Overview: Human Papillomavirus and Warts

• Warts are benign growths found on the epithelium of the skin and mucous membranes that appear as thick, hyperker-atotic lesions. They are caused by infections from a family of double-stranded DNA viruses known as human papilloma-virus (HPV).

• More than 100 types of HPV have been identified within this family. Infections by HPV are manifested mostly as cutaneous, nongenital disease (common warts, flat warts, plantar warts) and genital dis-ease (genital warts, cervical dysplasia, cervical cancer).

• HPV infection is also uncommonly found in the oral and respiratory mucosa. The clinical manifestation of the infection depends on the HPV type, the size of the inoculum, the immune status of the host, and the anatomic site. Individuals with impaired cell-mediated immunity are particularly more susceptible to HPV infection.

Important points to consider

• Observation is a reasonable first approach.

• A healthy combination of whole food with fruits and vegetables, particularly dark green and yellow ones such as papaya, pumpkin, oranges, broccoli, and spinach, has been reported spinach, to protect against the effects of HPV and to support a healthy immune system.

• Tobacco use is associated with increased risk of persistent HPV infections as well as with the development of warts and HPV-related malignant neoplasms.

• A diet high in carotenoids is recommended over supplementation.

• In a study that compared hypnosis, topical salicylic acid, and placebo, hypnosis produced significantly more wart regression than the salicylic acid or placebo treatment did at a 6-week follow-up.

• Therapies usually include local destruction of wart tissue directly by chemical agents, ablative therapies, and immunomodulating therapies that enhance the patient's immune response against HPV.

• The quadrivalent HPV vaccine (Gardasil) is effective for primary prevention against genital warts in males and females.

Prevention Prescription

• Maintain a healthy diet that consists of dark green and yellow vegetables and fruits.

• Avoid moderate to high consumption of alcohol and cigarette smoking.

• Workers handling meat, fish, and poultry should wear appropriate protective geat Wear shoes when using communal showers or locker rooms.

• her partner has genital warts, use condoms consistently during sexual intercourse If either Maintain regular screening for cervical HPV infection with Papanicolaou smear.

• Vaccinate against HPV types that lead to cervical cancer and genital warts (quadrivalent HPV vaccine (Gardasil), 0.5 ml. intramuscularly three times at 0, 2. and 6 months).

Integrative therapeutics review

Diet and Lifestyle

• Balanced, whole-food diet that comists of vitamin C, vitamin E, carotenoids, and folic acid. Also include lots of dark green and yellow vegetables and fruits.

Integrative Therapies

• Hypnotherapy

• Dact tape

• Topical green tea extract ointment (Veregen)

Supplements

• Vitamin C: 1000 mg two times daily

• Vitamin E: 400 units/day Folic acid: 400 mcg/day

Pharmaceutical Therapies

• Topical salicylic acid: 15% to 20% preparations, applied daily for 12 weeks.

• Topical podophyllotoxin (podofilox): 0.3% gel or solution, applied twice daily for 3 days. followed by 4 days of no treatment, then repeated up to four cycles

• Topical trichloroacetic acid: 80% to 90% preparations, applied weekly by physician for 4 to 6 weeks

Surgical Therapies

• Cryotherapy

• LEEP/LLETZ

Key Web Sources

• http://www.cdc.gov/kpy

• http://www.nlm.nih.gov/medlineplus/warts.html

• http://www.aafp.org/online/en/home/publications/journals/afp.html