Papilloma – good-quality opukholevidny formation of skin and mucous a virus etiology. Has a nipple appearance on the narrow basis (leg), a soft or dense consistence, from light till dark brown color. Localization of papillomas on skin leads to formation of cosmetic defect, in a throat – to violation of breath, a voice, on mucous internals - to ulcerations and bleedings. A disease recurrence, the most terrible complication – malignant regeneration are possible. Removal of papillomas can is carried out by electrothermic coagulation, cryodestruction, surgical excision, a radio wave method or laser influence.
Papillomas are the disease affecting epitelialny cages and skin. The virus of papilloma of the person which concerns to the Papoviridae family, the Papillomavirus group is the reason of papillomas. Distinguish viruses with high and low onkogenny risk from VPCh. The Onkogennost of papillomas is explained by ability of a virus to integrate the DNA into a genome of cells of the person.
Mechanism of infection with a virus of papilloma of the person
Getting into a human body, at the initial stage of VPCh strikes basal cages of an epithelium. Microinjuries, attritions, cracks and other injuries of skin promote penetration of a virus of papilloma into an organism. For a long time the virus can initially breed, without being shown clinically (a chronic carriage). If the virus breeds in skin blankets, then over time even at a chronic carriage of a virus of papilloma the giperplaziya of cages is observed.
As the virus of papilloma of the person is unstable in the external environment, infection occurs in direct contacts. Chaotic sexual communications lead to infection; smoking, pregnancy, endometriosis, avitaminosis, immunodeficiencies are the contributing factors that at interaction to a virus there was infection. The risk of infection increases at frequent contacts with naked skin of the person, for example at massage.
Clinical displays of papillomas
Papilloma is a new growth of skin or mucous and externally looks as sosochkovy growth which acts over surrounding fabric. Skin, mucous membranes papillomas, in inguinal area and on genitals are localized, in certain cases papillomas are found in kidney lokhanka and on mucous mochetochnik.
As papilloma consists of the connecting fabric covered with skin and comprises vessels, at its travmatization bleedings are possible. The new growth expands up outside in the form of scattered nipples in various directions and resembles a cauliflower superficially.
Skin color can not change, but in most cases papillomas have color from white to dirty-brown. Favourite localization – skin of brushes and hands. At patients with immunodeficiencies accepts widespread character. Primary changes on skin begin to be shown in 1-6 months after infection. Concentration of a virus in affected areas reaches a maximum by 6th month from the moment of infection, this period is the most infectious.
Depending on virus type, clinical displays of papillomas are variable. So, vulgar papillomas look in the form of the firm cone with a diameter from 1 mm with a rough orogovevayushchy surface. Vulgar papillomas are inclined to merge, and therefore often affect considerable sites of skin. Simple (vulgar) papillomas everywhere are localized, but more often them skin of fingers and the back of palms is surprised. At children of especially younger age papillomas knees are surprised, it is connected with physiological features as children creep without clothes. Usually vulgar papillomas are located small groups, however perhaps long existence of a single element within several years. Immunodeficiency and the general diseases promote process distribution, in isolated cases vulgar papilloma malignizirutsya.
Causative agents of plantar papillomas are VPCh 1,2,4. In several months after infection on skin of a sole there is a small brilliant shishechka which has all symptoms of usual papilloma and is surrounded by the speaker a rim. In certain cases around one papilloma there are affiliated new growths of the small sizes which resemble bubbles superficially. Then diagnose mosaic .
Papillomas on soles are often painful, especially when walking. Approximately in 30% cases they self-resolve, more often self-recovery is observed at children of younger age. They are often confused to callosities which appear between fingers at long squeezing. However callosities unlike papillomas have a smooth surface and keep the skin drawing.
Causative agents of flat papillomas are VPCh 3,10. These papillomas of not changed skin color also look in the form of smooth flat , can sometimes be yellowish or slightly pink shade is more often than roundish outlines. Also polygonal plantar papillomas meet. New growths hurt, itch, the affected area is hyperemic.
Threadlike papillomas diagnose for a half addressed aged is more senior than 50 years concerning new growths on skin, they are called still by akrokhordam. They are localized on skin around eyes, in a groin, in axillary hollows and on a neck. At first there are shishechka of the small size of a yellowish shade which increase further and will gradually be transformed to the dense extended elastic educations by the size to the 5-6th. If akrokhorda are localized in places where the travmatization is possible, then they inflame and hurt. Threadlike papillomas are not inclined to spontaneous disappearance. At patients with the diagnosed threadlike papillomas rectum polyps rather often are observed.
VPCh 13, 32 cause a local epitelialny giperplaziya which is characterized by emergence on a mucous membrane of a mouth and on a red border of lips of small sosochkovy new growths which slightly tower over skin and are inclined to merge.
