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Recent Advances in the Management of Cutaneous HPV Infection
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- There are over 200 types of human papillomavirus (HPV). The authors reviewed new HPV detection methods, subtypes of epidermodysplasia verruciformis (EV), how to differentiate EV from generalized verrucosis, the carcinogenesis pathway of HPV, and the various skin tumors associated with HPV. The high-risk mucosal HPV types were identified in most nail squamous cell carcinoma (SCC) or Bowen's disease cases. The authors suggested that nail unit SCC may be considered a sexually transmitted disease.
- Our understanding of the pathogenesis of HPV-induced malignancy is increasing. Future research will investigate the role of HPV status in disease prognosis. The authors propose that Bowen’s disease of the nail unit may be considered among high-risk HPV-associated cancers, such as cervical, anal, penile, and vulvar cancers.
abstract
This abstract is available on the publisher's site.
Access this abstract nowMore than 200 types of human papillomavirus (HPV) have been reported to date and have been associated with various dermatological diseases. Among dermatological diseases, viral verrucae are the most commonly reported to be associated with HPV. Epidermodysplasia verruciformis (EV) consists of three types: typical EV is an autosomal recessive genetic disorder with TMC6/TMC8 gene mutations, atypical EV develops due to various gene mutations that cause immunodeficiency, and acquired EV develops due to acquired immunodeficiency. Generalized verrucosis differs from EV in that it involves numerous verrucous nodules (mainly on the limbs), histopathologically no blue cells as seen in EV, and infection with cutaneous α-HPVs as well as β-HPVs. HPV-induced skin malignancies include squamous cell carcinoma (SCC) caused by β-HPV (especially HPV types 5 and 8) in EV patients, organ transplant recipients, and healthy individuals, and SCC of the vulva and nail unit caused by mucosal high-risk HPV infection. Carcinogenesis of β-HPV is associated with sunlight. Mucosal high-risk HPV-associated carcinomas may also be sexually transmitted. We focused on Bowen's disease of the nail, which has been the subject of our research for a long time and has recently come to the fore in the field of dermatology.
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Recent advances in cutaneous HPV infection
J Dermatol 2023 Jan 05;[EPub Ahead of Print], A Shimizu, R Yamaguchi, Y KuriyamaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This Japanese article is a concise and helpful review of HPVs, their genotypes, their clinical significance, and their role in the pathogenesis of skin and mucosal neoplasms. It is also a helpful reminder that not all warts “are created equal,” and that differences in their distribution, morphology, and the mutations both of the causative HPV and the infected host can have meaningful impact on treatment and prognosis. Of particular value is the authors’ focus on the clinical presentation and subtypes of the genetic disorders epidermodysplasia verruciformis and generalized verrucosis; it is important for providers to recognize these presentations to screen for causes of acquired systemic immunodeficiency, including HIV infection.
We note the authors’ emphasis on Bowen’s disease of the nail apparatus but hesitate to conclude with the authors that it is a sexually transmitted disease based on the presented evidence of distribution on the fingers. The lessons learned during the recent epidemic of Mpox (formerly monkeypox) serve to demonstrate that a disease may be spread by physical contact but not yet be associated with sexual intimacy.Looking forward, we hypothesize that, as in the case of squamous cell carcinoma of the head and neck, HPV positivity or the lack thereof will prove to have prognostic significance in squamous cell carcinoma of other mucosal tissues, including Bowen’s disease of the nail apparatus. We look forward to the publication of more of the authors’ work in this area.