Papillomas

Papillomas, in general, is a histopathological term used to describe benign tumours with a specific morphology. Papillomas, as mentioned above, are caused by the human papilloma virus – HPV. These lesions, called papillomas, usually have a crescentic central vascular core around which epithelial tissue develops. They are a fairly common skin condition and their size on the skin ranges from a few millimetres to 3 cm in diameter and up to 5 cm in height. They appear as a section of soft and sagging skin. In case they are quite sizable with a thin stalk they are called hanging termites. They are usually the same colour as the skin and appear in groups close to each other.

The human papilloma virus – HPV (Human Papilloma Virus) produces epithelial benign tumors of the skin and mucous membranes. Dermatologist – Venereologist Dr. Amalia Tsiatoura points out that of the 100 different HPV genotypes discovered to date, about 30 are responsible for infections involving the epithelia of the skin and mucous membranes of the lower genital tract. These 30 HPV genotypes are known as genital types.

The genital types of HPV are divided into two categories: low-risk and high-risk. Low-risk HPVs generally cause benign lesions. In the high-risk group there is a small chance that active infection of cells by HPV will, after a long period of time, lead to mutation and malignancy. Most commonly, HPV-induced malignancy occurs in the cervix, and there is also a risk of metastasis and malignancy in the penis or anus. It is important to note that even high-risk HPV genotypes are not capable of causing cancer on their own. Other factors need to coexist, the main ones being genetic predisposition and a weakened immune system.

Some of the HPV virus genotypes are responsible for papillomas, while others are responsible for papillomas located on the neck and body of patients. These latter HPV genotypes are always low risk and are not associated with outbreaks and carcinoma formation.

The most common causes include the following cases.

• Papillomas and body weight. It is probably due to more intense sweating and the formation of folds in the skin that are conducive to the development of human papilloma viruses. In these cases, weight loss also reduces the occurrence of new papillomas.
• Papillomas and pregnancy: papillomas often first appear or multiply during pregnancy. Both weight gain and hormonal factors probably play a role in this. It is also common for papillomas to increase in size during pregnancy. This should not be of concern to pregnant women. It is advisable to treat papillomas after childbirth.
• Papillomas and endocrinopathies: Thrombi often occur in diabetics. In these cases, they should be treated immediately, as the risk of inflammation of papillomas is higher in diabetics. Hypothyroidism and adrenal disorders may also lead to an increase in papillomas. Polycystic ovary syndrome, as well as pituitary adenomas causing acromegaly, are often associated with papillomas.
• Papillomas and skin trauma: Trauma favors the spread of papillomas. Therefore, rubbing with a sponge during bathing, as well as with towels, multiplies papillomas. Shaving the area favors papilloma formation, as the razor cuts off some papillomas while shaving and transfers them to new areas where the virus is incubated. Also neck chains and friction from clothing exacerbate the problem of cervical papillomas.
• Papillomas – association with warts and verruca: Papillomas are caused by the same group of viruses that cause warts and verruca. Therefore, thrush and warts or warts and tubercles often coexist in many patients.
• Papillomas- heredity: There is an inherited predisposition to papillomas, as it seems that when one person has papillomas other people in their family are likely to develop them. However, the nature of the inheritance has not been clarified.

The following measures prevent the occurrence of papillomas:

• No rubbing with a sponge or towels after bathing.
• Avoiding using chains and necklaces on the neck
• Avoiding shaving an area affected by papillomas
• Avoiding touching the area and frequent hand washing
• Reducing body weight if you are overweight
• Immediate destruction and laser removal of papillomas as soon as their existence is detected.
• Vaccination against HPV viruses with the Gardasil polyvalent vaccine reduces the risk of papillomas as it protects against HPV 6,11,16,18.

