Skip to main content

Advertisement

SpringerLink
Log in

Papillomviruserkrankungen

  • Leitthema
  • Published:
Der Hautarzt Aims and scope Submit manuscript

Zusammenfassung

Papillomviren sind weltweit verbreitet. Sie können Warzen oder Papillome hervorrufen. Einige onkogene Papillomviren sind zudem an der Entstehung maligner Tumoren beteiligt. Kutane Warzen und genitale Kondylome stellen die häufigste Viruserkrankung der Haut dar. Die Inzidenz von Verrucae vulgares und Condylomata wird in der europäischen sowie amerikanischen Bevölkerung auf 7–10% bzw. 1% geschätzt. HPV-Infektionen können durch klinische Untersuchung, Zytologie und Histologie, Antikörpernachweis, molekularbiologische Techniken sowie direkt über virale Strukturen nachgewiesen werden. Antikörper gegen HPV werden als Marker für lang andauernde Infektion und kumulativ hohe Expression von Viruspartikeln angesehen, da sie nach Abheilung einer Läsion mit niedrigem Titer über Jahre persistieren. Die Sensitivität erreicht selbst bei HPV-DNA-positiven Patienten nur 50–60%; eine Serodiagnostik erscheint für die Routine nicht geeignet und nicht notwendig. Eine kausale Therapie von Papillomviruserkrankungen existiert nicht. Je nach warzenspezifischen Faktoren, Compliance des Patienten und Erfahrung der Therapeuten sind verschiedene ablative, chemodestruktive bzw. neue immunmodulatorische Therapien vergleichbar. Jedoch finden sich im Preis und im therapeutischen Aufwand enorme Unterschiede, die bei der Auswahl des Verfahrens berücksichtigt werden müssen.

Abstract

Papillomaviruses are prevalent throughout the world. They can cause warts or papillomas. Some papillomaviruses are also involved in the pathogenesis of malignant tumors. Cutaneous and anogenital warts are the most frequent viral disease of the skin. The incidence of verrucae vulgaris and condylomata is estimated to be 7–10% in the European population and 1% in the American population. HPV infections can be verified by clinical examination, cytology and histology, detection of antibodies, molecular techniques and directly via viral structures. Antibodies against HPV are considered markers for prolonged infection and cumulatively high expression of viral particles since they persist with low titers years after a lesion has resolved. Sensitivity only reaches 50–60% even in HPV DNA-positive patients. Serodiagnosis does not appear to be appropriate for routine practice. No virustatic treatment exists. Depending on wart-specific factors, compliance of the patient, and experience of the attending therapist, all ablative, chemodestructive or novel immuno modulatory procedures are comparable. However, there are enormous differences in price and effort required for treatment, which should be considered when choosing the method.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1a–f
Abb. 2a–e
Abb. 3a–c

Literatur

  1. Abbey LM, Page DG, Sawyer DR (1980) The clinical and histopathologic features of a series of 464 oral squamous cell papillomas. Oral Surg Oral Med Oral Pathol 49:419–428

    CAS  PubMed  Google Scholar 

  2. Abdullah AN, Walzmann M, Wade A (1993) Treatment of external genital warts comparing cryotherapy and trichloracetic acid. Sex Transm Dis 20:344–345

    CAS  PubMed  Google Scholar 

  3. Ackerman LV (1948) Verrucous carcinoma of the oral cavity. Surgery 23:670–678

    Google Scholar 

  4. Adler-Storthz K, Ficarra G, Woods KV et al. (1992) Prevalence of Epstein-Barr virus and human papillomavirus in oral mucosa of HIV-infected patients. J Oral Pathol Med 21:164–170

    CAS  PubMed  Google Scholar 

  5. Aiba S, Rokego M, Tagaini H (1986) Immunhistological analysis of the phenomenon of spontaneous regression of numerous flat warts. Cancer 58:1246–1251

    CAS  PubMed  Google Scholar 

  6. Alam M, Stiller M (2001) Direct medical costs for surgical and medical treatment of condylomata acuminata. Arch Dermatol 137:337–341

    CAS  PubMed  Google Scholar 

  7. Axell T, Pindborg JJ, Smith CJ, van der Waal I (1996) Oral white lesions with special reference to precancerous and tobacco-related lesions: conclusions of an international symposium held in Uppsala, Sweden, May 18–21, 1994. J Oral Pathol Med 25:49–54

    CAS  PubMed  Google Scholar 

  8. Bal V, McIndoe A, Denton G et al. (1990) Antigen presentation by keratinocytes induces tolerance in human T cells. Eur J Immunol 20:1893–1897

