Usefulness of dermoscopy in anogenital warts: A descriptive study of 30 cases

Marouane Ben Kahla, Lina Bessaad, Nadia Ghariani Fetoui, Maha Lahouel, Sarra Saad, Mohamed Ben Rjab, Jacem Rouatbi, Haifa Mkhinini, Zeineb Nfikha, Dorra Chiba, Cyrine Chelli, Oumayma Ben Rejeb, Badreddine Sriha, Nadia Ben Lasfar, Sana Mokni, Amina Aounallah, Najet Ghriani, Mohamed Denguezli
{"title":"Usefulness of dermoscopy in anogenital warts: A descriptive study of 30 cases","authors":"Marouane Ben Kahla,&nbsp;Lina Bessaad,&nbsp;Nadia Ghariani Fetoui,&nbsp;Maha Lahouel,&nbsp;Sarra Saad,&nbsp;Mohamed Ben Rjab,&nbsp;Jacem Rouatbi,&nbsp;Haifa Mkhinini,&nbsp;Zeineb Nfikha,&nbsp;Dorra Chiba,&nbsp;Cyrine Chelli,&nbsp;Oumayma Ben Rejeb,&nbsp;Badreddine Sriha,&nbsp;Nadia Ben Lasfar,&nbsp;Sana Mokni,&nbsp;Amina Aounallah,&nbsp;Najet Ghriani,&nbsp;Mohamed Denguezli","doi":"10.1002/jvc2.545","DOIUrl":null,"url":null,"abstract":"<p>Dermoscopy applications are expanding beyond skin tumours to include various other cutaneous disorders, such as inflammatory and infectious dermatoses. Anogenital warts (AGW) are the most common sexually transmitted infection.<span><sup>1</sup></span> Our objective is to describe the dermoscopic characteristics of AGW.</p><p>We conducted a monocentric prospective study in the dermatology department of Farhat Hached Hospital in Sousse, Tunisia, from 1 January to 31 August 2023. All clinically diagnosed cases of AGW were included. Each patient underwent a clinical examination, a dermoscopy and a biopsy.</p><p>Thirty patients were included in the study, with a mean age of 34.24 years (ranging from 3 to 63 years). The male-to-female ratio was 3.28:1. Among the males, 52.17% of warts were located in the penile area and 43.47% in the perianal area. For females, all warts were located in the vulvar area. The papular warts represented 53.33% of the described lesions, condyloma acuminata 40% and Buschke−Lowenstein tumours were observed in two patients (6.66%). The dermoscopic pattern was mosaic-like (Figure 1a). In 53.33% of cases, corresponding clinically to the papular warts. A finger-like pattern (Figure 1b) was seen in 13.33% of cases, a cerebriform pattern in 13.33% of cases and a knob-like pattern (Figure 1c) in 10% of cases. In two female patients aged 18 and 55, the dermoscopy revealed finger-like structures but with separated bases and clinicopathological correlation concluded to vestibular papillomatosis. In a male patient with HIV, dermoscopy showed a cerebriform pattern (Figure 1d) in all warts, and in one wart, it revealed a whitish structureless area, a yellowish keratin area and polymorphous vessels. Malignancy was suspected, and a biopsy guided by dermoscopy confirmed invasive well-differentiated squamous cell carcinoma (SCC). All patients underwent biopsies confirming the diagnosis excepting two female patients with vestibular papillomatosis. However, HPV typing was performed for only five patients due to limited availability. It showed low-risk HPV 6 and 11 in three male patients and negative for two other patients.</p><p>AGW are a major risk factor for multiple malignancies, including cancers of the cervix, vagina, vulva, oropharynx, anus, penis and skin.<span><sup>2</sup></span> AGW are mostly diagnosed with the naked eye, but early-stage diagnosis can be challenging.