Update on human papilloma virus - part I: epidemiology, pathogenesis, and clinical spectrum

Geraldo Magela Magalhães, Érica Cristina Vieira, Lucas Campos Garcia, Maria de Lourdes Ribeiro De Carvalho-Leite, Antônio Carlos Martins Guedes, Marcelo Grossi Araújo, Geraldo Magela Magalhães, Érica Cristina Vieira, Lucas Campos Garcia, Maria de Lourdes Ribeiro De Carvalho-Leite, Antônio Carlos Martins Guedes, Marcelo Grossi Araújo

Abstract

Infection with human papilloma virus (HPV) is related to a great number of cutaneous and mucosal manifestations. The spectrum of HPV ranges from inapparent infections, through various clinical benign presentations including cutaneous and mucosal disease, to malignant and premalignant conditions. New HPV types are currently described in the literature; many of them are characterized as high-risk types due to their oncogenic potential. Knowledge regarding their epidemiology and pathogenesis is important to understand not only infection and disease processes, but also to formulate the clinical and laboratory basis for diagnosis, therapeutics, and prophylactic measures. This non-systematic review aims to discuss and to update those aspects, with an emphasis on relevant topics for dermatologists. HPV infection and related diseases in the Brazilian scenario are highlighted, including common dermatologic conditions seen at clinics as well as the condition of a public health problem as a sexually transmitted infection. The oncogenicity of the virus and the variety of clinical outcomes - especially in the immunocompromised individuals - are addressed.

Keywords: Papillomaviridae; Tumor virus infections; Tumor virus infections/complications; Tumor virus infections/diagnosis; Tumor virus infections/epidemiology.

Copyright © 2020 Sociedade Brasileira de Dermatologia. Published by Elsevier España, S.L.U. All rights reserved.

Figures

Figure 1
Figure 1
(A), Common wart, papules with keratotic surface, some with dark spots. (B), common wart at dermoscopy, vessels surrounded by a white halo and hemorrhagic dots. Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 2
Figure 2
(A), Mosaic plantar wart. (B), periungual wart. Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 3
Figure 3
(A), Myrmecia plantar wart (arrow). (B), Plantar wart at dermoscopy, hemorrhagic dots on a yellowish background with interruption of the skin lines. Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 4
Figure 4
(A), Epidermodysplasia verruciformis, erythematous and/or brownish plaques that resemble pityriasis versicolor lesions and seborrheic keratosis on the trunk. (B), WILD syndrome, numerous flattened erythematous papules forming plaques on the back of the hand and forearm, associated with lymphedema of the upper limb. Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 5
Figure 5
(A and B) Verrucous carcinoma, large tumor in the forefoot, multilobulated, with verrucous areas, reaching the dorsum of the foot (A) and sole (B). Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 6
Figure 6
(A), Condyloma acuminatum, papules and plaques, vegetating, skin-colored, pinkish and brownish, located in the suprapubic fold. (B), Condyloma acuminatum at dermoscopy, vessels surrounded by a white halo in digitiform projections. Source: Dermatology Service of HC-UFMG/EBSERH.
Figure 7
Figure 7
(A), Bowenoid papulosis, multiple hyperpigmented plaques on the female genitalia in an immunocompetent patient, with an infiltrative and eroded tumor (arrow). Source:Dermatology Service of HC-UFMG/EBSERH. (B), Oral condylomas, flattened papules, and pedunculated lesion on the lateral border of the tongue. Source: Dermatology Discipline, Botucatu Medical School - UNESP.
Figure 8
Figure 8
Giant condyloma acuminatum, extensive tumor with vegetating and verrucous areas. Personal Archives: Dra. Ana Tereza Orsi.
Figure 9
Figure 9
(A and B) Flat warts in a transplanted patient. (C), Condyloma acuminatum in an HIV-positive pregnant woman, showing multiple papules and condylomatous plaques, some eroded (secondary to the use of topical medication) affecting a large area. Source: HC-UFMG/EBSERH.

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