In vivo and ex vivo dermoscopy of lesions from implantation of human papillomavirus in tattoos: report of two cases

Abstract The number of individuals with tattoos has been increasing worldwide, alongside with reports of complications varying from reactions to the injected pigments to infections caused by agents inoculated in the pigmentation process. The diagnosis of such unwanted events can be obtained through complementary non-invasive methods, preserving the maximum of the tattoo design. The authors present two cases of patients with warts on tattooing, and correlate their clinical aspects to in vivo and ex vivo dermoscopy, and to the findings in the histopathological examination, aiming to determine patterns that aid the diagnosis of these lesions without performing biopsy.

Burden of genital warts in Colombia: an observational study / Carga das verrugas genitais na Colômbia: um estudo observacional

Introduction: Genital warts are benign lesions caused by sexual transmission of human papillomavirus types 6 and 11, with significant impact on healthcare resource use and patients' quality of life. Objective: To describe the epidemiology of genital warts in adults visiting a physician office for any reason, physician practice patterns, and healthcare resource use and costs in Colombia. Methods: Participants were a convenience sample of 53 physicians in 5 specialties: primary care (15), gynecology (24), urology (12), proctology (1), and dermatology (1). Physicians completed a survey and daily log of all patients 18-60 years old seen over 10 days in their practices in 2016-2017. The physician survey recorded genital warts consultation and management patterns. The daily log recorded patient demographic information and genital warts diagnosis. Results: Among 6,393 patients logged by physicians, the genital warts prevalence was 2.03% (95%CI 1.69­2.38) and incidence 1.30% (95%CI 1.02­1.58). Primary care physicians referred most of their genital warts cases for treatment (female: mean 63.3%, SD=44.8; male: mean 58.3%, SD=43.8). Treatment of non-resistant episodes (<6-month duration) lasted an average of 37.4 days (SD=29.4) and required an average of 4.0 (SD=1.9) office visits for females and 3.0 (SD=1.7) for males. The overall mean cost of an episode of care was USD558.13 (SD=507.30). Conclusion: Genital warts cases reported by most participant physicians were mainly direct-consult, but patients were typically treated by specialists. Much of the genital warts health care utilization and costs reported could be prevented by immunization with the quadrivalent or nonavalent HPV vaccine.

Introdução: As verrugas genitais são lesões benignas, de transmissão sexual, causadas pelo papilomavírus humano tipos 6 e 11 e que causam impacto significativo no uso de recursos de saúde e na qualidade de vida dos pacientes. Objetivo: Descrever a epidemiologia das verrugas genitais em adultos que buscaram atendimento médico ambulatorial por qualquer motivo, incluindo padrões de prática médica, uso de recursos de saúde e custos na Colômbia. Métodos: foi utilizada uma amostra de conveniência composta por 53 médicos em 5 especialidades: clínico geral (15), ginecologia (24), urologia (12), proctologia (1) e dermatologia (1). Os médicos completaram um questionário e registros diários de todos os pacientes com idade entre 18 e 60 anos atendidos durante 10 dias em seus consultórios em 2016-2017. O questionário registrou os padrões de prática médica e de tratamento de verrugas genitais. Os registros diários continham informações demográficas do paciente e o diagnóstico de verrugas genitais. Resultados: Entre 6.393 atendimentos médicos, a prevalência das verrugas genitais foi de 2,03% (IC95% 1,69­2,38) e a incidência de 1,30% (IC95% 1,02­1,58). Os clínicos gerais encaminharam a maioria dos pacientes com verrugas genitais para tratamento (mulheres: média de 63,3%, DP=44,8; homens: média de 58,3%, DP=43,8). O tratamento dos casos não-persistentes (<6 meses de duração) durou em média 37,4 dias (DP=29,4) e requereu uma média de 4,0 (DP=1,9) consultas para mulheres e 3,0 (DP=1,7) para homens. O custo médio geral do tratamento foi de US$ 558,13 (SD=507,30). Conclusão: Os casos de verrugas genitais relatados pela maioria dos médicos participantes derivaram-se principalmente de atendimentos primários e os pacientes foram tratados geralmente por especialistas. Grande parte da utilização de recursos e custos relacionados a verrugas genitais poderia ser evitada pela imunização com a vacina papilomavírus humano 4-valente ou 9-valente.

