Wart viruses

A growing recognition that there is an association between human papilloma viruses (HPV), which cause warts, and cancer has led to a renewed interest in these infections. The wart is one of the few tumours in which a virus can be seen to proliferate in the cell nucleus. The different clinical forms of wart are caused by range of HPV, currently divided into over 80 major types. These viruses are also responsible for cervical cancer and have been associated with squamous carcinomas in the immunosuppressed. Warts are classed as cutaneous or mucocutaneous. Epidermodysplasia verruciformis is a rare condition associated with a defect of specific immunity to wart virus. The following aspects should be remembered:

Genital warts (due to HPV) very rarely undergo malignant change but HPV infection of the cervix, caused by type 16, frequently leads to dysplasia or in some cases malignant changes. Cervical smears must be taken.

• Very extensive proliferation of warts occurs in patients receiving immunosuppressive therapy, such as renal transplant recipients—in whom wart-like lesions can develop into squamous carcinomas—and in patients with AIDS.

• There is an association between HPV infections of the skin in immunosuppressed patients and the subsequent development of atypical-looking squamous carcinomas.

• Epidermodysplasia verruciformis, an unusual widespread eruption of flat erythematous warty plaques, can also develop into carcinoma.

Common warts
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