Kuriyama Yuko, Kosaka Mieko, Kaneko Akira, Nishioka Hirokazu, Anzawa Kazushi, Hattori Tomoyasu, Igarashi Naoya, Tamura Masaaki, Motegi Sei-Ichiro, Shimizu Akira
Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
Diagnostics Division, Maruho Co., Ltd., Osaka, Japan.
J Dermatol. 2023 Nov;50(11):1450-1458. doi: 10.1111/1346-8138.16920. Epub 2023 Aug 25.
Warts, caused by human papillomavirus (HPV) infection, have various clinical presentations, making them difficult to differentiate from clavus, callus, and sometimes, squamous cell carcinoma. Although skin biopsies are the gold standard, a less-invasive method of examining these lesions is desired. Ninety patients with warts and related diseases, such as clavus and callus, were recruited to explore new differentiation methods using the surface of the warts. DNA was extracted from three types of specimens in each case: surface swab, shaved hyperkeratotic scale, and post-shaved surface swab. Total DNA was successfully extracted from these three specimens and was sufficient for subsequent HPV DNA detection. We analyzed samples for the HPV type and HPV viral load using polymerase chain reaction (PCR). Fifty-five cases were PCR-positive, and HPV1a, 2a, 4, 27, 57, and 65 were detected. The amount of HPV1a DNA produced was significantly greater than that of other HPV types. Regarding the correlation between the clinical diagnosis and HPV detection, the positive agreement rate was 90.9%, the negative agreement rate was 40.0%, and the overall agreement rate was 71.1%. Ten of the 21 cases clinically diagnosed as plantar warts were PCR-negative, especially in elderly patients. This suggests that it is difficult to distinguish plantar warts from clavus and callus in clinical practice. Although the amount of HPV DNA in the removed keratinization scale was highest for all HPV types, HPV detection by swabbing before and after shaving is also useful for follow-up as well as for differential diagnosis.
由人乳头瘤病毒（HPV）感染引起的疣有多种临床表现，这使得它们很难与鸡眼、胼胝区分开来，有时还难以与鳞状细胞癌区分。尽管皮肤活检是金标准，但仍需要一种侵入性较小的方法来检查这些病变。招募了90名患有疣及相关疾病（如鸡眼和胼胝）的患者，以探索利用疣表面进行新的鉴别方法。在每个病例中从三种类型的标本中提取DNA：表面拭子、刮除的角化过度鳞屑和刮除后表面拭子。从这三种标本中成功提取了总DNA，足以用于后续的HPV DNA检测。我们使用聚合酶链反应（PCR）分析样本的HPV类型和HPV病毒载量。55例PCR检测呈阳性，检测到HPV1a、2a、4、27、57和65型。产生的HPV1a DNA量显著高于其他HPV类型。关于临床诊断与HPV检测之间的相关性，阳性符合率为90.9%，阴性符合率为40.0%，总体符合率为71.1%。临床诊断为跖疣的21例病例中有10例PCR检测为阴性，尤其是老年患者。这表明在临床实践中很难将跖疣与鸡眼和胼胝区分开来。尽管所有HPV类型在去除的角化鳞屑中的HPV DNA量最高，但刮除前后通过拭子进行HPV检测对于随访以及鉴别诊断也很有用。