<span><sup>3</sup></span> Three principal dermoscopic patterns have been described, though none is specific. Consistent with our findings, the mosaic pattern is the most common. It resembles common warts, with a whitish network surrounding central dotted or glomerular vessels.<span><sup>4</sup></span> This pattern is associated with papular warts and can coexist with other patterns.</p><p>The finger-like and knob-like patterns are more commonly reported with exophytic condyloma acuminata. They are characterized by whitish, finger-like or knob-like papillae with varying heights and fusion at their bases. Inside the papillae, elongated and dilated vessels are more prominent at the periphery, caused by nitric oxide produced by HPV.<span><sup>5</sup></span></p><p>The cerebriform pattern is reported in pigmented keratotic lesions and mimics seborrhoeic keratosis.<span><sup>6</sup></span> The association of two patterns, most commonly finger-like and knob-like structures, has been reported.<span><sup>7</sup></span> Dermoscopy is also useful in differentiating (AGW) from vestibular papillomatosis and pearly penile papules, which show more irregular projections with tapering ends and separated bases.<span><sup>8</sup></span> Other differential diagnoses include Fordyce's spots, molluscum contagiosum, lymphangiomas and angiokeratomas, which are easily identifiable with dermoscopy. The dermoscopy of invasive SCC reveals keratin and vascular features. Keratin appears as white-to-yellow structureless areas, white circles and white clods. As seen in our patient, dermoscopy is invaluable for detecting malignant transformation and guiding the biopsy.<span><sup>9</sup></span></p><p>In conclusion, dermoscopy is crucial for AGW, aiding both in differential diagnosis and the early detection of SCC, particularly in immunocompromised patients.</p><p><b>Marouane Ben Kahla</b>: Conceptualization; writing—original draft. <b>Lina Bessaad</b>: Investigation; resources. <b>Nadia Ghariani Fetoui</b>: Supervision; review and editing. <b>Maha Lahouel</b>: Investigation; resources. <b>Sarra Saad</b>: Investigation; resources. <b>Mohamed Ben Rjab</b>: Investigation; resources. <b>Jacem Rouatbi</b>: Investigation; resources. <b>Haifa Mkhinini</b>: Investigation; resources. <b>Zeineb Nfikha</b>: Investigation; resources. <b>Dorra Chiba</b>: Investigation; resources. <b>Cyrine Chelli</b>: Investigation; resources. <b>Oumayma Ben Rejeb</b>: Investigation, writing review. <b>Najet Ghriani</b>: Investigation; resources. <b>Badreddine Sriha</b>: Investigation; resources. <b>Nadia Ben Lasfar</b>: Investigation; resources. <b>Sana Mokni</b>: Review. <b>Amina Aounallah</b>: Review. <b>Mohamed Denguezli</b>: Supervision; validation; writing—review and editing.</p><p>The authors declare no conflict of interest.</p><p>All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.</p>","PeriodicalId":94325,"journal":{"name":"JEADV clinical practice","volume":"4 1","pages":"293-295"},"PeriodicalIF":0.0000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jvc2.545","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JEADV clinical practice","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jvc2.545","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Dermoscopy applications are expanding beyond skin tumours to include various other cutaneous disorders, such as inflammatory and infectious dermatoses. Anogenital warts (AGW) are the most common sexually transmitted infection.1 Our objective is to describe the dermoscopic characteristics of AGW.

