What is Viral Warts?
Viral warts are benign neoplasms as large as a pinhead (1-2 mm) up to 1 cm or more of a viral origin.
Causes of Viral Wart
Warts are caused by viruses (a group of human papilloma viruses).
Papillomaviruses belong to the genus A of the family of papovaviruses. Virions do not have a shell, their diameter is 50-55 nm. The capsid has the form of an icosahedron and consists of 72 capsomeres. The genome is represented by a double-stranded, ring-shaped, twisted DNA, comprising about 8,000 main pairs. It seems that papillomaviruses are species specific, since human papillomavirus (HPV) viruses do not multiply in tissue culture or in experimental animals. For a complete characterization of the virus, it is necessary to have a sufficient amount of culture, which is difficult to obtain, therefore, the available information about papillomaviruses is insufficient. There is no adequate set of HPV antigens, which greatly complicates the implementation of epidemiological, pathogenetic, immunological studies and therapeutic measures.
It is known that structural proteins constitute up to 88% of the mass of the virion. Using electrophoresis in sodium dodecyl sulfate polyacrylamide gel, the main capsid protein with a molecular weight of 55,000 and 10 additional polypeptides was identified. Four cellular histones are associated with viral DNA. Type-specific antigenic determinants, apparently, are localized on the surface of the virion, and genus-specific – inside it. Antisera obtained by immunizing experimental animals by injecting destroyed PV-virions with it can cross-react with many agents.
The genomic organization of all papillomaviruses is similar. Types and subtypes are determined by the degree of homology of the sequence of polynucleotides. The DNA of each individual type of papillomavirus is at least 50% homologous to the DNA of other viruses of this class. Viruses that are homologous to each other by more than 50%, but less than 100%, are subtypes. More than 40 types of HPV are known, each of which causes a particular type of warts.
Seroepidemiological studies of infectious diseases caused by HPV are largely hampered by the absence of relevant antigens. There is only data on the frequency and distribution of warts in humans in well-chosen populations. Common warts occur in 25% of the members of certain groups of the population. Plantar warts are widespread, and they are more common in adolescents and young people. Over the past 10-15 years, the number of people who have venereal warts (genital warts) has increased dramatically. Currently, it is one of the most common venereal diseases in the world.
Pathogenesis During Viral Warts
HPV infection is transmitted by direct contact with the patient, and infection is more likely in the presence of minor injuries at the site of inoculation. In addition, infection can occur through autoinoculation or through objects. Scaly epithelium of all types may be infected with HPV. Macro – and micromorphological changes in each individual case vary depending on the place of infection and the type of virus. Exophytic warts are characterized by papillomatosis, hyperkeratosis and lengthening of the papillae. Acantosis, thickening of the spinous layer of the epidermis and epithelium of the mucous membranes with lengthening of the interaparticular processes, is combined with the synthesis of viral DNA. Inside the nuclei of cells of the granular layer, in which koilocytosis develops, signs of expression of late genes appear, which leads to the formation of structural proteins and virion assembly. Coylocytes are large round cells with pycnotic nuclei and wide areas of perinuclear vacuolization, surrounded by a ring of dense amphophilic cytoplasm.
Protective reactions of the microorganism on the introduction of HPV are poorly understood. The results of most immunological studies are difficult to interpret, since poorly purified and poorly studied drugs were used as antigens. The potential importance of type-specific reactions was not properly evaluated, since it was believed that there were many new types of HPV, and there were not enough antigenic materials. In patients with clinical signs of active infection (or without them), virus-specific antibodies of the IgM and IgG classes were detected. Were also investigated the reaction of cellular immunity to the introduction of viral antigens. There is reason to believe that persons with weakened cellular immunity are more susceptible to HPV infection, they sometimes develop an extensive process.
Symptoms of Viral Wart
Until the mid-1970s, it was believed that there was only one type of HPV and that the clinical manifestations and morphological features of warts were determined by the nature of the squamous epithelium at the site of infection. After identifying the many types of HPV, it became clear that the nature of the disease depends primarily on the specific characteristics of HPV. Thus, the clinical manifestations of HPV infections depend on the location of the lesion and on the type of virus. Ordinary warts often appear on the hands, their color varies from flesh to brown. These are exophytic, hyperkeratotic papules.
There are several varieties of warts.
Common warts are dense, painless, nodules of a rounded shape (3-10 mm in diameter) with a rough surface. They are located on the rear of the hands, fingers, face, scalp.
On the soles occur so-called plantar warts. They are usually painful and consist of bundles of filiform papillae, surrounded by a roller of powerful horny layers, resembling a corn. The occurrence of plantar warts contributes to the constant pressure and friction of shoes.
Plantar warts differ from most other warts in that their growth is directed inwards. They can be quite painful, as opposed to corns at the cut, thrombosed capillaries are visible, which bleed easily.
Flat (juvenile, juvenile) warts are small (0.5-3 mm) nodules of the color of normal skin or yellowish, round or polygonal with a smooth flattened surface, barely protruding above the level of the skin. They are usually located on the face, back of the hands, neck, chest and flexor surfaces of the forearms and legs. More often observed in young people, especially among schoolchildren.
Anogenital warts (genital or venereal warts) appear on the skin and mucous membranes of the external genitalia and in the perianal area. They should be distinguished from widespread condylomas in secondary syphilis, molluscum contagiosum, granular papules of the penis, fibroepithelium and various malignant tumors of the skin and mucous membranes. Anogenital warts are sexually transmitted. The incubation period is 1-6 months. In men, condylomas are localized in the area of the bridle or coronary sulcus, but they can also be found in areas of the penis. Often they appear in the area of the external opening of the urethra and can spread proximally.
