Papillomas: types, manifestations and characteristics 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 them, viruses with high, medium and low oncogenic risk are distinguished. Therefore, in addition to an aesthetic inconvenience, papillomas can pose a serious danger to human life and health, since some of them can transform 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 of the time the infection occurs at an early age at the time of initiation of sexual activity and at its peak, that is, between 15 and 25 years. In addition, several strains (types) of HPV can be 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 with the skin or mucous membranes with detached skin particles or mucous membranes from an infected person. They adhere to the membranes of immature epithelial cells, from where they penetrate the cytoplasm of the cell and subsequently the nucleus. It is in the cell nucleus where DNA is contained, that HPV damages. As a result, when the affected cell divides, the consequence of this will be the formation of new cells that are not healthy, but which already have 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, as well as flat and genital warts. However, it can be asymptomatic. In this case, the patient will not show outward signs of human papillomavirus infection, but will act as a carrier and can infect others during unprotected sex 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 most often the first small papillomas appear between 1 and 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 an opportunity to provoke cell proliferation. But with a 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 (types 16 and 18 are considered the most dangerous).

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

The magnitude of the danger posed by papillomas directly depends on the type of HPV. Infection by strains with high oncogenic risk 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 they are infected with low oncogenic risk strains and the formation of papillomas, they must be treated with care. Convex neoplasms are often injured by clothing, bleed, and tend to become inflamed. At the same time, perhaps the greatest discomfort is provoked 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. Also, papillomas can form on the mucous membranes of almost any internal organ, which leads to disruption of their work. So, papillomatosis of the upper respiratory tract is often found, which causes shortness of breath.

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 delivery. The contact-home route of transmission of the virus is not excluded, that is, 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 transfer to healthy areas of the skin and affect them.

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

But infection with a virus does not always lead to the formation of papillomas, genital warts, etc. The probability of developing papillomatosis depends on several 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 has not yet been 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), 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 abortions;
• the presence of serious chronic diseases, in particular diabetes mellitus;
• leading an unhealthy lifestyle, the presence of bad habits;
• bad life conditions.

Older and overweight people are more prone to the formation of papillomas. In addition, their neoplasms often form in the folds of the skin, contributing 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 majora, vulva, vagina, cervix, penis, especially along the coronal sulcus and 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.

The human papillomavirus can give rise to neoplasms of different kinds. 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 pink, white, pearl, or light brown neoplasms that most commonly form on the eyelids, lips, chest, armpits, and neck. They are localized on their own and generally do not tend to fuse, even with multiple lesions. Papillomas are usually round or bulging, resembling the head of cauliflower, more often they have one leg.
• Warts are benign, dirty brown or paler formations in the shape of a cockscomb or a set of villi joined by a common base. Most of the time they are found in the genital area, the anus, and around the mouth. They tend to merge with each other and, as a result, cover large areas of the body. Its appearance is due to infection with HPV types 6 and 11. Distinguish between pointed, flat and intraepithelial warts.
• Warts are bumpy, slight, benign growths that look like a plaque-shaped tumor 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 they differ from them on a broad basis. They usually occur with HPV types 1-5, 7-10, 12, 14, 15, 17, 19-24 infection.

These tumor-like formations can range in size from a few millimeters to large growths that cover large areas of the 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 common - bumps of dense consistency with a diameter of more than 1 mm. They tend to merge and clump together.
• Plantar warts rise above the surface of the skin, often painful bumps with a shiny surface and edge. A characteristic feature is the absence of a skin pattern. Its 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, which is why they are often injured, painful, and inflamed. The cause of its formation are strains 3 and 10 of HPV.
• Filiforms (skin tags) are one of the most common papillomas, especially among elderly patients. It is most often found on the face, around the eyes, in the groin, armpits, and neck. They are yellowish in color and tend to grow gradually, turning into bumps of dense but elastic consistency.
• Genital warts on the perineum, genitalia.

