Abstract
Background: Assessment of human papillomavirus (HPV) type-specific viral load (VL) is a valid tool for determining the etiology of HPV-related skin tumors, especially when more than one HPV type is detected within one lesion.Methods: The causative HPV type was determined in 185 fresh-frozen tissue specimens of histologically confirmed common warts (CWs) collected from 121 immunocompetent patients. All tissues were tested using the type-specific quantitative real-time polymerase chain reactions (PCR) for the most common wart-associated Alpha-PV (HPV2/27/57) and Mu-PV types (HPV1/63/204). The presence of 23 additional low-risk HPVs was evaluated using a conventional wide-spectrum PCR.Results: HPV DNA was detected in 176/185 (95.1%) CWs and multiple HPV types in 71/185 (38.4%) lesions. Using the VL approach and a robust cutoff of one viral copy/cell established in this study, HPV2/27/57 were determined as causative agents in 41/53 (77.3%) and 53/71 (74.7%) CWs with single and multiple HPVs, respectively.Conclusions: CWs are mostly etiologically associated with HPV2/27/57 and only rarely with HPV1. In the majority of CWs containing multiple HPVs, a single HPV type was present in high concentration, indicating etiological association. No significant differences in VLs of lesion-causing HPV types in CWs containing single or multiple HPVs were found.
Highlights
Cutaneous warts are ubiquitous benign skin tumors, clinically presented as single or multiple dome-shaped keratotic lesions with exophytic growth or endophytic keratotic papules on pressure points of soles or smooth-surfaced flat-topped papules on the face and dorsum of hands (Jablonska et al, 1985; Cardoso and Calonje, 2011; Hogendoorn et al, 2018)
Based on large population studies, which were mostly performed on swabs of warts’ surfaces, cutaneous warts have been associated with various papillomavirus (PV) types belonging to genera Alpha, Gamma, Mu, and Nupapillomavirus (Alpha, Gamma, Mu, and Nu-PVs) (Schmitt et al, 2011; Bruggink et al, 2012; Al Bdour et al, 2013; de Koning et al, 2015) with the type spectrum varying across different anatomical regions
CWs have usually been linked with infection with human PV (HPV) types HPV1, 2, 4, 7, 27, and 57, plantar warts are usually associated with HPV1, 4, 57, 60, 63, 65, and 66, and plane warts with HPV3, 10, 26–29, and 41 (Cardoso and Calonje, 2011)
Summary
Cutaneous warts are ubiquitous benign skin tumors (van Haalen et al, 2009; de Koning et al, 2015), clinically presented as single or multiple dome-shaped keratotic lesions with exophytic growth (common warts; CWs) or endophytic keratotic papules on pressure points of soles (plantar warts) or smooth-surfaced flat-topped papules on the face and dorsum of hands (plane warts) (Jablonska et al, 1985; Cardoso and Calonje, 2011; Hogendoorn et al, 2018). De Koning et al recently showed the presence of wart-associated HPVs in up to 80% of swab samples of clinically normal skin (de Koning et al, 2015), raising the question of whether HPV types detected on warts’ surfaces represent colonization, latent or productive HPV infection. Assessment of human papillomavirus (HPV) type-specific viral load (VL) is a valid tool for determining the etiology of HPV-related skin tumors, especially when more than one HPV type is detected within one lesion
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