We conducted a monocentric prospective study in the dermatology department of Farhat Hached Hospital in Sousse, Tunisia, from 1 January to 31 August 2023. All clinically diagnosed cases of AGW were included. Each patient underwent a clinical examination, a dermoscopy and a biopsy.

Thirty patients were included in the study, with a mean age of 34.24 years (ranging from 3 to 63 years). The male-to-female ratio was 3.28:1. Among the males, 52.17% of warts were located in the penile area and 43.47% in the perianal area. For females, all warts were located in the vulvar area. The papular warts represented 53.33% of the described lesions, condyloma acuminata 40% and Buschke−Lowenstein tumours were observed in two patients (6.66%). The dermoscopic pattern was mosaic-like (Figure 1a). In 53.33% of cases, corresponding clinically to the papular warts. A finger-like pattern (Figure 1b) was seen in 13.33% of cases, a cerebriform pattern in 13.33% of cases and a knob-like pattern (Figure 1c) in 10% of cases. In two female patients aged 18 and 55, the dermoscopy revealed finger-like structures but with separated bases and clinicopathological correlation concluded to vestibular papillomatosis. In a male patient with HIV, dermoscopy showed a cerebriform pattern (Figure 1d) in all warts, and in one wart, it revealed a whitish structureless area, a yellowish keratin area and polymorphous vessels. Malignancy was suspected, and a biopsy guided by dermoscopy confirmed invasive well-differentiated squamous cell carcinoma (SCC). All patients underwent biopsies confirming the diagnosis excepting two female patients with vestibular papillomatosis. However, HPV typing was performed for only five patients due to limited availability. It showed low-risk HPV 6 and 11 in three male patients and negative for two other patients.

AGW are a major risk factor for multiple malignancies, including cancers of the cervix, vagina, vulva, oropharynx, anus, penis and skin.2 AGW are mostly diagnosed with the naked eye, but early-stage diagnosis can be challenging.3 Three principal dermoscopic patterns have been described, though none is specific. Consistent with our findings, the mosaic pattern is the most common. It resembles common warts, with a whitish network surrounding central dotted or glomerular vessels.4 This pattern is associated with papular warts and can coexist with other patterns.

The finger-like and knob-like patterns are more commonly reported with exophytic condyloma acuminata. They are characterized by whitish, finger-like or knob-like papillae with varying heights and fusion at their bases. Inside the papillae, elongated and dilated vessels are more prominent at the periphery, caused by nitric oxide produced by HPV.5

The cerebriform pattern is reported in pigmented keratotic lesions and mimics seborrhoeic keratosis.6 The association of two patterns, most commonly finger-like and knob-like structures, has been reported.7 Dermoscopy is also useful in differentiating (AGW) from vestibular papillomatosis and pearly penile papules, which show more irregular projections with tapering ends and separated bases.8 Other differential diagnoses include Fordyce's spots, molluscum contagiosum, lymphangiomas and angiokeratomas, which are easily identifiable with dermoscopy. The dermoscopy of invasive SCC reveals keratin and vascular features. Keratin appears as white-to-yellow structureless areas, white circles and white clods. As seen in our patient, dermoscopy is invaluable for detecting malignant transformation and guiding the biopsy.9

In conclusion, dermoscopy is crucial for AGW, aiding both in differential diagnosis and the early detection of SCC, particularly in immunocompromised patients.

Marouane Ben Kahla: Conceptualization; writing—original draft. Lina Bessaad: Investigation; resources. Nadia Ghariani Fetoui: Supervision; review and editing. Maha Lahouel: Investigation; resources. Sarra Saad: Investigation; resources. Mohamed Ben Rjab: Investigation; resources. Jacem Rouatbi: Investigation; resources. Haifa Mkhinini: Investigation; resources. Zeineb Nfikha: Investigation; resources. Dorra Chiba: Investigation; resources. Cyrine Chelli: Investigation; resources. Oumayma Ben Rejeb: Investigation, writing review. Najet Ghriani: Investigation; resources. Badreddine Sriha: Investigation; resources. Nadia Ben Lasfar: Investigation; resources. Sana Mokni: Review. Amina Aounallah: Review. Mohamed Denguezli: Supervision; validation; writing—review and editing.

The authors declare no conflict of interest.

All patients in this manuscript have given written informed consent for participation in the study and the use of their deidentified, anonymized, aggregated data and their case details (including photographs) for publication. Ethical Approval: not applicable.