    CAS  PubMed  Google Scholar 

  9. Bassioukas K, Danielides V, Georgiou I et al. (2000) Oral focal epithelial hyperplasia. Eur J Dermatol 10:395–397

    CAS  PubMed  Google Scholar 

  10. Beutner KR, Wiley DJ, Douglas JM et al. (1999) Genital warts and their treatment. Clin Infect Dis 28:537–556

    PubMed  Google Scholar 

  11. Bonnez W, Da Rin C, Rose RC et al. (1991) Use of human papillomavirus type 11 virions in an ELISA to detect specific antibodies in humans with condylomata acuminata. J Gen Virol 72:1343–1347

    PubMed  Google Scholar 

  12. Butler S, Molinari JA, Plezia RA et al. (1988) Condyloma acuminatum in the oral cavity: four cases and a review. Rev Infect Dis 10:544–550

    CAS  PubMed  Google Scholar 

  13. Castle PE, Lorincz AT, Scott DR et al. (2002) A comparison of Hybrid Capture 3 to Hybrid Capture 2 for the detection of oncogenic HPV. 20th International Papillomavirus Conference, Paris 2002, Abstract No O-013

  14. Centers for Disease Control and Prevention (2002) Sexually transmitted disease treatment guidelines 2002. MMWR 51:53–57

    Google Scholar 

  15. Chang F, Syrjänen S, Nuutinen J et al. (1990) Detection of human papillomavirus (HPV) DNA in oral squamous cell carcinomas by in situ hybridization and polymerase chain reaction. Arch Dermatol Res 282:493–497

    CAS  PubMed  Google Scholar 

  16. Ciuffo G (1907) Innesto positivo con filtrato di verruca volgare. Giorn Ital Mal Venerol 48:12–17

    Google Scholar 

  17. Coleman N, Birley HD, Renton AM et al. (1994) Immunological events in regressing genital warts. Am J Clin Pathol 102:768–774

    Google Scholar 

  18. de Villiers EM (2001) Taxonomic classification of papillomaviruses. Papillomavirus Report 12:57–63

    Google Scholar 

  19. Dunagin WG, Millikan LE (1982) Dinitrochlorobenzene immunotherapy for verrucae resistant to standard treatment modalities. J Am Acad Dermatol 6:40–45

    CAS  PubMed  Google Scholar 

  20. Dürst M, Kleinheinz A, Hotz M, Gissmann L (1985) The physical state of human papillomavirus type 16 DNA in benign and malignant genital tumours. J Gen Virol 66:1515

    PubMed  Google Scholar 

  21. Fazel N, Wilczynski S, Lowe L, Su LD (1999) Clinical, histopathologic, and molecular aspects of cutaneous human papillomavirus infections. Dermatol Clin 17:521–536

    CAS  PubMed  Google Scholar 

  22. Fehr MK, Chapman CF, Krasieva T et al. (1996) Selective photosensitizer distribution in vulvar condyloma acuminatum after topical application of 5-aminolevulinic acid. Am J Obstet Gynecol 174:951–957

    CAS  PubMed  Google Scholar 

  23. Fehr MK, Hornung R, Degen A et al. (2002) Photodynamic therapy of vulvar and vaginal condyloma and intraepithelial neoplasia using topically applied 5-aminolevulinic acid. Lasers Surg Med 30:273–279

    Article  PubMed  Google Scholar 

  24. Franceschi S, Bidoli E, Herrero R, Munoz N (2000) Comparison of cancers of the oral cavity and pharynx worlwide:etiological clues. Oral Oncol 36:106–115

    Article  CAS  PubMed  Google Scholar 

  25. Frank RG, Bos JD (1996) Photodynamic therapy for condylomata acuminata with local application of 5-aminolevulinic acid. Genitourin Med 72:70–71

    CAS  PubMed  Google Scholar 

  26. Gibbs S, Harvey I, Sterling JC, Stark R (2001/2003) Local treatments for cutaneous warts. Cochrane Database Syst Rev 2003; (3):CD001781. Cochrane Database Syst Rev. 2001; CD001781

  27. Giovanelli L, Campisi G, Lama A et al. (2002) Human papillomavirus DNA in oral mucosal lesions. J Infec Dis 185:833–836

    Article  Google Scholar 

  28. Gissmann L (1996) Immunologic responses to human papillomavirus infection. Obstet Gynecol Clin North Am 23:625–639

    Google Scholar 

  29. Godley MJ, Bradbeer CS, Gellau M et al. (1987) Cryotherapy compared with trichloracetic acid in treating genital warts. Genitourin Med 63:390–392