One of seldom found papillomas are Lewandowski-Lyuttsa's papillomas (a warty epidermodisplaziya). Children and teenagers are ill generally. Sometimes the warty epidermodisplaziya has family character. Clinically looks as multiple red-brownish spotty papillomas on brushes and feet. If papillomas are located on sites of skin which are most subject to ultra-violet radiation, then in 30% of cases they malignizirutsya and regenerate in malignant tumors with germination in the next fabrics.
VPCh which are causative agents of peaked condylomas can be with low, average and high risk of oncological regeneration therefore when diagnosing peaked condylomas it is always necessary there takes place PTsR-inspection. The incubatory period from several weeks to several months. As in certain cases changes are minimum, these papillomas remain unnoticed. The main way of transfer – sexual. People with immunodeficiencies and often changing sexual partners enter into risk group. Externally look as the pink or pale gray pigmented peaked outgrowths on a leg.
Pain, burning, itch, irritation at a touch and friction is in most cases noted by underwear, are often injured and bleed. Are localized in anticipation of a vagina, on small vulvar lips, less often peaked condylomas meet in a vagina and on a uterus neck. At men the urethra opening is surprised. The zone of defeat depends on sexual behavior so, at the persons practicing anal contacts, peaked condylomas meet in a crotch and in a perianalny zone. In certain cases peaked condylomas diagnose on mucous a mouth and on a red border of lips that is besides connected with features of sex life.
Juvenile papillomas of a throat register seldom, they are caused by VPCh 6,11; children up to five years are ill mostly. Infection happens at the time of delivery when the woman in labor has papillomas in a vagina and the child during passing on patrimonial ways, takes a premature breath. The disease is characterized by papillomchaty growths on vocal chords that leads to difficulty of air circulation and to violations of the speech.
Diagnosis of papillomas
Diagnosis of papillomas is carried out by the dermatologist or the venereologist. Because of a large number of types of a virus it has the features. It is possible to make the exact diagnosis on the basis of visual survey only in a classical case of peaked condylomas, however it does not give exact information on type of a virus and its onkogennost. Therefore at suspicion on the papillomatozny nature of new growths, resort to virus DNA PTsR-diagnostics.
PTsR-diagnostics allows not only to confirm existence of a virus of papilloma of the person in an organism and to define its type, but also to diagnose what quantity of viruses is available in an organism at the time of carrying out the analysis. It has diagnostic value as, knowing percent of maintenance of a virus and its type, it is possible to determine approximate terms of infection and to reveal contact persons for the purpose of inspection and purpose of preventive therapy. PTsR-diagnostics also gives information on whether have papillomas a chronic current or they are a consequence of one-stage decrease in immunity. Thanks to such data it is possible to appoint adequate therapy.
If the only method of treatment is removal of papillomas, then in parallel with surgery carry out a biopsy for carrying out a cytologic research. Histologic inspection of fabric of papillomas yields more exact results as are surveyed as cages, so correctness of an arrangement of their layers and feature of a structure of fabric. It yields reliable results about extent of changes in an organism and about probability of a malignization as it is long the current and uncured papillomas more often lead to oncological diseases, than VPCh in time revealed with high degree of an onkorisk.
As a rule, PTsR-diagnostics has skrinigovy character and if the analysis confirms existence of a virus, then conduct an additional research.
Treatment of papillomas
The scheme of treatment of papillomas in each case is selected individually. If during diagnostics VPCh is found, but there are no clinical manifestations yet, then appoint preventive therapy cytostatics. It is quite effective and the virus for several years allows "to lull". To patients, the being VPCh carriers, it is recommended to carry out periodically PTsR-inspection and to use barrier contraceptives not to endanger infection with a virus of papilloma of the person of the partner.
Inosine – medicine for treatment of papillomas from group of antiviral means which suppresses reproduction of viruses. It is one of the most preferable as has immunomodulatory properties. Indications for application are the diagnosed papillomas with a combination of other viral infections, such as Cytomegaloviral infections, viruses of measles and parotitis. Existence of a virus of herpes, chronic viral hepatitises and immunodeficiencies also demands Izoprinozin's inclusion in the scheme of treatment. As therapy of papillomas long, inosine needs to be accepted only under control of the doctor as control of laboratory indicators is necessary. Application of immunomodulators and rates of vitamins are shown to all patients with VPCh.
If there are manifestations of VPCh on skin and mucous, then depending on localization and symptomatology resort to cryodestruction of papillomas, electrothermic coagulation or removal of papillomas the laser. Application of one more modern way of surgical treatment - removal of papillomas radio waves is possible. If papilloma has malignization signs, then carry out excision by a scalpel of the struck zone with capture of healthy fabrics.
It is necessary to consider that removal of papillomas does not conduct to an absolute recovery as today medicines which perniciously act on VPCh, no. Therefore patients with earlier diagnosed papillomas need to undergo periodically inspection and to conduct courses of antiviral therapy.
As VPCh is generally transferred sexually, the only prevention of papillomas is the barrier way of contraception. When planning pregnancy it is necessary to carry out diagnostics and if it is required, then treatment of a virus to reduce probability of infection of the child at the time of delivery and in the first years of life.