GENERALIZED VERRUCOSIS

By Gary M. White, MD

Generalized verrucosis


Generalized verrucosis (GV) has been defined as cutaneous human papillomavirus (HPV) infection presenting with more than 20 lesions distributed in more than one region of the body.

Clinical

By definition, patients have more than 20 verrucous lesions distributed in more than one region of the body. GV may affect a majority of the digits, limiting the patent's ability to function.

HPV Typing

Detection of high risk HPV types, e.g., HPV-5, 14, 17, 20, 22, and 47 can help predict the development of skin cancer. The detection of HPV-16, 18 and 31 in extragenital verruca can indicated the need to surveil of the development of SCC.

Genetic Testing

Genetic testing should be performed in familial cases and in those patients with a clinical presentation characteristic of an inherited disease.

Treatment

Other than treating any underlying condition or immunodeficiency, the usual treatments for warts may be done. Treating smaller areas one at a time is usually necessary. Skin cancer screening at routine intervals should be done. Sun protection should be recommended.

For involvement so widespread that local therapies would be inadequate, therapies to be considered include: intralesional Candida, oral acitretin, topical cidofovir [Int J STD AIDS 2008;19;715], intravenous cidofovir [Peds Derm 2008;25;387], and topical, intralesional or systemic interferon alfa [Dermatol Ther 2004;17;441]. For organ-transplant patients, minimizing immune suppression is always advisable and switching to sirolimus can cause wart regression [Liver Transplant 2006;12;1883]. Radiation therapy has been employed with benefit [BJD 2007;156;760].

References

This reference contains a photo of multiple diffuse warts in a 10 year old girl with Dock8 deficiency. Pediatrics 2014;134

JAAD review of GV [JAAD 2012;66;292-311].

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