Papilloma

What is Papilloma?

A papilloma is a type of non-cancerous growth that can occur on various parts of the body covered by a layer of cells known as the epithelial surface. These growths project outward and often take on a leaf-like appearance. When we talk about a ‘papilloma’, we typically mean a ‘squamous cell papilloma’. You can find them almost anywhere on the body where there are squamous cells:

• Skin, where they show up as warts or skin papillomas
• Lip
• Inside the mouth
• Eyelid
• Tongue
• Throat
• Voice box
• Food pipe
• Neck of the uterus, or cervix
• Genital area, where they are referred to as genital warts

Human Papillomavirus (HPV), a common virus, is generally responsible for these growths. They can be passed on through contact, aside from skin papillomas or ‘skin tags’. For people with healthy immune systems, these growths typically resolve on their own.

What Causes Papilloma?

Papillomas, which are small, wart-like growths, are mostly caused by a virus called human papillomavirus (HPV). There are more than 170 types of this virus, but types 6, 7, and 11 are most often associated with papillomas. These are labeled as “low-risk” types because they generally don’t lead to precancerous changes and rarely turn into cancer. HPV can cause papillomas to pop up in many places where the body has layered, flat cells known as stratified squamous epithelium. This includes areas like the skin, eyes, mouth and throat, voice box, and windpipe.

Many studies have found that HPV types 6 and 11 are present in about 96% to 100% of all genital wart cases. This type of HPV is spread very easily through close contact, especially during sex. Skin tags or papillomas on the head and neck are typically not contagious, even though they also contain HPV. One study even found that there was no significant link between skin tags and HPV. This is why growths not caused by viruses are known as acrochordons.

Mothers can also pass HPV to their babies during childbirth. This could lead to the baby developing multiple papillomas in the voice box and windpipe, a condition known as Recurrent Respiratory Papillomatosis. This can be a serious illness, because the growths can become large and block the airway.

It’s also important to know that some papillomas are not caused by viruses, but by other factors. For instance, a kind of papilloma in the urinary tract is strongly linked to smoking. Nasal papillomas can be caused by irritation or injury to the nose lining. Some skin papillomas might be linked to skin irritation. For example, papillomas in rats, mice, and hamsters have been seen after the animals’ skin was exposed to powerful cancer-causing substances. Finally, there are some types of papillomas where we don’t yet fully understand why they happen, like those found in the milk ducts of the breast and in a part of the brain known as the choroid plexus.

Risk Factors and Frequency for Papilloma

HPV infection, which is the main reason behind the formation of papillomas, affects around 11% to 12% of the global population. However, it’s hard to get solid data on the occurrence of warty lesions. With respect to non-genital warts, the prevalence rates are 0.84% in the United States and 12.9% in Russia, based on two extensive studies. These warts are more common in children and young adults. Genital warts appear at rates of 0.1 to 0.2% every year in developed countries, mostly among teenagers and young adults.

On the other hand, skin tags, also known as Acrochorda, are found in about 46% of the general population. These are more common among older age groups, unlike warty papillomas. People who are obese are more prone to have skin tags, and they usually appear in areas where skin touches skin. Their distribution is similar amongst males and females.

Signs and Symptoms of Papilloma

When visiting a doctor, patients typically report a small rough bump on the skin that may or may not cause discomfort. It is common for patients to mention specific habits that could expose them to the virus causing the bumps. These habits might include using public showers, frequent handling of meat products or farm animals without protective gloves, or engaging in unprotected sex. Depending on its location, the papilloma may cause additional symptoms.

• Papillomas found in breast ducts may cause bloody nipple discharge.
• Recurring respiratory papillomas in the larynx or trachea can lead to stridor (a high-pitched wheezing sound) and voice hoarseness.
• Nasal papillomas may cause sinusitis and a loss of smell.

Upon physical examination, the doctor may identify single or multiple solid bumps. If the bump is on the skin, it might look like a rough solid patch, usually covered with hardened skin. When present on the inside surfaces of the body, these bumps might appear as a soft, stalk-like growth with many finger-like projections. These can be long and sharp or short and rounded, if hardened skin, or keratin, has built around the bump. Lesions with less keratin are often pink or red and might resemble a raspberry. In contrast, heavily keratinized lesions are usually white and may look similar to cauliflower.

Testing for Papilloma

Squamous cell papillomas are usually identified through a routine examination and often don’t require additional tests, especially in individuals with a healthy immune system. These papillomas typically go away on their own and don’t turn into cancer. However, for some that are more likely to turn cancerous, such as ones in the anal or throat area, they may be removed and sent for further testing. But this is only if there’s doubt about the diagnosis or there’s worry about the cells changing abnormally.

