VERUCCA VULGARIS

ByKamilah

Fitriyani B.Zulkifli Thamrin

Advisor:dr. Saribumi

Supervisor:dr. Suswanto Wahab, Sp.KK

INTRODUCTION

• Wart is a benign proliferation of the skin and mucosa caused by HPV

• Verruca vulgaris is known as common wart

• Common wart rarely undergoes malignant transformation, therefore it’s not dangerous

Other types of verruca :

• Plantar wart,

• Genital wart,

• Flat wart

ETIOLOGY

• Caused by the human papilloma virus (HPV)

• There are more than 100 types of HPV

• The ones which caused common wart are type 2 and 4 (most common) followed by type 1, 3, 27, 29 and 57

PATHOGENESISviral inoculation at the epidermis

HPV infection

Maseration infection the on the skin epidermal stem cell

Basal cell infection

• Mitosis virus

Replicated and transported epithelium

Differentiated

Hiperkeratosis

CLINICAL MANIFESTATIONS

• Usually occurs in children of school age, but rare in infants. It can also occurs in adults

• Locations : any parts of the body but most commonly on hands and knees

• Efflorescent : hyperkeratotic papules with rough irreguler surface, can be less than 1mm to more than 1 cm in size

• Rarely itches, pain (-)

• Common warts with hyperkeratotic, rough irregular surface

• Common warts on the scalp, note the long, slender shape of the wart. Because of its unique shape, it is also known as the filiform wart.

• Sometimes a single common wart can caused the growth of other warts near its location

• Flat wart : smooth and flat surface, brownish in color, usually on the neck and face

• Plantar wart : wart on the sole of the feet

• Condyloma : note the cauliflower shape

DIAGNOSIS

• Diagnosis of verucca vulgaris is made based on its clinical manifestations

• If uncertain, histopathology findings can be made using skin biopsy

• Histopathology findings can differentiate most papillomas

• Histopathologic features of common warts include digitated epidermal hyperplasia, acanthosis, papillomatosis, compact orthokeratosis, hypergranulosis etc.

Histopatologis

• Sometimes, elongated rete ridges may point radially toward the center of the lesion

• In the granular layer, HPV-infected cells may have coarse keratohyaline granules and vacuoles surrounding wrinkled-appearing nuclei. Koilocytic (vacuolated) cells are pathognomonic for warts.

Other lab studies…..

– Immunohistochemical detection of HPV structural proteins

– Viral DNA identification using Southern blot hybridization (identify specific HPV type in tissue)

– Polymerase chain reaction (used to amplify viral DNA for testing)

DIFFERENTIAL DIAGNOSIS

• Tuberculosis cutis verrucousa

• A single lesion, rougher, may elongate in a serpiginous spreading

• Prurigo nodularis

• Usually on the extremities, itchy

• Can be differentiated from verruca vulgaris using histopathology

• The histologic features : hyperkeratotic epidermis with acanthosis and parakeratosis.

• Rete ridges are elongated and irregular with a dense dermal infiltrate consisting of neutrophils, eosinophils, histiocytes, and monocytes.

• Also notable in the dermis are thickened nerve fibers and fibrosis with thickened collagen bundles.

• Squamous cell carcinoma

• Cauliflower-like vegetation, easily bled, smelly

• Keratinocyte windblown appearance

TREATMENTS

• Some resolve on its own

• Include non-surgical and surgical methods

Non-surgical methods

• Using keratolytic agentscause cornified epithelium to swell, macerate, and desquamate

• Trichloroacetic acid 50%-80%

• Salicylic acid 20%, lactate acid 10%

Surgical methods

• Cryosurgery : Liquid nitrogen (-196ºC) is the most effective method

• Electrodesiccation and curettage: effective but painful

• Lasers : expensive• Surgical excision: Avoided risks of

scarring and recurrence.•

PROGNOSIS

• Approximately 65% of warts disappear spontaneously within 2 years.

• When warts resolve on their own, no scarring is seen. However, scarring can occur as a result of different treatment methods.

THANK YOU