Comparative study between oral zinc sulphate, amino acids chelated zinc and placebo in treatment of viral warts

Background: Warts are tumors or growths caused by infection with Human Papilloma virus [HPV]. More than 100 HPV subtypes are known. They are a common presenting disease in children and adolescents which spread by direct contact or autoinoculation

The aim of the Work: The aim of this work was to assess and compare the efficacy and safety of oral zinc sulphate and amino acids chelated zinc in treatment of viral warts

Patients and Methods: This cross sectional case control study included 60 patients with multiple viral warts who were collected from the Dermatology, STDs and Andrology outpatient clinic of Fayoum university hospital during the period from November 2014 to November 2015. The patients were 29 males and 31 females with ages ranging from 15 to 60 years

Results: There was statistically significant difference in degree of response in zinc and control groups as no patient in control group showed any response while in both zinc groups 27.5% of patients showed variable degrees of response. Also, there was no statistically significant difference in degree of response in both zinc groups

Conclusion: Oral zinc in its both forms used in our study is safe but needs time to act and the response is not high, so it is not fit to be used as a monotherapy, but rather to be combined with other wart treatment modalities

Recommendations: More studies are needed to assess the therapeutic effect of zinc and its efficacy in combinations in warts treatment with higher doses and longer duration of treatment

Infecção pelo papilomavírus humano: etiopatogenia, biologia molecular e manifestações clínicas / Human papillomavirus infection: etiopathogenesis, molecular biology and clinical manifestations

O papilomavírus humano (HPV) é um vírus DNA que apresenta tropismo por células epiteliais, causando infecções na pele e nas mucosas. A replicação do HPV ocorre no núcleo das células escamosas e o seu ciclo de vida é diretamente relacionado ao programa de diferenciação da célula hospedeira. Até o momento, foram completamente caracterizados cerca de 100 tipos diferentes de HPVs e há um grande número adicional de tipos ainda não sequenciados. Além de ser o responsável por lesões benignas de pele e mucosas, o HPV também está envolvido no desenvolvimento de diversos tumores cutaneomucosos: doença de Bowen, cânceres de pele não melanoma e carcinomas genitais. Esta revisão aborda as características do HPV, quadros cutâneos e mucosos benignos e malignos causados por ele e os principais métodos empregados em sua detecção e tipagem.

Human papillomavirus (HPV) is a DNA virus that presents tropism for epithelial cells, causing infections of the skin and mucous membranes. Replication of HPV occurs in the nuclei of squamous cells and its life cycle is directly related to the differentiation program of the host cell. To date, nearly 100 different types of HPV have been characterized and there is a large number of other types that have not been sequenced yet. Besides being responsible for benign lesions of the skin and mucous membranes, HPV is also involved in the development of various mucocutaneous tumors: Bowen's disease, non-melanoma skin cancers and genital carcinomas. This review discusses the characteristics of HPV, malignant and benign mucous and skin manifestations caused by HPV, besides the main methods of detection and typing of the virus.

Caracterização clínica e histopatológica e tipagem do papilomavírus humano das verrugas vulgares nos receptores de transplante renal / Clinical and histopathological characterization and typing of the human papillomavirus in common warts of kidney transplant recipients

Os pacientes receptores de transplante renal apresentam elevada prevalência de lesões cutâneas por HPV. Foram estudados 20 receptores de transplante renal com diagnóstico de verruga vulgar. A detecção do HPV foi realizada pela polimerização em cadeia (PCR) com os primers MY09/MY11 e RK91. A tipagem do HPV foi feita por meio da restrição enzimática e do sequenciamento automatizado. Identificamos a presença do HPV em 10 pacientes (50 por cento) e os tipos identificados foram: HPV-2, 27, 29, 34 e 57.

The prevalence of skin lesions caused by the human papillomavirus (HPV) is high in kidney transplant patients. Twenty recipients of kidney transplants with a diagnosis of common warts were evaluated. HPV detection was performed by polymerase chain reaction (PCR) using the MY09/MY11 and RK91 primers. HPV typing was performed by restriction fragment length polymorphism analysis and direct sequencing. The presence of HPV was identified in 10 patients (50 percent) and the types identified were HPV-2, 27, 29, 34 and 57.