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 endophytic and one of their manifestations is cervical dysplasia. The defeat of the female internal genital organs by papillomatosis may indicate:

• itching, burning, crying in the perineum;
• profuse leucorrhoea;
• bloody discharge, in particular, arising after sexual intercourse;
• discomfort during intimacy.

Sometimes papillomatosis can lead to back and pelvic pain, weakness, leg swelling, and unnecessary weight loss. These signs are among the most alarming, as they can indicate the development of complications from 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 observe changes in existing ones.

It is especially important not to hesitate to visit a doctor if signs of growth, discoloration of the papilloma, unpleasant odor or pain appear in the area of its location.

First, the doctor will perform a dermoscopy, that is, an examination of the neoplasms with a special magnifying device. This will allow to determine its 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 can be treated successfully and have a favorable prognosis in the future.

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

To confirm papillomatous infection, patients are usually assigned a PCR test. With their 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.

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 latent HPV in the body to become active, first of all, drug therapy is prescribed to patients with papillomatosis. It includes taking 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 diseases, appropriate treatment for the situation should be prescribed, and sometimes it is required to additionally consult a specialized specialist and undergo therapy under her supervision.

Warts of all kinds are subject to mandatory removal, as well as papillomas, which are often injured and inflamed. In other cases, the extraction is performed 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 concomitant diseases, if any, 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 waves or plasma coagulation.

After the papilloma is removed 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 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 formation of new papillomas. If immunity is lowered due to the action of certain factors, papillomatosis becomes chronic, periodically relapses, and can lead to serious complications.

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 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 conduct a histological examination, since 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 with a scalpel and captures the surrounding healthy tissue. This is necessary to eliminate the risk of a papilloma re-forming 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 there is a suspicion of cancer cell formation.

Cryodestruction

The method involves the use of low temperatures to destroy the papilloma cells. This is done by using 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 turns into ice crystals, which destroy them from the inside. The procedure is performed with or without local anesthesia, since 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 in order to remove the papilloma in all its depth and not to damage healthy tissues, which will lead to the formation of scars.

Immediately after liquid nitrogen treatment, a white spot forms at the papilloma site. Later, a small bubble with a clear or pink liquid content forms, and the surrounding skin becomes red and may swell a little. This may be accompanied by a minor discomfort in the form of a burning or tingling sensation.

After 3-4 days, the bubble bursts and a scab forms in its place, which disappears after a few days, exposing young, healthy skin. In no case should you independently pierce the bladder, damage it or otherwise scab.

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 genital warts and papillomas on:

• 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 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 the exposure does not exceed 1 minute.

As a result, a scab forms on the papilloma site, and the skin around it becomes red and swollen. The scab will go away on its own in a week. It cannot be soaked and steamed for 3 days, as well as plucked and wounded, as it is riddled with scars. Also, within 2 weeks after the papilloma is removed, 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 a laser, do not apply decorative cosmetics to the affected area until it is completely healed.

Once the scab falls off, healthy, pink skin is exposed, gradually taking 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 be formed 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 heat energy, instant coagulation of small blood vessels occurs.

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

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

The 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 the papillomas. With a special device 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 coagulation of small blood vessels. But the procedure can be painful, especially if growth needs to be removed in areas of the body with delicate skin.

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

The method is used to remove papillomas on different parts of the body. In addition, electrocoagulation can also be used in cases where it is required to perform a histological examination of a neoplasm and precisely establish its nature. But the result of the procedure depends entirely on the qualification and experience of the doctor, however, as in other cases, because if the removal 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 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 the papilloma of any size and location, as well as avoid scars.

Chemical removal of papillomas

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

Thus, 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 discomfort to a person, except for genital warts and anus, 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 another strain, there is a possibility that the problem will return. Appear. 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. Your doctor will be able to accurately differentiate papillomas from other skin neoplasms and will solve this problem in a matter of minutes.