Genital warts are commonly due to particular types of Human Papilloma Virus (HPV) that pose a low risk. But, 5% to 20% of people with genital warts can contract other sexually transmitted diseases. Therefore, people with genital warts should take precautions for high-risk HPV infections that can cause precancerous lesions. A regular screening should be done for such cases. Screening for cervical changes or cancer is usually done with a speculum examination and a test called a Pap smear.

Treatment Options for Papilloma

Cutaneous papillomas are skin growths that often don’t cause pain. Sometimes, they can disappear without treatment over time. They usually don’t get bigger and there’s a low chance of them turning into cancer, especially in people with good immune systems. If doctors decide that treatment is necessary, the chosen method will depend on the type, size, and location of the papilloma.

There are different types of papillomas, including skin warts and genital warts. These can be treated with creams or gels placed on the skin, or procedures such as freezing (cryotherapy) or laser surgery. Skin warts can also be removed by making a small cut and removing it with a surgical knife (scalpel), or by using heat (cauterizing) to remove it.

If papillomas are found in the brain, the ducts in the breast or the respiratory tract, surgery may be the primary method of treatment. A papilloma can sometimes return in the same place it was before. If this happens, the treatment might need to be repeated.

There are specific surgical techniques that can help prevent spreading the virus that caused the papilloma, and reduce the chance of it returning. This includes freezing (known as cryotherapy) which doctors perform without touching the papilloma directly.

What else can Papilloma be?

There are various diseases which result in excess growth of the skin’s tissue layer. These diseases result in solid bumps on the skin that need to be identified and distinguished from papillomas. These include:

• Acrochordon
• Adenoma
• Basal cell carcinoma
• Chancroid
• Condyloma latum
• Corns & calluses
• Cysts
• Emilia
• Herpes simplex
• Keratoacanthoma
• Molluscum contagiosum: This is caused by the poxvirus and leads to the formation of fleshy bumps.
• Psoriasis
• Moles
• Neurofibromas
• Nevus lipomatosus
• Seborrheic keratoses

What to expect with Papilloma

People who have a healthy immune system generally have a good outcome when they get papillomas, or noncancerous skin growths, caused by Human Papillomavirus (HPV). However, these growths may come back from time to time. It’s important to know that some types of HPV can cause serious changes in the cells of the vulva and cervix (parts of a woman’s reproductive system), which can lead to cervical cancer. Even though these particular types of HPV don’t usually cause skin growths, they’re often found in people who have genital papillomas.

People with weakened immune systems may see a quicker spread and increase in papillomas. There’s also a higher chance of these growths turning into cancer in such individuals.

Possible Complications When Diagnosed with Papilloma

Papillomas, which can develop in various parts of the body, hardly cause serious or life-threatening problems. What complications they can cause largely depends on where in the body the growth forms.

• Papillomas in the respiratory system, specifically in the larynx and the upper trachea, can grow rapidly and extensively. This can cause a blockage in the upper airways and a harsh, noisy breathing sound known as stridor.
• Choroid plexus papillomas that form in the brain can hike up the production of cerebrospinal fluid. This can result in increased pressure inside the skull and a condition known as hydrocephalus. In dire cases, it may lead to a serious condition where the brain moves downward and herniates, which can be fatal.
• Papillomas rarely transform into cancer in individuals with a healthy immune system, but it’s not impossible that such a transformation occurs.
• A papilloma that forms at the lacrimal punctum, a tiny opening in the inner corner of the eyelids, can grow into the punctum and the canaliculus. In some cases, it may also affect the lacrimal sac and the nasolacrimal duct. This type of papilloma is termed an inverted papilloma.

Preventing Papilloma

It’s essential to take some precautions to prevent papilloma, which is a small, wart-like growth on your skin, caused by certain types of the human papillomavirus (HPV):

* Practicing safe sex is recommended as HPV can be sexually transmitted.
* Regular Pap smear screenings can help detect HPV early. This is where a doctor collects cells from your cervix to test for cancer or precancerous changes.
* Wearing flip-flops in communal shower areas can reduce the risk of picking up the virus from the floor.
* If your job involves handling meat, it’s safer to wear disposable gloves. This will help reduce the risk of skin contact with potentially infectious material.
* Warts, unlike skin tags, can be passed on by touching. This means you can get infected if you touch a wart on someone else’s skin or if you share personal items like towels or razors.
* There are vaccines available to prevent infection with certain types of HPV. It’s recommended for both boys and girls to get this vaccine at the ages of 9-12. The current version of the vaccine protects against nine HPV types – 6, 11, 16, 18, 31, 33, 45, 52, and 58, which are known to cause most cases of cancer related to HPV.