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 tumor-like formations on the skin and mucous membranes of different parts of the body. They are just one of the manifestations of infection with the human papillomavirus (HPV), the strains 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 drawback, 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 most common among sexually active people. This explains the fact that most often infection occurs at a young age at the time of the onset of sexual activity and at its peak, that is, 15-25 years. Moreover, several strains (types) of HPV can be simultaneously in the human body, provoking the appearance of different types of tumor-like 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 particles of sloughing skin or mucous membrane of an infected person. They attach 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 HPV damages. As a result, when the affected cell divides, the consequence of this will be the formation of not healthy new cells, but already having 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 external signs of human papillomavirus infection, but he will act as a carrier and can 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 more 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 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).

HPV strains of high oncogenic risk 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, its anti-cancer 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 human papillomavirus strains of high oncogenic risk.

The magnitude of the danger posed by papillomas directly depends on the type of HPV. Infection with strains with a high oncogenic risk is dangerous for the 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 strains of low oncogenic risk and the formation of papillomas, they should be treated carefully. Convex neoplasms are often injured by items of 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 organs, which leads to disruption of their work. So, 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-household 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 one 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 sex partner changes 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 has 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;
• depletion of the body, 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 the formation of 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 majora, vulva, vagina, cervix, penis, especially along the coronal groove 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 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, pearl or light brown color, most often forming on the eyelids, lips, chest, in the armpits, on the neck. They are located alone and usually do not tend to merge, even with multiple lesions. Papillomas are usually round or bumpy, resemble the head of cauliflower, more often have a leg.
• Condylomas are benign formations of a dirty brown or paler color in the form of a cockscomb or a set of villi united 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 HPV types 6 and 11. Distinguish between pointed, flat and intraepithelial warts.
• Warts are uneven, light, benign tumor-like formations in the form of a plaque or a small nodule on the surface of the skin of the hands, at the nails, feet, face, and the front of the body. Warts may look like papillomas, but differ from them by a wide base. They usually occur with HPV infection of 1-5, 7-10, 12, 14, 15, 17, 19-24 types.

Such tumor-like formations can be of different sizes from a few millimeters to large growths that cover large areas of the skin or mucous membranes.

Also, neoplasms may 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 group together.
• Plantar warts are raised above the surface of the skin, often painful bumps with a shiny surface and rim. A characteristic feature is the absence 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 slightly yellowish, pinkish. They can provoke itching, so they are often injured, painful and inflamed. The cause of their formation is HPV strains 3 and 10.
• Filiform (acrochords) are one of the most common papillomas, especially among elderly patients. Most often found on the face, around the eyes, in the groin, 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 with 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, weeping in the perineum;
• profuse leucorrhoea;
• bloody discharge, in particular, arising after sexual intercourse;
• discomfort during intimacy.

Sometimes papillomatosis can provoke back and pelvic pain, weakness, leg swelling, and unnecessary weight loss. Such signs are among the most alarming, as they may 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 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 discoloration, unpleasant odor or pain in the area of its localization appear.

First of all, the doctor will conduct a dermatoscopy, that is, an 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 indicating a high probability of the 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 are recommended to be tested for STDs, especially if warts are found in the genital area. Also, in such situations, women are 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, prescribing 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 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 soon a new one or even several will form in its place. Since the main reason for the formation of papillomas is a decrease in the body's own defenses, which allows the HPV dormant 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 may also be prescribed. But they are taken under the supervision of a doctor, since they can provoke serious side effects.

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

Warts of all types are subject to mandatory removal, as well as 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 start eliminating the visible manifestations of HPV infection only after the end of treatment for 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 - implies the removal of papillomas by surgery, using 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 accelerate 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 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 severe 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 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, 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 itself with a scalpel and captures the surrounding healthy tissue. This is necessary to eliminate the risk of re-formation of papilloma 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 the formation of cancer cells.

Cryodestruction

The method involves the use of low temperatures to destroy papilloma cells. This is realized 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 turns into ice crystals, which destroy them from the inside. The procedure is performed under local anesthesia or without it, 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 to its full depth and not harm healthy tissues, which will lead to scar formation.

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

After 3-4 days, the bubble bursts, and a crust forms in its place, which itself disappears after a few days, exposing healthy young skin. In no case should you independently pierce the bladder, injure it or the crust 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 most often used to remove papillomas and genital warts on:

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

Removal of papillomas with a laser

Using 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 in evaporation of moisture in the cells of the papilloma with the thermal energy of a laser. Thus, 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 turns red and swells. The crust will go away on its own within a week. It cannot be soaked and steamed for 3 days, as well as torn off and injured, as this is fraught with scarring. 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 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 crust falls off, healthy pink skin is exposed, which gradually takes on a normal shade. This is the main advantage of laser removal of papillomas, since it does not involve the formation of scars and scars. 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, 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.

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 an electric current to remove papillomas. Using a special apparatus called an electrocoagulator, the doctor captures the papilloma and cuts it off within 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 it is necessary 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 crust 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. Moreover, electrocoagulation can also be used in cases where it is required 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 kind. It involves the use of a special apparatus. But at the same time, it has a lot in common with laser removal of papillomas. The procedure is carried out under local anesthesia, and the removal directly occurs due to exposure of the neoplasm to radio waves. Thanks to them, it is possible to completely cut off the papilloma of any size and location, as well as to 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 let the substance get on healthy skin.

Thus, everyone can face 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. Nevertheless, in most cases, they do not cause significant inconvenience to a person, with the exception of genital warts and anus, 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 medication, and there is always a risk of becoming infected again or with another strain, there is a possibility that the problem will return again. The only reliable way to minimize the likelihood of papillomas is to strengthen the immune system. And if they do 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 will solve this problem in a matter of minutes.