Viral warts
What is it?
Warts are benign epithelial neoformations of viral nature that occur in the form of exophytic papules with warty surface or epidermal vegetations and are located on the skin (common or vulgar, filiform or digitate and flat) or mucous membranes (viral papillomas and condylomas).
They can be classified according to their clinical appearance into vulgar or common warts (58-70%), filiform or digitate and flat warts (2-4%) and according to their localization into plantar (24-34%), genital or condyloma acuminata and papillomas of the oral mucosa and larynx.
Warts represent common skin conditions that most frequently affect children and young adults, being quite rare in the early years of life and in the elderly. They are caused by Papilloma viruses (HPV Human Papillomavirus), a circular DNA double helix virus of the papovavirus class, of which more than 80 types are known.
Each type of HPV shows a particular tropism for stratified squamous epithelia, of which it induces proliferation with predilection for certain body areas, where it produces a certain type of skin lesion. Transmission of warts is direct or indirect interhuman and is favored by an alteration of the skin barrier function following microtrauma and/or maceration, as well as by the hot humid environment. This transmission may depend on several factors, including the location of the lesions, the type of contact, the viral load and both the general and local immunological status of the subject (cell-mediated and humoral response).
The incubation period is variable, from a few weeks to over 1 year; the infection can also remain in a subclinical phase with the presence of viral particles and absence of skin and mucosal changes, or in a latent phase with the presence of viral DNA in the tissue that can be detected with specific diagnostic techniques (HPVscreening/qualitative PCR analysis and HPV genotyping).
Which are the symptoms?
The viral infection is generally asymptomatic, some patients may report mild itching, sometimes pain (such as in walking and pressure in case of plantar warts), discomfort (localizations in visible and genital areas) and functional distress (localizations in periorificial areas). Larger lesions can become macerated and ulcerated with secondary overinfection.
- Itching
- Pain
- Discomfort
- Bleeding
How is it diagnosed?
The diagnosis is primarily clinical. The shape, surface and localization allow to define the diagnosis. The disappearance of normal skin furrows (dermatoglyphics) and the presence of thrombized capillary vessels are easily found in plantar warts. Dermoscopy allows to observe specific patterns such as the dotted mosaic pattern, the knoblike pattern and the fingerlike pattern.
To support the physician, in cases where the clinic is not well defined, it is possible to implement other methods of help such as the 5% acetic acid test and biopsy with histological examination. The infection can also remain in a subclinical phase with the presence of viral particles and absence of skin and mucosal changes, or in a latent phase with the presence of viral DNA in the tissue that can be detected with specific diagnostic techniques (HPVscreening/qualitative PCR analysis and HPV genotyping). In case of genital or anal localization it would be appropriate to integrate with the execution of colposcopy, anoscopy and urethroscopy.
How is it treated?
The type of treatment depends on the type (vulgar, flat, mosaic), location, number and size of lesions, as well as the age of the patient and any associated diseases (diabetes, allergies). The treatment aims to prevent the spread of warts to other body sites or other individuals, eliminate functional disorders related to the presence of warts also in relation to the aesthetic and psychological motivations of the patient.
Regardless of the type of treatment performed, there are rather resistant forms and recurrence rates are reported in about 30% of cases.
Where do we treat it?
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