Overview
Pseudopapillary warts, or pseudo warts, should be diagnosed with caution. It is a benign papillomatosis, not a sexually transmitted disease, and is not contagious. In women between the ages of 20 and 30, most 1-2mm smooth papules are found on the inside of the labia minora, clustered but not fused with each other, resembling caviar-like or small polyps, and sometimes itchy, probably due to physiological variation or increased leucorrhea stimulation from vaginal Candida albicans. The incubation period is from 3 weeks to 8 months, with an average of 3 months. It is usually seen in sexually active young and middle-aged men and women, with the peak age of onset being 20-25 years. Most patients are generally asymptomatic. The lesions vary in size and shape. They can be just a few or a large number of pinhead-sized lesions. Pseudomonal warts have no health consequences and the rash is self-limiting, so treatment is not usually necessary. If necessary, laser treatment can be used in batches.
Symptoms
The incubation period of 3 weeks to 8 months, an average of 3 months, mostly seen in sexually active young and middle-aged men and women, the peak age of onset is 20-25 years old, the average duration of the disease in 3-5 months of male and female patients, soon after sexual contact onset, while the average duration of the disease 12 months of male patients, their sexual contacts may not develop. Most patients are generally asymptomatic. The lesions vary in size and shape. There may be only a few or many pinhead-sized lesions.
The pseudo-acute warts were light red (mucous membrane color) in 67 cases and light brown in 13 cases.
The size of the pseudo-acute warts is 1 to 2 mm in diameter.
The pseudo-acute warts are caviar-like in 66 cases, villous in 7 cases, polypoid in 2 cases, papular in 3 cases, mossy in 1 case and filiform in 1 case.
The pseudo-acute warts were found in 46 cases on the inner side of the labia minora, 32 cases in the vaginal vestibule, and 2 cases on the unilateral labia minora.
Etiology
Endocrine factors (45%).
The etiology of pseudopalatine warts is unknown, and it is generally believed to be a benign papilloma associated with developmental abnormalities. Whether the occurrence of this disease is related to hormone levels in the body is subject to further study.
Other factors (35%).
The etiology of female pseudoacanthomas (villous labia minora) may be a physiological abnormality or may be related to other infections, such as Candida infection, urinary tract infections, and associated with chronic vaginal discharge irritation.
Diagnosis
Diagnostic criteria
The clinical manifestations of this disease are extremely similar to those of atypical acromegaly. The misdiagnosis rate of this group is 50%, and the reasons for misdiagnosis are as follows.
① Some physicians have insufficient knowledge of pseudoacute warts. The two diseases can not be distinguished from each other from a clinical point of view. The first diagnosis is arbitrarily diagnosed as condyloma acuminata and misdiagnosed.
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The majority of the pathologists are not dermatologists, not enough to grasp the characteristics of pseudo-acute warts, in the reading of the film alone based on the cellular vacuole-like changes, then diagnosed as acerbic warts, plus clinicians, especially obstetricians and urologists rely too much on pathological diagnosis, resulting in misdiagnosis.
In this group of cases, the diagnosis was suspected to be wrong based on the skin lesions, and the diagnosis was corrected after PCR and white acetate tests were performed.
Differential diagnosis
The clinical differentiation can be done with gauze or cotton swabs dipped in 5% acetic acid solution tightly applied to the affected area and observed after 2-5 minutes: if the wart is acute, the local area becomes white, which is a positive reaction; pseudo warts are a negative reaction, i.e. no color change. If you have a local inflammation, it can be a false positive reaction, if necessary, you can do pathological examination. The cause of pseudo warts is unknown, but it is generally believed to be a benign papilloma associated with developmental abnormalities. Whether the occurrence of this disease is related to hormone levels in the body is subject to further study.
Treatment
Western medical treatment for pseudoacanthomas
As there are no effective anti-viral drugs, the treatment of pseudoprosthetic warts must be comprehensive.
A. Treatment of causative factors: excessive leucorrhea, circumcision, gonorrhea.
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1.Surgical treatment
For single, small area of warts, can be surgically removed; for huge condyloma acuminata, available Mohs’s surgery to remove, surgery with frozen section to check whether the damage is removed clean.