Abstract Image

皮肤镜检查在肛门生殖器疣中的应用:对30例病例的描述性研究
皮肤镜的应用范围正从皮肤肿瘤扩展到各种其他皮肤疾病,如炎症性和传染性皮肤病。肛门生殖器疣(AGW)是最常见的性传播感染我们的目的是描述AGW的皮肤镜特征。我们于2023年1月1日至8月31日在突尼斯苏塞Farhat Hached医院皮肤科进行了一项单中心前瞻性研究。所有临床诊断的AGW病例均被纳入。每位患者都接受了临床检查、皮肤镜检查和活检。研究纳入30例患者,平均年龄34.24岁(3 ~ 63岁)。男女比例为3.28:1。男性中,52.17%的疣位于阴茎区,43.47%位于肛周区。对于女性,所有疣都位于外阴区域。其中丘疹疣占53.33%,尖锐湿疣占40%,Buschke - Lowenstein肿瘤2例(6.66%)。皮肤镜下呈马赛克状(图1a)。在53.33%的病例中,临床对应为丘疹性疣。13.33%的病例呈指状(图1b), 13.33%的病例呈脑状(图1c), 10%的病例呈旋钮状(图1c)。2例年龄分别为18岁和55岁的女性患者,皮肤镜检查显示手指样结构,但基底分离,临床病理相关,结论为前庭乳头状瘤病。在一名男性HIV患者中,皮肤镜检查显示所有疣都呈脑状(图1d),其中一个疣显示白色无结构区、黄色角蛋白区和多形性血管。怀疑为恶性,皮肤镜引导下活检证实浸润性高分化鳞状细胞癌(SCC)。除2例女性前庭乳头状瘤外,所有患者均行活检证实诊断。然而,由于可用性有限,仅对5名患者进行了HPV分型。结果显示,三名男性患者的HPV 6和11风险较低,另外两名患者的HPV 6和11风险为阴性。AGW是多种恶性肿瘤的主要危险因素,包括宫颈癌、阴道癌、外阴癌、口咽癌、肛门癌、阴茎癌和皮肤癌AGW大多用肉眼诊断,但早期诊断可能具有挑战性已经描述了三种主要的皮肤镜模式,尽管没有一个是具体的。与我们的发现一致,马赛克图案是最常见的。它类似于普通疣,有白色的网状物围绕着中心的点状或肾小球血管这种模式与丘疹疣有关,并可与其他模式共存。指状和节状形态在外生性尖锐湿疣中更为常见。它们的特征是白色的,手指状或节状乳头,具有不同的高度和融合在它们的基部。在乳头内,由hpv产生的一氧化氮引起的延长和扩张的血管在周围更为突出。据报道,在色素性角化病变中出现脑状模式,类似脂溢性角化病据报道,两种结构的关联,最常见的是指状结构和旋钮状结构皮肤镜检查在鉴别(AGW)与前庭乳头状瘤病和珍珠状阴茎丘疹方面也很有用,后者表现出更多的不规则突起,末端变细,基部分离其他鉴别诊断包括福代斯斑、传染性软疣、淋巴管瘤和血管角化瘤,这些都很容易通过皮肤镜检查发现。侵袭性鳞状细胞癌的皮肤镜检查显示角蛋白和血管特征。角蛋白表现为白色到黄色的无结构区域,白色圆圈和白色块。正如我们的病人所见,皮肤镜检查对于发现恶性转化和指导活检是非常宝贵的。总之,皮肤镜检查对AGW至关重要,有助于鉴别诊断和早期发现SCC,特别是免疫功能低下的患者。Marouane Ben Kahla:概念化;原创作品。莉娜·贝萨德:调查;资源。Nadia Ghariani Fetoui:监督;审查和编辑。Maha Lahouel:调查;资源。萨拉·萨阿德:调查;资源。Mohamed Ben Rjab:调查;资源。Jacem Rouatbi:调查;资源。海法·姆希尼尼:调查;资源。Zeineb Nfikha:调查;资源。千叶多拉:调查;资源。Cyrine Chelli:调查;资源。Oumayma Ben Rejeb:调查,写作评论。Najet Ghriani:调查;资源。Badreddine Sriha:调查;资源。Nadia Ben Lasfar:调查;资源。Sana Mokni:回顾。Amina Aounallah:回顾。Mohamed Denguezli:监督;验证;写作-审查和编辑。作者声明无利益冲突。 本文中的所有患者均已书面同意参与本研究,并同意使用其去识别、匿名、汇总的数据和病例详细信息(包括照片)进行发表。伦理批准:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
0.30
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信