Nymphenburg Skin Center, Munich, Germany.
Freelance Scientific Writer, Maisach, Germany.
J Dtsch Dermatol Ges. 2019 Jun;17(6):613-634. doi: 10.1111/ddg.13878.
Extragenital cutaneous warts are benign epidermal tumors caused by human papillomaviruses (HPVs) and a frequent reason for patients to consult a dermatologist. Depending on wart type and site involved, the clinical presentation is highly varied. Given that warts represent a self-limiting condition, a wait-and-see approach may be justified. However, treatment is always indicated if the lesions become painful or give rise to psychological discomfort. Factors to be considered in this context include subjective disease burden, patient age, site affected, as well as the number and duration of lesions. Destructive treatment methods involve chemical or physical removal of diseased tissue. Nondestructive methods consist of antimitotic and antiviral agents aimed at inhibiting viral proliferation in keratinocytes. Some of the various immunotherapies available not only have localized but also systemic effects and are thus able to induce remission of warts located at any distance from the injection site. Especially patients with warts at multiple sites benefit from this form of treatment. Intralesional immunotherapy using the mumps-measles-rubella (MMR) vaccine is a particularly promising option for the treatment of recalcitrant warts in adult patients. For children, on the other hand, HPV vaccination is a novel and promising approach, even though it has not been approved for the treatment of cutaneous warts. At present, there is no universally effective treatment available. Moreover, many frequently employed therapies are currently not supported by conclusive clinical trials.
生殖器外皮肤疣是由人乳头瘤病毒（HPV）引起的良性表皮肿瘤，也是患者咨询皮肤科医生的常见原因。根据疣的类型和受累部位，临床表现差异很大。鉴于疣是一种自限性疾病，观望等待可能是合理的。然而，如果病变变得疼痛或引起心理不适，则始终需要治疗。在这种情况下需要考虑的因素包括主观疾病负担、患者年龄、受影响的部位，以及病变的数量和持续时间。破坏性治疗方法包括化学或物理去除病变组织。非破坏性方法包括抗有丝分裂和抗病毒药物，旨在抑制角质形成细胞中的病毒增殖。一些现有的各种免疫疗法不仅具有局部作用，而且具有全身作用，因此能够诱导注射部位以外任何距离的疣消退。尤其是多部位疣的患者受益于这种治疗形式。使用腮腺炎-麻疹-风疹（MMR）疫苗进行皮损内免疫疗法是治疗成人顽固性疣的一种特别有前途的选择。另一方面，对于儿童，HPV 疫苗接种是一种新颖且有前途的方法，尽管它尚未被批准用于治疗皮肤疣。目前，尚无普遍有效的治疗方法。此外，许多常用的治疗方法目前没有得到明确临床试验的支持。