2, cryotherapy
The use of -196 ℃ low temperature liquid nitrogen, using the pressure freezing method of treatment of condyloma acuminata, to promote necrosis of the wart tissue off, the method is suitable for the number of small, small area of warts, feasible 1-2 times the treatment, the interval of a week.
3, laser treatment
Usually with CO2 laser, using the cautery method to treat condyloma acuminata, this therapy is most suitable for female vagina, penis or perianal warts. The actual fact is that you can find a lot of people who are not able to get a lot of money from the internet.
4, electrocautery treatment
The use of high-frequency electric needle or electric knife to remove warts. The method: local anesthesia, and then electrocautery, this therapy to adapt to the number of small, small area of warts.
5, microwave treatment
The actual microwave surgical treatment machine, lidocaine local anesthesia, the rod-shaped radiation probe tip inserted into the acutely wet straight to the base of the wart, when seen on the body becomes smaller, darker, from soft to hard, the thermal radiation coagulation is complete, you can withdraw the probe. The coagulated lesions can be removed with forceps. In order to prevent recurrence, coagulation can be repeated once for the residual base.
6.Beta-radiation treatment
We apply beta-radiation treatment of acromegaly has achieved more satisfactory results, the method of high efficacy, no pain, no damage, less side effects, low recurrence rate, in the clinical promotion value.
7, drug therapy
(1) foot leaf grease: this therapy is suitable for moist areas of warts, such as the occurrence of prepuce and have not made circumcision surgery glans and perineum warts. However, cervical warts should not be treated with pedicel resin. The actual tincture of the 20% footwear tincture is applied to the lesions or before the medication, there is an oily antibacterial ointment to protect the normal skin or mucous membrane around the lesions, then apply the medication, after 4-6 hours, wash with 30% boric acid water or soap and water, if necessary, 3 days later repeat the medication, the medication is the first foreign medication used for the treatment of this disease, generally with a healing. But there are many shortcomings, such as the destructive nature of the tissue, improper use can cause local ulcers. Toxicity, mainly manifested as nausea, intestinal obstruction, leukocyte and thrombocytopenia, tachycardia, urinary closure or oliguria, so the use must be cautious, and when the above reactions are found, the drug should be discontinued immediately.
(2) Antiviral drugs: 5% phthalamide cream or 0.25% herpes net ointment, applied externally twice a day can be used. Acyclic guanosine oral, 5 times a day, each time 200mg, or its ointment for external use, alpha-interferon daily injection of 3 million units, five days a week medication. Or interferon 3 million units injected into the base of the wart twice a week. The main side effects are flu-like syndrome, and the topical side effects are fewer and milder.
(3) corrosive or disinfectant: commonly used are 30%-50% trichloroacetic acid or saturated dichloroacetic acid, or 18% peroxyacetic acid. The 10% salicylic acid glacial acetic acid or 40% formaldehyde, 2% liquefied phenol, 75% ethanol distilled water 100ml mixed solution, spot coating local, for glans, perianal warts, daily or every other day, the effect is very good. The disinfectant can be applied externally with 20% tincture of iodine, or 2.5-5% tincture of iodine injected into the base of the wart, 0.1-1.5ml each time, or with the new Jieer externally or with 0.1-0.2% externally, the latter needs to be combined with systemic therapy.
(4) anti-cancer drugs
The first of these is the 5-fluorouracil (5-Fu): generally topical 5% ointment or cream, twice a day, 3 weeks as a course of treatment. 2.5% to 5% fluorouracil wet dressing for penile and perianal warts, each dressing 20 minutes, once a day, 6 times as a course of treatment. It is also possible to use polyethylene glycol as a base, adding 5% of its dry 5-Fu powder to make a suppository, treatment of male and female urethral warts, but also available 5-Fu base injection, more than one can be injected in batches.
②Thiotepe: mainly used for 5-Fu treatment failure of intra-urethral warts, daily suppositories (each containing 15mg) for 8 days, also can be added 60mg of this product into 10-15ml of sterile water, weekly drops into the urethra, keep half an hour, side effects have urethritis. You can also add 10mg of this product to 10ml of soaked affected area, 3 times a day for half an hour, for the treatment of penile and glans coronal warts, mainly for those who still have residual warts or recurrence after other methods of treatment. You can also dilute this solution twice to soak the area to prevent recurrence.