    CAS  PubMed  Google Scholar 

  30. Gollnick H, Barasso R, Jappe U et al. (2001) Safety and efficacy of imiquimod 5% cream in the treatment of penile genital warts in uncircumcised men when applied three times weekly or once per day. Int J STD AIDS 12:22–28

    Article  CAS  PubMed  Google Scholar 

  31. Greenstone HL, Nieland JD, de Visser KE et al. (1998) Chimeric papillomavirus virus-like particles elicit antitumor immunity against the E7 oncoprotein in an HPV16 tumor model. Proc Natl Acad Sci USA 95:1800–1805

    Google Scholar 

  32. Gross G, Tyring SK, von Krogh G, Barrasso R (1997) External genitalia: Treatment. In: Gross G, Barrasso R (eds) Human papilloma virus infection: a clinical atlas. Ullstein Mosby, Berlin Wiesbaden, pp 365–376

  33. Hasumi K (1987) A trial of topical idoxuridine for vulvar condyloma acuminatum. Br J Obstet Gynaecol 94:366–368

    CAS  PubMed  Google Scholar 

  34. Heid CA, Stevens J, Livak WK et al. (1996) Real-time quantitative PCR. Genome Res 6:986–949

    CAS  PubMed  Google Scholar 

  35. Heidingsfield ML (1901) Condylomata acuminata linguata. J Cutan Genitourin Dis 19:226–234

    Google Scholar 

  36. Heim K, Christensen ND, Höpfl R et al. (1995) Serum IgG, IgM and IgA reactivity to human papillomavirus types 11 and 6 virus like particles in different gynecologic patient groups. J Infect Dis 172:395–402

    CAS  PubMed  Google Scholar 

  37. Hengge U (2003) Spektrum der HPV-Infektion in der Dermatologie: Besonderheiten bei Organtransplantierten und HIV-Patienten. In: U. Hengge (Hrsg) HPV-Infektionen und Neoplasien der Haut. UNI-MED, Bremen

  38. Hengge UR, Esser S, Schultewolter T et al. (2000) Self-administered topical 5% imiquimod for the treatment of common warts and molluscum contagiosum. Br J Dermatol 143:1026–1031

    Article  CAS  PubMed  Google Scholar 

  39. Hengge UR, Tietze M (2000) Successful treatment of recalcitrant condyloma with topical cidofovi. Sex Transm Inf 76:143

    Article  CAS  Google Scholar 

  40. Hengge UR, Benninghoff B, Ruzicka T, Goos M (2001) Topical immunomodulators—progress towards treating inflammation, infection, and cancer. Lancet Infect Dis 1:189–198

    Article  CAS  PubMed  Google Scholar 

  41. Herrero R, Castellsague X, Pawlita M et al. (2003) Human papillomavirus and oral cancer: the International Agency for Research on Cancer multicenter study. J Natl Cancer Inst 95:1772–1783

    Article  PubMed  Google Scholar 

  42. Howley PM, Lowy DR (2001) Papillomaviruses and their replication. In: Knipe DM, Howley PM (eds) Fields virology, 4th edn. Lippincott Williams & Wilkins, Philadelphia, pp 2197–2229

  43. Iscimen A, Aydemir E, Goksugur N, Engin B (2004) Intralesional 5-fluorouracil, lidocaine and epinephrine mixture for the treatment of verrucae: a prospective placebo-controlled, single-blind randomized study. J Eur Acad Dermatol Venereol 18:455–458

    Article  CAS  PubMed  Google Scholar 

  44. Kaspari M (2003) Therapie von Condylomata acuminata. In: Hengge U (Hrsg) HPV-Infektionen und Neoplasien der Haut. UNI-MED, Bremen

  45. Kellokoski JK, Syrjänen SM, Chang F et al. (1992) Southern blot hybridization and PCR in detection of oral human papillomavirus (HPV) infections in women with genital HPV infections. J Oral Pathol Med 21:459–464

    CAS  PubMed  Google Scholar 

  46. Koutsky LA, Galloway DA, Holmes KK (1988) Epidemiology of genital human papillomavirus infection. Epidemiol Rev 10:122–163

    CAS  PubMed  Google Scholar 

  47. Lookingbill DP, Kreider JW, Howett MK et al. (1987) Human papillomavirus type 16 in bowenoid papulosis, intraoral papillomas, and squamous cell carcinoma of the tongue. Arch Dermatol 123:363–368

    Article  CAS  PubMed  Google Scholar 

  48. Lörincz AT (1992) Diagnosis of human papillomavirus infection by the new generation of molecular DNA assays. Clin Immunol Newsl 12:123–128

