Page 208 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 6-33 Integumentary System

HUMAN PAPILLOMAVIRUS (HPV) INFECTION

Uterine cervical canal

VERRUCAE (WARTS) Uterine cervix
Vagina

Verrucae are one of the most frequently encountered
viral infections in humans. They are capable of causing
disease in any individual, but severe infections seem to
be more likely in those who are immunocompromised.
Warts can affect any cutaneous surface, and unique wart
subtypes are more prone to cause disease in different
clinical locations. By far the most important aspect of
infection with the human papillomavirus (HPV) is the Vaginal
ability of the virus to cause malignant transformation. lumen
This malignant potential is specific to certain subtypes
and is especially a concern in women, who are at risk
for cervical cancer. Most cases of cervical cancer can be
traced to prior infection with certain HPV strains. In
June 2006, the U.S. Food and Drug Administration Stratified cervical epithelium
approved the use of a prophylactic HPV vaccine in
prepubertal girls. The vaccine is a recombinant quad-
rivalent vaccine against HPV types 6, 11, 16, and 18. Basal layer of the cervical epithelium
Types 16 and 18 are believed to have been responsible
for up to 70% of cervical cancers.
Clinical Findings: Verruca vulgaris, also called the
common wart, is the most prevalent wart that infects
the human. It can be located on any cutaneous surface.
These warts often appear as small papules with a rough
surface studded with pinpoint, dark purple to black
dots. These dots represent the thromboses of the tiny
capillaries within the wart. Most warts are between Lamina propria
5 mm and 1 cm in diameter, but some can become quite Virus
large and encompass much larger areas of the skin. The
coalescence of multiple warts into one larger wart is
called mosaic warts. These are most commonly seen on
the plantar aspect of the foot. Verruca vulgaris can come
in many sizes and shapes. Most lesions spontaneously
resolve within a few years. A good rule of thumb is that
50% of verrucae will disappear spontaneously in 2
years. Many distinctive clinical forms of warts exist.
The filiform wart is represented by a small verrucal
papule with finger-like projections extruding from the
base of the papule. The projections are typically 1 to
2 mm thick and 4 to 7 mm long. They are commonly
found on the face. The flat wart is frequently encoun-
tered and manifests as a 3- to 5-mm, flat papule with a
slight pink to red to purple coloration. Flat warts are
frequently seen on the legs of women and in the beard The warts are well defined and characteristically inter- Subungual and periungual warts, a subclassification
region of men, and they can be arranged in a linear rupt the skin lines. This is in contrast to a callus, in of palmar/plantar warts, are found around and under
pattern if the warts are spread during the act of shaving. which the skin lines are retained, and this sign can be the nail apparatus. These warts can cause nail dystrophy
Flat warts have been found to be highly associated with used to differentiate the two conditions. Plantar warts and pain on grasping of objects. They tend to affect
HPV types 3 and 10. can cause pain and discomfort if they are located in more than one finger and can be more difficult to treat
Plantar warts (myrmecia) are seen on the plantar areas of pressure such as the heels or across the skin than the common wart. Long-standing periungual or
aspect of the foot and are caused for the most part by underlying the metatarsal heads. Palmar warts are very subungual warts that have a changing morphology
HPV types 1, 2, and 4. They are deep-seated papules similar to plantar warts and have the same clinical should be biopsied to rule out malignant transforma-
and plaques that may coalesce into large mosaic warts. appearance. tion into a squamous cell carcinoma. This is not

194 THE NETTER COLLECTION OF MEDICAL ILLUSTRATIONS