The most common types of papillomas are:

• Common papillomas: appear as skin lesions near the fingernails of the hand, but can also appear on any other part of the hand. The most commonly affected are adults and children. Common papillomas are painless and largely asymptomatic.
• Papillomas: appear on the feet and may look like small black dots. These dots are actually small blood vessels. Plantar papillomas are most often painful because they are pressed inwards when walking.
• Warty papillomas: these are papillomas of the body and face that have an irregular, warty (anthracnose) rather than smooth surface. They resemble warts, but are caused by other HPV genotypes and are less contagious than warts.
• Mouth sores: these are small lumps, usually pointed, on the mucous membrane or tongue of the mouth, as well as on the corners of the lips. Proper diagnosis and treatment is required as they can become extremely painful and make it difficult to chew or take food.
• Genital papillomas: may be genuine papillomas or may be confused with warts. The latter are sexually transmitted and require immediate treatment as they are highly contagious. Their differential diagnosis can only be made with an HPV-DNA test.
• Vaginal papillomas: these are papillomatous growths located in the vagina and vulvar lips. It is also important to make a differential diagnosis from warts and it is recommended to perform a vaginoscopy, biopsy and HPV-DNA test. Vaginal papillomas should be treated immediately as they can lead to pain during sexual intercourse, burning sensation, bleeding and infections.
• Anal papillomas: these are small soft lumps around the lining of the anus. They can be confused with the warts that are common in this area or even with haemorrhoids. Anal papillomas should be removed and treated immediately, as they can easily become infected and lead to painful conditions. HPV-DNA testing also helps in this case for an accurate diagnosis, and in some cases, an orthoscopy may be required.

Oral papillomas may appear as small white papules on the lining of the mouth or tongue and the patient may feel pain or burning sensation when taking food. Papillomas in the mouth should be differentiated from oral leukoplakia and/or oral warts. This differential diagnosis of oral papillomas is based on the biopsy that should be taken from the mouth, but also on the HPV-DNA test that is recommended in all cases of oral papillomas.

The main culprits responsible for papillomas are HPV 6 and HPV 11, as well as numerous other types of low-risk HPV viruses. Therefore, papillomas are not associated with an increased risk of developing skin cancer, although in rare cases the development of dysplasia and in situ cancer has been described on papillomas.

However, these strains are reported as low risk, therefore dysplasia on papillomas is rarely observed. Dermatologist – Venereologist Dr. Amalia Tsiatoura recommends taking a biopsy from a papilloma if rapid growth in size is observed, with bleeding and an abnormal surface of it.

Note that papillomas are benign skin tumors and have no relation to any form of skin cancer. They do not mutate into malignant tumors. However, it is recommended that they are removed when they cause various aesthetic or functional problems.

CO2 Laser treatment leads to complete elimination of existing lesions, without creating marks and scars on the skin. Its use is painless, bloodless and immediately after the treatment the person returns to his/her activities immediately. The CO2 Laser beam is directed with millimeter precision to the desired spot without affecting the surrounding healthy tissue at all.

CO2 laser papilloma treatment is easy, quick, painless and with excellent results, and is associated with the lowest risk of recurrence compared to other treatment methods.

There are no serious complications, except for a slight burning sensation after treatment and the appearance of a small scab at the sublimation site of the papillomas that resolves in 2 to 3 days. This is a bloodless method and topical antibiotic treatment is recommended as a precaution to prevent the small possibility of infection in the area.

Cosmetic Derma Medicine Medical Group is the largest and most specialized medical group in the field of Dermatology and Plastic Surgery, with 15 clinics in Greece and Cyprus. In Cosmetic Derma Medicine, we have the latest generation equipment and it is possible to remove papillomas painlessly and bloodlessly with CO2 Laser, while the treatment is carried out exclusively by a dermatologist. The lesions are eradicated and destroyed even in a single session, and we can also intervene on large papillomas such as termites.

The Dermatologists who staff Cosmetic Derma Medicine have been trained in Dermoscopy and Mapping at Universities in Greece and abroad. The Scientific Director of Cosmetic Derma Medicine is Dermatologist – Venereologist Dr. Amalia Tsiatoura, while the personnel consist of a medical team of highly experienced and specialized doctors of many different specialties, as well as a fully trained team of nurses. Our team is at your side every day, 24/7 for whatever you need.