and one of their manifestations is cervical dysplasia. Loss of the female internal genital organs by papillomatosis may indicate:

• itching, burning, crying in the perineum;
• abundant leucorrhoea;
• bloody discharge, in particular, arising 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 of HPV infection.

Diagnosing

If papillomas form on the body, face or genitals, you should consult a dermatologist. This will make it possible 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 signs of growth, papilloma stain, unpleasant odor or pain appear in the area of its localization.

First of all, the doctor will perform a dermatoscope, i. e. an examination of the neoplasms using a special magnifying device. This will make it possible to determine their nature, as well as to warn of dangerous signs indicating a high probability of degeneration of a benign formation into a malignant one, not to mention a cancer formed. If detected at an early stage of development, they are successfully treated and have a favorable prognosis in the future.

Necessary weight that patients are recommended to be tested for sexually transmitted diseases, especially if warts are found in the genital area. Also, in such situations, women are shown to get 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, prescribing appropriate treatment.

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

Treatment and removal of papillomas

Treatment of human papillomavirus infection is always complex. Of course, you can simply remove the troublesome papilloma, but in this case there is a high risk that a new one or even some will form in its place soon. 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. It involves taking immunomodulators and antiviral agents. With 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 provoke serious side effects.

If a patient is diagnosed with concomitant infections or illness, he or she should be prescribed appropriate treatment for the situation, and sometimes required to additionally consult a specialized specialist and undergo therapy under his or her supervision.

Warts of all types undergo mandatory removal as well as papillomas, which are often damaged and inflamed. In other cases, removal is performed at the request of the patient. But it is possible to begin to eliminate the obvious manifestations of HPV infection only after the end of treatment of concomitant diseases, if any, and in the background of continuing antiviral therapy.

In general, all modern methods of destroying or removing papillomas can be divided into 2 major groups:

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

After removing the papilloma with one method or another, it is important to use the local agents prescribed by the doctor to speed up the 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 from the moment 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 immunity is reduced due to the action of several factors, papillomatosis becomes chronic, gives periodic 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 the ages of 9 and 25 years.

Surgical removal of papillomas

The essence of the method is the removal of the neoplasm with a scalpel, which is accompanied by the formation of scars and an increase in 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 perform a histological examination, as the formation of malignant cells in it is assumed.

The procedure is performed under local anesthesia, which makes it painless. The doctor removes the neoplasm himself with a scalpel and seizes the surrounding healthy tissue. This is necessary to eliminate the risk of papilloma re-formation in the same place. If there is 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 performed mainly when there is a suspicion of cancer cell formation.

Cryodestruction

The method involves using low temperatures to destroy papilloma cells. This is accomplished through the use of liquid nitrogen, whose temperature is -196 ° C. The essence of the procedure is the use of a special nozzle or touching the papilloma with a cotton swab dipped in liquid nitrogen. Under its action, the water contained in the cells immediately 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 lies in choosing the correct duration of exposure so that the papilloma is removed to its full depth and does not damage healthy tissue, which will lead to scar formation.

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

After 3-4 days, the blister bursts and in its place a crust is formed, which itself disappears after a few days, exposing the new healthy skin. Under no circumstances should you independently pierce the bladder, damage it or peel it in any other way.

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

• centuries;
• face;
• small nodes;
• genitals.

Laser papilloma removal

Using 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 moisture into papilloma cells with the thermal energy of a laser. Thus, a focused laser beam is directed at the neoplasm. Exposure time 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 crust will disappear on its own within a week. It can not be soaked and evaporated for 3 days, as well as torn and damaged, as it is full of scars. In addition, within 2 weeks after papilloma removal, it is worth protecting the treatment area from sunlight. Otherwise, there is a high probability of hyperpigmentation of this area.

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

After peeling, a 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 marks. They can form 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, as under the influence of thermal energy, immediate coagulation of small blood vessels occurs.

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

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

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

Electrocoagulation of papillomas

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

After electrocoagulation, a crust is also formed. And the whole recovery period lasts 7-10 days. Once the crust 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. Moreover, electrocoagulation can also be used in cases where a histological examination of a neoplasm is required to be performed and its nature to be accurately determined. But the outcome 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 may form again in the same area.

Radio wave surgery

This method is one of the most advanced in removing 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 direct removal occurs 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 indentation.

Chemical removal of papillomas

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

Thus, anyone can cope with the formation of papillomas. There is no effective prevention of HPV infection, and vaccines only protect against the most dangerous types of the virus in terms of cancer risk. However, in most cases, they do not cause significant discomfort to a person, except for the genital and anal warts, which need to 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 medication, and there is always a risk of infection again or with some other type, there is a possibility that the problem willcomes back again. 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 within minutes.