The Best Verruca Vulgaris Treatment
INTRODUCTION Also known as a viral wart, or a viral papilloma, this lesion is a papilloma caused by an epidermal infection with the human papillomavirus, which is spread by direct contact and fomites. Immunocompromised patients are more susceptible to infection. Verruca vulgaris is more common in children and young adults between the ages of 5 and 20 years. They may occur anywhere on the skin, including the eyelids. Two common variants exist Verruca filiformis or filiform warts (which include the subgroup known as digitate warts) and verruca plana, or flat warts. HISTOPATHOLOGY Verruca vulgaris is characterized by marked hyperkeratosis and acanthosis. Papillomatosis is prominent in the filiform variant of verruca vulgaris. Parakeratosis, often arranged as vertical tiers, overlies the papillomatous projections. The granular cell layer is usually prominent, and the cells contain coarse clumps of basophilic keratohyaline granules. Dilated capillary loops may be conspicuous in the core of...
Illustrated by skin warts and genital warts, their well-known clinical manifestations. All around the world, HPV5 and HPV16 are the types most frequently associated with EV skin cancers and cervical carcinomas, respectively. Differences in geographic distribution have been noted for some HPV types. A higher prevalence of cervical cancer associated with HPV45 has been reported in Africa, and with HPV52 or HPV58 in China and Japan. HPV13 and HPV32 cause an oral disease mostly restricted to Central and South America, Alaska and Greenland.
Margination describes the nature of the transition between the lesion and normal skin. In general margination is said to be either sharp (distinct) or diffuse (Fig. 11). Lesions are considered to be sharply marginated or well circumscribed when the transition from normal to abnormal skin occurs in the space of a millimeter or less, and when this degree of sharpness is maintained around the whole periphery of the lesion. In many cases further description of the transitional zone is helpful. Thus a lesion can have square borders or shoulders (verruca vulgaris, seborrheic keratosis), rolled borders (basal cell carcinoma), or sloped or domed borders (dermatofibroma). In
INTRODUCTION Inverted follicular keratosis is a benign skin lesion that is common on the face and less frequently on the eyelids. It occurs in older individuals from the fifth decade on, and is considerably more common in males. It is frequently mistaken for a malignant tumor. These lesions arise from the infundibular epithelium of the hair follicle and therefore are related to epidermoid cysts. Inverted follicular keratosis may be an irritated form of seborrheic keratosis or verruca vulgaris. DIFFERENTIAL DIAGNOSIS The differential diagnosis includes verruca vulgaris, papilloma, senile keratosis, seborrheic keratosis, cutaneous horn, keratoacanthoma, and squamous cell carcinoma.
Koilocytes are vacuolated keratinocytes with eccentrically placed, basophilic, shrunken nuclei surrounded by clear halos. They are found in the upper spinous and granular cell layers of the epidermis in human papillomavirus infections (verruca vulgaris, in the eyelid). Papillomatosis is characterized histologically by abnormally elongated epidermis and papillary dermis resulting in irregular undulation of the epidermal surface. Papillomatosis is seen most commonly in seborrheic keratosis and verruca vulgaris (shown).
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes basal cell carcinoma, sebaceous cell carcinoma, Bowen's disease, actinic keratosis, keratoacanthoma, inverted follicular keratosis, papilloma, pseudoepitheliomatous hyperplasia, seborrheic keratosis, trichilemomma, fungal infection, and verruca vulgaris.
Cutaneous HPVs belong to other phylogenetic subgroups than mucosal HPVs. Some of them play a role in benign epidermal proliferation, e.g., HPV 1 which is causally related to verruca vulgaris (warts). In addition, associations between cutaneous HPVs and malignant skin diseases were discovered (reviewed in Ref. 3 ). For example, squamous cell carcinomas (SCCs) from patients with the rare hereditary disorder epidermodys-plasia verruciformis (EV) are associated with a particular group of 22 phylogenetically related cutaneous HPVs which are therefore designed EV-HPVs. They include HPV 5, 8, 9, 12, 14, 15, 17, and 19-25. These types were also detected in other cutaneous malignancies such as SCC in individuals without EV and basal cell carcinomas (BCC). The prevalence of HPV in skin tumors is especially high in immunosuppressed individuals.
Basal cell carcinoma (translucent, dome-shaped) Part V Keratoacanthoma (dome-shaped) Part V Malignant melanoma Part V Molluscum (dome-shaped umbilicated) Part II Rosacea (red) Part VI Squamous cell carcinoma (indurated) Part V Verruca vulgaris Part II Papules Scabies (papulovesicle at end of burrow) Part II Seborrheic dermatitis (red-brown, follicular) Part II Seborrheic keratosis Part V SLE (sharply defined, may coalesce) Part IV Squamous cell carcinoma (indurated) Part V Striae distensae (yellow papules as secondary lesions) Part IV Tinea (follicular) Part III Verruca vulgaris Part II Patches
Common variant (verruca vulgaris) hard papules with a rough, irregular, scaly surface, most commonly seen on hands Filiform variant elongated, slender papules with filiform fronds, usually seen on face, around the lips, eyelids, or nares Palmoplantar warts (myrmecia) small, shiny papules, progressing to deep endo-phytic, sharply defined, round papules or plaques with keratotic surface, surrounded by a smooth collar of thickened horn plantar lesions usually found on weight-bearing areas, such as metatarsal head and heel hand lesions often are subungual or periungual Flat wart (plane wart, verruca plana) variant flat or slightly elevated, flesh-colored,
In natural infection, humoral responses are essentially directed against conformational epitopes borne by intact viral particles. Low levels of antibodies reacting against HPV1 virions are found in patients with skin warts or in nonselected individuals, with a frequency that varies from 10 to 100 , according to the method used, the age group and the type of warts. Antibodies neutralizing HPV11 infectivity assayed in the nude mouse xenograft system have been detected in patients with genital warts or laryngeal papillomas. Owing to the availability of VLPs and the design of sensitive VLP-based ELISA tests, the evaluation of serological responses to HPV infection has recently entered a new era. When using HPV6 or HPV11 LI VLPs, IgG antibodies have been found in about half of the patients with genital warts. IgG and IgA humoral responses to HPV16 L1 L2 VLPs have been detected in 50-75 of women with HPV16-associated CIN. Antibodies are found in 15 25 of women showing no current signs of...
HISTOPATHOLOGY Cutaneous horn is a clinical diagnosis that corresponds histologically to a protuberant mass of keratin. To be designated a horn , the height should exceed at least one-half of the greatest diameter of the lesion from which it arises. Cutaneous horns are most commonly associated with actinic (solar) keratosis, verruca vulgaris, seborrheic keratosis, squamous cell carcinoma, inverted follicular keratosis, or tricholemmoma. DIFFERENTIAL DIAGNOSIS The cutaneous horn is easy to diagnose, but its significance is determining the underlying lesion. They can develop from a variety of underlying lesions, including seborrheic keratosis, actinic keratosis, inverted follicular keratosis, verruca vulgaris, tricholemmoma, subepidermal calcified nodules, basal cell carcinoma, squamous cell carcinoma, metastatic tumors, and other epidermal tumors.
DIFFERENTIAL DIAGNOSIS The differential diagnosis includes seborrheic keratosis, actinic keratosis, verruca vulgaris, intradermal nevus, keratoacanthoma, and sebaceous carcinoma. Occasionally malignant lesions can look like a papilloma, but these more often have telangiectatic vessels or are associated with lash loss or ulceration.