    Article  Google Scholar 

  49. Majewski S, Jablonska S (2002) Do epidermodysplasia verruciformis human papillomaviruses contribute to malignant and benign epidermal proliferations? Arch Dermatol 138:649–654

    Article  PubMed  Google Scholar 

  50. Maschke J, Hengge UR (2002) Therapy of the focal epithelial hyperplasia (Heck’s disease) with 5% of imiquimod. Z Hautkr 77:191–193

    Article  Google Scholar 

  51. Massing AM, Epstein WL (1963) Natural history of warts. Arch Derm 87:306–310

    CAS  PubMed  Google Scholar 

  52. Melchers WJ, van den Brule ACJ, Walboomers JMM et al. (1989) Increased detection rate of human papillomavirus in cervical scrapes by the polymerase chain reaction as compared to modified FISH and Southern blot analysis. J Med Virol 27:329–335

    CAS  PubMed  Google Scholar 

  53. Meyer T (2003) Diagnostik der HPV-Infektion. In: Hengge U (Hrsg) HPV-Infektionen und Neoplasien der Haut. UNI-MED, Bremen

  54. Miller CS, White DK (1996) Human papillomavirus expression in oral mucosa, premalignant conditions, and squamous cell carcinoma: a retrospective review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 82:57–68

    CAS  PubMed  Google Scholar 

  55. Naylor MF, Neldner KH, Yarbrough GK et al. (1988) Contact immunotherapy of resistant warts. J Am Acad Dermatol 19:679–683

    CAS  PubMed  Google Scholar 

  56. Orth G (1987) Epidermodysplasia verruciformis. In: Salzman NP, Howley PM (eds) The papovaviridae, the papillomaviruses. Plenum Press, New York, pp 199–235

  57. Pfister H, ter Schegget J (1997) Role of HPV in cutaneous premalignant and malignant tumors. Clinics Dermatol 15:335–347

    Article  CAS  Google Scholar 

  58. Pfister H, Hettick I, Runne U et al. (1983) Characterization of human papillomavirus type 13 from focal epithelial hyperplasia Heck lesions. J Virol 47:363–366

    CAS  PubMed  Google Scholar 

  59. Phelps WC, Alexander KA (1995) Antiviral therapy for human papillomaviruses: rationale and prospects. Ann Intern Med 123:368–382

    CAS  PubMed  Google Scholar 

  60. Ramoz N, Rueda LA, Rueda B et al. (2002) Mutations in two adjacent novel genes are associated with epidermodysplasia verruciformis. Nature Genet 32:1–3

    Article  PubMed  Google Scholar 

  61. Ringström E, Peters E, Hasegawa M et al. (2002) Human papillomavirus type 16 and squamous cell carcinoma of the head and neck. Clin Cancer Res 8:3187–3192

    PubMed  Google Scholar 

  62. Rinne D, Linhart C, Schofer H (2000) Lip papillomatosis in immunodeficiency: therapy with imiquimod. Br J Dermatol 142:196–197

    Article  CAS  PubMed  Google Scholar 

  63. Robson KJ, Cunningham NM, Kruzan KL et al. (2000) Pulsed-dye laser versus conventional therapy in the treatment of warts: a prospective randomized trial. J Am Acad Dermatol 43:275–280

    Article  CAS  PubMed  Google Scholar 

  64. Sawchuk WS, Weber PJ, Lowy DR, Dzubow LM (1989) Infectious papillomavirus in the vapor of warts treated with carbon dioxide laser or electrocoagulation: detection and protection. J Am Acad Dermatol 21:41–49

    CAS  PubMed  Google Scholar 

  65. Schock RK, Wood W (1969) Familial focal epithelial hyperplasia. Oral Surg 28:598–602

    CAS  Google Scholar 

  66. Schon M, Bong AB, Drewniok C et al. (2003) Tumor-selective induction of apoptosis and the small-molecule immune response modifier imiquimod. J Natl Cancer Inst. 95:1138–1149

    Google Scholar 

  67. Shear M, Pindborg JJ (1980) Verrucous hyperplasia of the oral mucosa. Cancer 46:1855–1862

    CAS  PubMed  Google Scholar 

  68. Stone K, Becker T, Hadgu A, Kraus S (1990) Treatment of external genital warts: a randomised clinical trial comparing podophyllin, cryotherapy, and electrodesiccation. Genitourin Med 66:16–19

    CAS  PubMed  Google Scholar 

  69. Suzich JA, Ghim SJ, Palmer-Hill FJ et al. (1995) Systemic immunization with papillomavirus L1 protein completely prevents the development of viral mucosal papillomas. Proc Natl Acad Sci USA 92:11553–11557