Zinc deficiency in patients with persistent viral warts

To determine the association of low serum zinc levels with persistent, progressive or recurrent viral warts. A comparative study. Dermatology outpatient department of Combined Military Hospital, Abbottabad in collaboration with Department of Chemical Pathology, Army Medical College, Rawalpindi, from June 2006 to May 2007. Seventy five patients having warts of more than six months duration, more than 10 in number, who either not responded to or had recurrence after previous treatments for viral warts and not having other chronic dermatological or systemic illness were included in the study after informed consent. Seventy five age and gender matched healthy individuals were taken as control. Serum zinc analysis was carried out by atomic absorption spectrometry using Perkin elmen [USA] apparatus. Independent sample t-test was used to compare mean zinc levels in microgram/litre with significance at p<0.05. Age of the patients as well as controls ranged from 12-65 years with a mean of 25.88 +/- 8.90 years. Serum zinc level was low in 42 [56%] patients and 24 [32%] controls [p=0.003]. Among the patients, serum zinc level ranged from 695-1090 micro-gram/litre with a mean of 804.38 +/- 100.60, whereas the level ranged from 690-1100 microgram/litre with a mean of 836.17 +/- 91.04 among controls [p 0.044]. Zinc deficiency is associated with persistent, progressive or recurrent viral warts in the studied patients. Randomized controlled trials with careful dose adjustment of oral zinc sulphate may be helpful to formulate guide lines to manage such patients

Diagnóstico y terapia del virus papiloma humano / Diagnosis and treatment of human papilloma virus

Tanto el diagnóstico como el tratamiento de la infección producida por el virus papiloma humano y el cáncer asociado a este virus, nos plantean uno de los mayores desafíos en la última década. Las principales dificultades radican en la identificación del genotipo viral, la ausencia de una terapia antiviral efectiva y las altas tasas de recurrencia y persistencia a pesar de la terapia empleada. Se presenta un resumen de la terapia disponible en la actualidad.

The identification and treatment of human papillomavirus (HPV) infections and HPV-associated neoplasm are complex. Difficulties in diagnosis and treatment of HPV-associated diseases arise from inabilities to detect HPV efficiently, the lack of specific antiviral drugs active against HPV and the high rates of recurrence and persistence of HPV infections after treatment. We present a review of therapies for HPV infections.

Citologia anal para rastreamento de lesões pré-neoplásicas / Anal cytology for screening of pre-neoplasic lesions

OBJETIVO: Avaliar se a citologia anal com escova pode servir para rastreamento das lesões clínicas e subclínicas provocadas pelo HPV. MÉTODOS: Colhemos citologia anal, com escova, do canal anal de 102 doentes HIV-positivo com queixas proctológicas. Eram 86 homens e 16 mulheres com média etária de 37 anos. Destes, 33 negavam infecção pelo HPV, 14 haviam tratado verrugas, 28 tinham condilomas externos, sete apresentavam lesões internas e 20 os tinham em associação. O material foi enviado para exame de papanicolaou e coloração pela hematoxilina-eosina. Avaliamos as contagens de linfócitos T CD4+ para observar se o estado imunológico determinou as displasias mais avançadas. RESULTADOS: Somente um exame não pôde ser aproveitado. Os demais revelaram padrões celulares que variaram da normalidade até NIAa, incluindo a presença do HPV. Ocorreram 30 NIAs de baixo e 13 de alto grau em todos os grupos de doentes, com ou sem infecção pelo HPV. Em um dos doentes com NIAa e sem história prévia de infecção pelo HPV, e com úlcera no canal anal, a biópsia revelou carcinoma espinocelular invasivo. As médias de células T CD4+ nos portadores de NIA de baixo grau foi 281/mm³ e naqueles com NIAa foi 438/mm³. A análise estatística mostrou diferença significante, revelando que, ao contrário do esperado, displasias menos acentuadas acometem doentes com contagens menores de linfócitos T CD4+. Esse fato demonstra que a imunidade sistêmica isolada parece não interferir na gênese dessas lesões, sugerindo que aspectos da imunidade local devam ser estudados. A avaliação estatística feita com a tabela 2x2 revelou sensibilidade de 74 por cento e especificidade de 61 por cento. CONCLUSÃO: Acreditamos que a citologia anal possa servir para esse rastreamento, selecionando os doentes para colposcopia anal e biópsias.

BACKGROUND: High grade intra-epithelial neoplasias (HAIN) are probable precursors of anal carcinoma, with association to high-risk types of Human Papillomavirus (HPV). This progression could be related to severity of the dysplasia and, albeit not yet confirmed, treatment of these lesions would prevent the evolution to cancer. Standardization and improvement of screening methods should therefore be essential to treat or prevent precursor lesions, mainly in patients at risk such as seropositives to Human Immunodeficiency Virus (HIV). The aim of this study was to evaluate if anal cytology, with a cytobrush, could be useful to screen clinic and pre-clinic lesions provoked by HPV. METHODS: Brushes were used to obtain smears from the anal canal of 102 HIV-positive patients with proctologic complaints. There were 86 males and 16 females with a mean age of 37 years. HPV infection was denied by 33 patients, 14 had treated anal warts in the past, 28 had condylomas in the anal verge, seven had internal clinical lesions and 20 had both internal and external condylomas. The smears were submitted to Pappanicolaou and hematoxilin-eosin stains to identify cytological changes including HAIN. T CD4+ lymphocyte counts were also evaluated to check if the immunologic status caused more advanced dysplasia. RESULTS: One smear only proved insufficient. All the others revealed cellular patterns varying from normality to HAIN. Low grade AIN (LAIN) occurred in 30 and HAIN in 13 patients. One patient with HAIN, without a history of HPV infection in the past, presented an anal canal ulcer which at biopsy was diagnosed as invasive squamous-cell carcinoma. T CD4+ cells averaged 281/mm³ for LAIN patients and 438/mm³ for HAIN patients. Analyses disclosed a statistical difference, showing that despite expectations, more advanced dysplasias occurred in patients with higher counts of T CD4+ cells. This fact demonstrated that isolated systemic immunity did not...