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8.Immunotherapy
②Interferon inducers: polymyocyte and tilorone are available. Polymyxin is injected 2ml daily for 10 days, and then continued after 1-2 months of discontinuation. Tilorone 300mg 3 times a day for 4 days with discontinuation, or 600mg orally every other day.
(3) The combination of interferon, interleukin II, lindenolides, and Libido is more effective.
(4) Choice of treatment methods.
① male and female external genital area visible below the size of medium warts (single warts diameter <0.5cm, warts mass diameter <1cm, the number of warts <15), general topical drug treatment.
②Warts in the urethra and perineum in men, vestibule, urethral orifice, vaginal wall and cervical orifice in women; or warts of both sexes that exceed the above criteria in size and number, are recommended to be treated with physical methods.
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⑤ Treatment of acromegaly in pregnant women: early treatment should be given in early pregnancy; cesarean section should be considered in those who still have lesions close to delivery, if obstruction of the birth canal, or if vaginal delivery will lead to severe bleeding; onychotoxin (pediculosis toxin), pediculosis ester, and fluorouracil have teratogenic effects and are prohibited in pregnant women; the safety of imiquimod in pregnant women has not been determined. The use of topical 50% trichloroacetic acid solution, laser treatment, cryotherapy or surgical treatment is available for pregnant women. The wart is not an indication for termination of pregnancy. When the wart is large, obstructing the birth canal or causing severe bleeding, a cesarean section needs to be considered.
9, precautions
(1) The natural form of regression: self-receding, unchanged, increasing in size and number. Some patients may also heal without any treatment.
(2) Current treatments for acromegaly can reduce the infectiousness, but may not eradicate it.
(3) The appropriate treatment should be selected based on the patient’s condition and requirements, available resources, and the experience of the physician.
(4) Patients are often combined with other infections and should undergo the necessary tests before treatment. If there is localized inflammation or other infections combined, other infections and inflammation should be controlled first to avoid causing the spread of lesions after treatment.
(5) After treatment should be followed up, regardless of the program of treatment, once the warts are removed, should keep the local clean and dry, to promote wound healing, can be local topical antibiotic ointment, if necessary, oral antibiotics to prevent secondary bacterial infection.
Pseudo-acute warts Chinese medicine treatment
1, the wet poison gathered
The main symptoms] vulvar anal skin mucous membrane soft superfluous cauliflower-shaped, cockle-shaped, the surface gray and white wet yas or pink slippery, or accompanied by itching discomfort. Women’s white often increase in color yellow. Dry mouth and bitterness, dry stools or thin and unpleasant, yellow urine. Tongue red coating yellow or yellow greasy, fat pulse slippery or moist tenancy.
Treatment】Drying dampness and clearing heat, detoxifying and dispersing nodules.
[Formula] Drying dampness, detoxifying and removing warts. Pan Lan Gen, Tu Beimu, Hu Zhi, Comfrey, Tu Fu Ling, Xuan Shen, Yin Chen Gao, Curcuma longa, Red Peony, Gentian Herb, Coix Seed, Licorice. Take one dose daily with water decoction.
2.Spleen deficiency and toxicity
The main symptom is the recurrence of vulvar-anal warts, repeatedly untreated, weakness and tiredness, low voice and little food, loose stools, urine clear and long or female leucorrhea and clear.
【Treatment】Benefiting Qi and strengthening the spleen, resolving dampness and detoxification.
[Formula] Ginseng-Qi Fu Zheng Formula. Radix Astragali, Radix Codonopsis Pilosulae, Rhizoma Atractylodis Macrocephalae, Semen Coicis, Poria Cocos, Radix Panax notoginseng, Radix tigrinus, Radix Comfrey, Radix et Rhizoma Liu, Radix et Rhizoma Biflorum, Radix Curcuma longa, Radix Glycyrrhiza Uralensis. Take one dose daily with water decoction.