Perianal warts are usually found in homosexual men, but can also occur in heterosexual men. In women, the warts usually appear in the posterior region of the entrance to the vagina and on the underlying parts of the labia. They then spread to other areas of the external genital organs and usually affect the entire perineum and anus. Condylomas are often localized in the vagina and on the cervix. These lesions can be detected in the absence of external warts.
Laryngeal papillomatosis is rare and predominantly in preschool children. Infection occurs at the birth of a child during the passage of the birth canal. These lesions can be quite numerous and cause life-threatening airway obstruction. In adults, infection is possible with oral-genital sexual contact.
Immunocompromised patients, especially those who have undergone organ transplants, often develop roseole pithiriasis and similar changes. In such cases, the DNA scales of several types of HPV can be isolated from skin scales. Sometimes these processes can take on a malignant form.
Warty epidermisplasia is a rare autosomal recessive disorder characterized by the malignancy of skin scaly cells. The lesions resemble flat warts or spots similar to those with roseolous pitiriasis.
The complications of warts include itching and sometimes bleeding. In rare cases, a secondary bacterial or fungal infection may join. Large accumulations of warts can serve as a mechanical obstacle, closing, for example, the birth canal. Epidemiological, cytopathological, and histopathological data suggest that there is a link between HPV infection and cervical dysplasia or carcinoma. The nucleic acid sequence characteristic of HPV was detected in cervical scrapings and biopsy specimens obtained from patients with similar morphological changes. A nucleic acid sequence homologous to HPV 16 and 18 types was found in 70-80% of tissue preparations taken from patients with cervical cancer. It was shown that these viruses were also isolated from other malignant tumors found in the genital tract.
Diagnosis of Viral Wart
In most patients, the diagnosis can only be made on the basis of anamnesis and physical examination, provided that the warts are visible to the naked eye. With the defeat of the vagina and cervix, colposcopy is a valuable diagnostic method. Evidence of the presence of HPV infection can be obtained using a Papanicolaou study of swabs taken from the cervical mucosa. If persistent or atypical lesions are detected, a biopsy must be performed and the material obtained is examined using histological methods. In addition, in cuts of tissues using immunological methods can detect genus-specific capsid antigen, and determine the type of virus using restriction endonuclease analysis of DNA isolated from infected tissues, as well as using the method of hybridization using nucleic acid samples.
Treatment of Viral Wart
Treatment of warts should go only under the supervision of a physician, because the wrong treatment can lead to the overgrowth of warts into a malignant tumor.
The only radical treatment for warts is their removal. To date, there are quite a few methods of removing warts. They are selected depending on the location and type of warts. Some of these methods have complications. For example, laser removal of warts can cause scarring. Incorrect use of the Surgitron apparatus to remove simple warts and papillomas can lead to scars, including disfiguring keloid scars. Therefore, sparing methods of wart removal – cryotherapy and electrocoagulation – retain their value today.
When starting treatment, it should be borne in mind that there are currently no safe and effective methods. At the same time, many warts can disappear spontaneously. Treatment methods such as the application of caustic agents, cryosurgery, electrodrying, surgical excision and laser ablation are shown. It is also possible local application of antimetabolites, such as 5-fluorouracil. However, none of these methods of treatment leads to complete recovery of the patient. Recurrences can be explained by the presence of HPV DNA in apparently healthy tissues adjacent to the affected areas, and in those places where the wart existed before, but the viral DNA remained, despite remission. Over the years, podophyllin preparations have been topically applied to remove genital warts. However, the effectiveness of these substances is small – less than 50%, therefore, cryosurgical intervention is preferable to remove venereal warts. Promising preliminary results were obtained in the treatment of patients with laryngeal papillomatosis and genital warts with interferon preparations.
Currently, there are no effective methods for preventing the development of warts, so contact with infected tissues should be avoided. To prevent infection with genital warts, it is advisable to use barrier methods of contraception.
Common and palmar plantar warts. Rubbing 5% fluorouracil ointment, 0.5% colchamic ointment, 20% interferon ointment, cauterization with trichloroacetic acid. Freezing with snow of carbonic acid or liquid nitrogen, electrocoagulation, scraping with a pointed Volkmann spoon, coagulation with a laser.
With flat warts. Inside the magnesium oxide at 0.15-0.25 g 3p / day for 2-3 weeks. Topically keratolytic ointments with salicylic and benzoic acids, tretinoin 2p / d for 4-6 weeks, phonophoresis with 50% interferon ointment.
The prognosis for treatment is favorable, although in some patients relapses occur. In 50% of cases, warts are resolved spontaneously.
Warts viral oral cavity. Local use of antiviral drugs for 3-4p / day after oral hygiene. This must be combined with a thorough reorganization of the oral cavity. In the presence of warts on the skin and mucous membranes of the genital organs conduct a combined treatment. The parallel effect of antiviral drugs (bromnaftoquinone, etc.) inwards gives a good effect. Treatment should be long (at least 3-4 weeks) and accurately performed by the patient.
Viral Wart Prevention
How to get rid of warts forever?
Warts are a viral infection. She can get infected again. It can occur when immunity is weakened. Our clinic has all the possibilities to evaluate how weak your immune system is and how it can withstand human papillomavirus infection. If there is such a problem, then we know its solution.