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Dermatology
Human Papillomaviruses
Built from Dermatology, 5th Edition
What’s inside
11 sections · 129 slides
Overview
- What are human papillomaviruses
- Key features of HPV disease
History and Epidemiology
From a suspected contagion to the discovery of a cancer-causing virus.
- A century of discovery
- How cutaneous warts spread
- Genital HPV: a very common infection
- Persistent infection and cervical cancer
- Immunosuppression and respiratory papillomatosis
Virology and the Viral Life Cycle
How the virus is built, how its genome is organised, and how it hijacks a skin cell.
- Classifying HPV types
- HPV genus classification
- Building the virus shell
- Organisation of the viral genome
- HPV-16 genome organization
- How HPV infects skin
- Gene expression follows skin layers
- The papillomavirus life cycle
- How the immune system responds
How HPV Causes Cancer
Why some HPV types are harmless and others drive decades-long cancer risk.
- Oncogenic potential differs by type
- How high-risk HPV drives cancer
- Why some types are riskier than others
Cutaneous HPV Infections
Common, plantar, flat, and butcher's warts: how they look and where they occur.
- Classifying skin warts
- Common warts on the hand
- Warts affecting the nail
- Palmar, plantar, and mosaic warts
- Plantar warts (verrucae plantares)
- Filiform warts on the face
- Myrmecial and mosaic warts of the foot
- Chronic verrucosis in liver disease
- Chronic verrucosis without immune disease
- Periungual warts with lymphoma
- Flat warts and butcher's warts
- Flat warts (verrucae planae)
- Epidermodysplasia verruciformis (EV)
- The genetics behind EV
- Clinical appearance of EV
- Generalized macules in EV
- EV clinical course and cancer risk
- WHIM syndrome and HPV
- Immunodeficiencies linked to severe HPV disease
- HPV warts in DOCK8 deficiency
- HPV warts in hyper IgM syndrome
Mucosal and Anogenital HPV Infections
Condylomata acuminata, bowenoid papulosis, and the intraepithelial neoplasias.
- Anogenital warts (condylomata acuminata)
- Condylomata acuminata of the penis
- Extensive and confluent condylomata
- Penile genital warts
- Treatment-resistant warts after transplant
- Perianal warts with maceration
- Perianal condylomata acuminata
- Flat cervical warts and diagnosis
- Bowenoid papulosis and erythroplasia of Queyrat
- Bowenoid papulosis of the vulva
- Bowenoid papulosis of the anus
- Erythroplasia of Queyrat
- Buschke-Löwenstein tumor
- Giant condylomata (Buschke-Löwenstein tumor)
- Verrucous carcinoma of the skin
- Naming the intraepithelial neoplasias
- From intraepithelial lesion to invasive cancer
- Invasive squamous cell carcinoma of the penis
- Anogenital warts in children
Oral and Respiratory HPV Disease
Oral warts, Heck disease, head and neck cancer, and laryngeal papillomatosis.
- Oral warts and Heck disease
- Oral warts in a child
- HPV and head and neck cancer
- Oral florid papillomatosis and PVL
- Proliferative verrucous leukoplakia
- Recurrent respiratory papillomatosis (RRP)
Pathology of HPV Lesions
What the biopsy shows: the koilocyte, and how the histology differs by lesion type.
- Koilocytosis: the hallmark HPV change
- Histology of common and plantar warts
- Histology of a common wart
- Histology of flat warts and EV
- Histology of epidermodysplasia verruciformis
- EV histology in another patient
- Histology of anogenital warts
- Histology of vulvar intraepithelial neoplasia
- Histology of Buschke-Löwenstein tumor
- Buschke-Löwenstein tumor histology
- Grading intraepithelial neoplasia
Differential Diagnosis
Confirming the diagnosis, and what else can mimic an HPV lesion.
- Confirming the diagnosis
- Mimics of common, flat, and plantar warts
- Bowen disease mimicking a wart
- Warts in immunodeficiency, and mollusca
- Mimics of anogenital warts
- Epidermal nevi mistaken for warts
- Diagnosing giant condyloma and oral lesions
Therapy
No cure exists for HPV itself, so treatment targets the visible lesion.
- General principles of treatment
- Local destructive therapy for genital warts
- A complication of cryotherapy
- Treating cutaneous (skin) warts
- Treatment of common warts
- Managing anogenital warts
- Management of anogenital warts with grading of recommendations
- Management of anogenital warts with grading of recommendations (continued)
- Topical cytotoxic therapy
- Topical immunomodifiers: imiquimod
- Sinecatechins and systemic immunomodifiers
- Immunotherapy for recalcitrant warts
- Antiviral agents and retinoids
- Immune checkpoint therapy in HPV cancer
- Treatment of anogenital warts
- Special considerations: pregnancy
- Treating the intraepithelial neoplasias
- HPV types linked to each clinical presentation
- Clinical manifestations and associated human papillomavirus (HPV) types
- Clinical manifestations and associated human papillomavirus (HPV) types (continued)
HPV Vaccines
From virus-like particles to a worldwide cervical-cancer prevention strategy.
- The virus-like-particle vaccine strategy
- Proving vaccine efficacy in humans
- Three licensed HPV vaccines
- Milestones in HPV vaccine development
- Vaccination policy and population impact
- What vaccines cannot yet do
- Next-generation and therapeutic vaccines
- Key takeaways
- References
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- Dermatology, 5th Edition (2-Volume Set)