Presençca de condiloma lata em criançcas com síilis / Presence of condyloma lata in children with syphilis

Introdução: doenças sexualmente transmissíveis são verdadeiras epidemias e a sífilis vem causando danos ao longo da história, só se comparando com a aids. Objetivo: relatar três casos de sífilis em crianças, com manifestação clínica inicial de condiloma lata. Método: relato de caso por revisão de prontuários de crianças acompanhadas no Hospital Infantil Nossa Senhora da Glória. Caso 1: L, 9 anos, masculino, lesão em região anal sugestiva de condiloma lata. Avaliação médico-legal não evidenciou sinais de abuso sexual. VDRL 1:128, FTA-Abs IgG positivo e IgM negativo, líquor normal com VDRL não-reator. Mãe com VDRL 1:8, FTA-Abs IgG positivo e IgM negativo. Caso 2: G, 5 anos, feminino, lesão condilomatosa perianal, suspeita de abuso sexual não comprovada por avaliação médico-legal. VDRL 1:256, líquor normal com VDRL não-reator. Não foi realizada sorologia materna Caso 3: K, 4 anos, feminino, lesão condilomatosa perianal. Avaliação médico-legal não mostrou sinais de abuso sexual. VDRL 1:256, FTA-Abs IgM reagente, líquor normal com VDRL não-reator. Não foi realizada sorologia materna. Nos três casos não houve confirmação da classificação da doença, se congênita ou adquirida. Conclusão: há poucos dados na literatura sobre condiloma lata em crianças e o diagnóstico constitui um desafio para o pediatra, pois pode ser confundido com condiloma acuminado do papiloma vírus, por este ser mais comum. Além da importância de reconhecer a lesão condilomatosa da sífilis, é necessário dar ênfase à realização adequada da assistência pré-natal, visando reduzir os casos de sífilis congênita.

Introduction: sexually transmitted diseases are a real epidemic and Syphilis has been historically provoking terrible harm; perhaps as much harm asaids. Objective: present three cases of syphilis in children, with initial clinical manifestation caused by condyloma lata. Method: case report extracted from children's medical handbooks at Hospital Infantil Nossa Senhora da Gloria. Case 1: L, nine years old, male, lesion at anal region suggesting condyloma lata. Sexual molestation not present according to medical evaluation. VDRL 1:128, FTA-Abs IgG positive and IgM negative, normal liquor with non-reactive VDRL. Mother with VDRL 1:8, FTA-Abs IgG positive and IgM negative. Case 2: Gnb, five years old, female, Condylomatosa lesion at perianal region; sexual molestation suspicion not confirmed according to medical evaluation. VDRL, 1:256, normal liquor with nonreactive VDRL. Maternal sorology not undertaken. Case 3: K, four years old, female, aspects of Condylomatosa lesion at perianal region. Sexual molestation not present according to medical evaluation. VDRL 1:256, FTA-Abs IgG reactive, normal liquor with non-reactive VDRL. Maternal sorology not undertaken. In all three cases, the classification of the disease, congenital or acquired, was not confirmed. Conclusion: there is not many information on the medical literature regarding condyloma lata in children. Hence, it becomes a challenge to pediatricians when diagnosing such disease, mainly because it may be confused with condyloma acuminado of papiloma virus ? this being more frequent. Besides the importance of recognizing the condylomatosa lesion of syphilis, it is necessary to emphasize an adequate pre-natal assistance, aiming the reduction of congenital syphilis.

Viral warts: clinico-epidemiological study is Baghdad

The study was conducted in two dermatology departments in Baghdad. The prevalence rate of viral warts was 6.32%. The commonest type was common warts [68%]. Warts affected both sexes equally with the highest prevalence during the second decade of life. There was a high percentage of patients who had a positive history of stress, physiological trauma and family history. The study showed no relation between viral warts and marital status