    Google Scholar 

  70. Syrjänen K, Syrjänen S (2000) Papillomavirus infections in human disease. J. Wiley & Sons, New York, pp 1–615

  71. Syrjänen K, Syrjänen S, Lamberg M et al. (1983) Morphological and immunohistochemical evidence suggesting human papillomavirus (HPV) involvement in oral squamous cell carcinogenesis. Int J Oral Surg 12:418–424

    PubMed  Google Scholar 

  72. Syrjänen S, Puranen M (2000) Human papillomavirus infections in children: the potential role of maternal transmission. Crit Rev Oral Biol Med 11:259–274

    PubMed  Google Scholar 

  73. Terai M, Hashimoto K, Yoda K, Sata T (1999) High prevalence of human papillomaviruses in the normal oral cavity of adults. Oral Microbiol Immunol 14:201–205

    Article  CAS  PubMed  Google Scholar 

  74. Thompson JPS, Grace RH (1978) The treatment of perianal and anal condyloma: a new operative technique. J R Soc Med 71:180–185

    PubMed  Google Scholar 

  75. Tindle RW (2002) Immune evasion in human papillomavirus-associated cervical cancer. Nat Rev Cancer 2:59–65

    Article  CAS  PubMed  Google Scholar 

  76. Tyagi S, Kramer FR (1996) Molecular beacons: probes that fluoresce upon hybridization. Nat Biotechnol 14:303–308

    CAS  PubMed  Google Scholar 

  77. Van Duin M, Snijders PJ, Schrijnemakers HF et al. (2002) Human papillomavirus 16 load in normal and abnormal cervical scrapes: an indicator of CINII/III and viral clearance. Int J Cancer 98:590–595

    Article  PubMed  Google Scholar 

  78. von Krogh G, Szpak E, Andersson M et al. (1994) Self-treatment using 0,25%–0,5% podophyllotoxin ethanol solutions against penile condylomata acuminata—a placebo-controlled comparative study. Genitourin Med 70:105–109

    PubMed  Google Scholar 

  79. von Krogh G, Lacey CJN, Gross G et al. (2000) European course on HPV associated pathology: guidelines for primary care physicians for the diagnosis and management of anogenital warts. Sex Transm Inf 76:162–168

    Article  Google Scholar 

  80. Weissenbacher ER, Schneider A, Gissmann L et al. (2001) Empfehlungen zur Diagnostik und Therapie der HPV Infektion des weiblichen Genitale. Eur J Infect Immunol Dis Obstet Gynecol Suppl 1:1–12

    Google Scholar 

  81. Weisshaar E, Gollnick H (2000) Potentiating effect of imiquimod in the treatment of verrucae vulgares in immunocompromised patients. Acta Derm Venereol 80:306–307

    Article  CAS  PubMed  Google Scholar 

  82. Whitcombe D, Newton CR, Little S (1998) Advances in approaches to DNA-based diagnostics. Curr Opin Biotech 9:602–608

    Article  CAS  PubMed  Google Scholar 

  83. Wieland U, Ritzkowsky A, Stoltidis M et al. (2000) Papillomavirus DNA in basal cell carcinomas of immunocompetent patients: an accidental association? J Invest Dermatol 115:124–128

    Article  CAS  PubMed  Google Scholar 

  84. Wienert V (1987) Therapeutische Möglichkeiten bei virusinduzierten anorektalen Tumoren. In: Mahlke G, Mann CV, Willital GH (Hrsg) Aktuelle Koloproktologie. Edition Nymphenburg, München, S 173–177

  85. Zhou J, Stenzel DJ, Sun XY, Frazer IH (1993) Synthesis and assembly of infectious bovine papillomavirus particles in vitro. J Gen Virol 74:763–768

    CAS  PubMed  Google Scholar 

  86. zur Hausen H (2002) Papillomaviruses and cancer: from basic studies to clinical application. Nat Rev 2:342–349

    Article  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Klinik für Dermatologie, Heinrich-Heine-Universität, Düsseldorf

    U. R. Hengge

  2. Klinik für Dermatologie, Heinrich-Heine-Universität, Moorenstraße 5, 40225 , Düsseldorf

    U. R. Hengge

Authors
  1. U. R. Hengge
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to U. R. Hengge.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hengge, U.R. Papillomviruserkrankungen. Hautarzt 55, 841–854 (2004). https://doi.org/10.1007/s00105-004-0795-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00105-004-0795-3

Schlüsselwörter

Keywords

Search

Navigation