verucca vulgaris presentation.ppt
TRANSCRIPT
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