What is it?
Human Papilloma Viruses or HPVs are very common viruses. There are more than 150 types: HPV1, 14, 16, 18, and so on. Papillomaviruses can infect the skin and mucous membranes 1 and be responsible for benign or malignant lesions:
Human infection with HPV is most often responsible for benign lesions such as:
- on the cutaneous plane: vulgar and plantar warts
- on the mucosal plane: condyloma, also called genital warts
However, HPV can be associated with the occurrence of certain cancers:
- Cutaneous: the occurrence of skin cancer associated with verruciform epidermodysplasia, a rare and genetic disease, caused by HPV 5 and 8.
- Mucosal: the occurrence of anogenital carcinomas, including cervical cancer in case of contamination with HPV 16 or 18.
The symptoms of Papillomavirus
HPV contamination is mostly symptom free, and incubation can range from weeks to years.
When HPVs express themselves, they can give:
On the cutaneous plane
There are many types of warts like:
- Common wart : Common on the elbows, knees, hands or toes, it looks like a hard, rough, flesh-colored or whitish dome.
- The plantar wart : located as the name suggests on the sole of the foot, it looks like a whitish and indurated area. Plantar warts include myrmcia , which is often unique and punctuated by small black dots, and the mosaic wart , which is composed of various coalescent whitish lesions.
- The flat warts . They are small elevations of flesh-colored skin or discretely brownish, frequent on the face.
- The verrucous papillomas . These are filiform growths protruding from the skin and frequent on the beard.
On the mucous plane
The condylomas usually form small growths of a few millimeters reminding the texture of the cutaneous warts. Sometimes, the condylomas form only small pink or brownish elevations more difficult to see.
It can also be condyloma almost invisible to the naked eye. In women, the symptoms can only be genital bleeding or itching.
People at risk for papillomavirus
People with immunodeficiency (cortisone or other immunosuppressive therapy, HIV / AIDS, etc.) are more susceptible to HPV contamination.
On the cutaneous level, people at risk are children and young adults, especially when they are in sports halls or swimming pools. There is also a type of HPV transmitted by animals, the HPV 7. It is common on the hands of butchers, renders or veterinarians.
On the genital level, the HPV is for sexually active people and in particular, those who have multiple partners and who do not use a condom.
Small skin wounds are the gateway for viruses in the skin (scratches or cuts) and therefore represent a risk factor for contamination.
Infection with another STI ( genital herpes , HIV / AIDS , etc.) is a risk factor for HPV infection. Indeed, there may be genital lesions constituting entry doors into the mucous membranes.
Medical treatment of papillomavirus (HPV)
Treatment of cutaneous HPV
Treatment depends on the age of the patient, the type of wart and its location. Most treatments require several sessions (especially for plantar wart, more resistant to treatment). Doctors tend not to treat plantar warts if they are not painful. There are many treatments, but none offers a total guarantee.
Many salicylic acid products (some of which also contain lactic acid) are available over the counter and may work well, especially for common warts (eg Duoplant in Canada, Duofilm in Canada, Compound W and Off-Ezy in Canada). The effect of salicylic acid is comparable to that of a burn: after application, the skin becomes withered and whitish. Every day, a thin layer of this withered skin is removed. The acid also creates a local inflammation that could help the immune system fight the virus. It is important to follow the manufacturer’s instructions carefully and apply the product daily to be effective. These treatments are usually followed for 3 to 4 weeks.
The concentration of salicylic acid varies from one product to another, between 10 and 60%. The concentration chosen will depend on where the wart is and how resistant it is to treatment. Some products are in the form of liquid, some of gel or dressings to be placed on the war. It is not recommended to use them on the face or other sensitive areas. The faster applications are started, the lower the risk of spreading the virus.
The cryotherapyis a process that uses cold to “burn” the war. The doctor drops liquid nitrogen directly to -196 ° C on the war, causing the wart to detach. Nitrogen is applied until the skin is frozen for about 5 seconds. The product destroys both the wart and the virus, but a blister then appears, and the procedure is painful. Usually, several sessions (2 or 3 weeks apart) are required to remove the wart permanently. It is possible to make this treatment less painful by applying a local anesthetic 1 hour before the procedure. It should also be noted that this treatment may depigment the skin or, on the contrary, make it darker. A product (Freeze-Away in Canada, Cryopharma in France) based on cold,
Many other treatments exist and can be offered for plantar warts and more resistant warts.
Sold without prescription, however, cantharidin must be applied by a doctor. A bulb forms under the wart and disappears in 1 to 2 weeks. The application is not painful and this product can be effective on plantar warts.
After performing local anesthesia, the doctor can incise and extract the wart or destroy it by electrocoagulation. Both of these minor procedures should be done carefully to avoid scar formation.
Again in rebellious cases or in people whose immunity is fragile, it is possible to inject interferons into the wart (in Canada). Interferons are substances that fight against viral infections.
In the most severe cases, bleomycin, a substance that prevents cells from multiplying, is sometimes injected. This method is suitable for all types of warts, but it remains unpopular because of the intense pain it causes.
Other products are sometimes used: imiquimod, trichloroacetic acid, cimetidine and 5-fluorouracil or 5-FU (often used for genital warts).
Another method is to destroy the laser wart. This technique does not cause any bleeding, but the healing is sometimes long and it often leaves a scar. It is therefore a solution of last resort.
In 2006, a meta-analysis compiled the results of 60 clinical trials on the treatment of warts (excluding genital warts). According to its authors, salicylic acid solutions are the treatment with the most evidence of efficacy. Their use leads to healing in 73% of cases. As for the treatment with cold liquid nitrogen, its effectiveness would not be greater than that of salicylic acid, contrary to what we have long believed. However, a randomized trial published in 2010 compared the efficacy of these two treatments in 250 patients. For common warts, cryotherapy seemed more effective. On the other hand, cryotherapy, salicylic acid application or treatment abstention all gave equivalent results on plantar warts.
Treatments of genital HPV
The condylomas can diminish or disappear without any intervention. However, medical treatment eliminates visible lesions more quickly, reducing the risk of transmission and helping the immune system fight infection. The doctor treats the consequences (condylomas) of the infection and not its cause (HPV), which means that the warts can come back even after they are gone.
There are different approaches to eliminating genital warts.
At home, infected people can apply creams or ointments containing, for example, podofilox, which burns warts. Other creams have the effect of stimulating the immune system, such as imiquimod.
In the clinic, a doctor may use trichloroacetic acid to burn the warts.
If necessary, the condyloma can be removed by laser, cryotherapy (with liquid nitrogen) or electrocoagulation, where electric current is used to burn the warts.