BAGIAN ILMU KULIT DAN KELAMIN REFERAT

FAKULTAS KEDOKTERAN JULI 2018

UNIVERSITAS PATTIMURA

VERUKA VULGARIS

OLEH:
CECILIA CASANDRA UNEPUTTY
NIM. 2016-84-046

KONSULEN:
DR. FITRI KADARSIH BANDJAR, SP. KK, M. KES

DIBAWAKAN DALAM RANGKA TUGAS KEPANITERAAN KLINIK

BAGIAN ILMU KULIT DAN KELAMIN
RSUD DR. M. HAULUSSY
FAKULTAS KEDOKTERAN UNIVERSITAS PATTIMURA
AMBON
2018
 PRELIMINARY

Veruka is a benign proliferation of the skin and

mucosa of the epidermis caused by certain types of
Human Papillomavirus (HPV)

Verruca vulgaris (warts, common wart) is a

cutaneous type of deformity found in almost all age
groups, but often in children, and is mostly caused
by HPV types 2 and 4

Polyclinic Dermatovenereologi RSUP Prof. Dr. R. D.

Kandaou Manado, explained that from 4099 new
cases there are 43 cases of veruka vulgaris (1.05%),
most are female patients (51,16%), with age group 5-
14 year (30,22%).
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The causes of VLL-1, 2, 4, 27, 57, and 63, but the most common
types are 2 and 4. Transmission can be directly from skin to skin
or indirectly through objects used such as towels, bed sheets, etc.,
so that autoinoculation often occurs (transmission from one part
to another part of the body in the same person).

The virus enters through the epithelium the defect then replicates
in the epidermal layer, causing excessive proliferation

Based on Indonesian Doctor Competency Standard (SKDI), veruca

vulgaris has 4A ability level
 CHAPTER II

LITERATURE REVIEW
DEFINITION

Transmission can be directly from

the skin to the skin or indirectly
Veruka vulgaris is a benign
through the objects used such as
proliferation of skin and mucosal
towels, bed sheets, etc., so it often
epidermis caused by Human
occurs autoinokulasi (transmission
Papillomavirus (HPV)
from one part to another body part
in the same person)

The virus enters through the

epithelium the defect then
replicates in the epidermal layer,
causing excessive proliferation.
EPIDEMIOLOGY

The highest prevalence RSUP Prof. Dr. R. D.

In Australia, the incidence
rates are in children and Kandaou Manado,
of congenital verrucae
young adults. Studies in explained that from 4099
vulgaris in school-age
school populations have new cases there are 43
children reached 22% (16%
shown a 12% prevalence cases of veruka vulgaris
of veruka vulgaris, 6%
rate in children aged 4-6 (1.05%), most are female
plantar verruca, and 2%
years and 24% at 16-18 patients (51,16%), with age
veruka plana).
years. group 5-14 year (30,22%).
ETIOLOGY

Verruca vulgaris is the most common type of warts

caused by HPV serotypes 2 and 4

HPV is difficult to understand because it can not be

cultured on tissue culture. But advances in
molecular biology have enabled the characterization
of the HPV genome and the identification of some
of the functions of the HPV gene.

HPV infection is not only common but also difficult

to treat and prevent. There are often long latent
periods and subclinical infections, and HPV DNA
can be found in normal adult tissues
PATHOGENESIS
To get a persistent infection, it
may be important to enter the
HPV infection occurs via viral
epidermal basal cell that is
inoculation of the viable
also the top cell (stem cell) or
epidermis via defects in the
altered by the virus into
epithelium
something with properties
such as stem cells

As these cells divide, the viral

After HPV inoculation
experiments, verruca usually
appears within 2 to 9 months
genome also replicates and
partitions into each progeny
cell, then is transported in
replicated cells as they
migrate upward to form
differentiated layers
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Viral expression
(transcription) is
very low up to the The DNA of this Viral proteins known
upper Malpighi layer, newly synthesized as E1-E4 (a split
just before the virus is packed into RNA product from
granulosum layer, a virion in the E1 and E4 genes)
where viral DNA nucleus of these can induce collapse
synthesis produces differentiated of these keratin
hundreds of copies Malpigi cells filament filaments
of the viral genome
of each cell
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 HPV has a high need for human epidermal cells

at a certain degree of differentiation.
 This causes the proliferation of keratinocytes
which partly keratonisasi and ultimately protect
this virus from the elimination by the immune
system. These lesions may be sporadic,
recurrent, or persistent
CLINICAL FINDINGS
ANAMNESIS PHYSICAL EXAMINATION

 Ordinary lumps appear 2-9  These lesions can grow

months after inoculation.
Usually the patient complains anywhere but most often
of a small, dense lump in the grow in the hands, especially
area of the hands and feet, the dorsal and peringual
especially on the fingers and
soles. surfaces, and the lesions
appear gray to brown, flat to
Clinical features, history of the
disease, slow-growing papules conventional papules, 0.1 to
are usually helpful in 1.0 cm in size, and rough
establishing a diagnosis of surfaces such as gravel
verruca vulgaris

DIAGNOSIS
TYPE OF VERUKA

Plantar
warts

Filiform
Myrmecia
wart

Punctate Pigmented
wart wart
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HISTOPATHOLOGY EXAMINATION

 Veruka consists of an
acantotic epidermis with
papillomatosis,
hyperkeratosis, and
parakeratosis
DIFFERENTIAL DIAGNOSIS

 PRURIGO NODULARIS
 In the lower limb
accompanied by itching.
Can be distinguished
from verruca vulgaris
from histopathological
examination.
DIFFERENTIAL DIAGNOSIS

 VERUCCA PLANA
 Warts that are blackish,
soft, flat-shaped papules
1-3mm in diameter,
mainly arising in the face
area, neck, extensor
surfaces of the forearm
and hand.
DIFFERENTIAL DIAGNOSIS

 MOLLUSCUM CONTAGIOSUM.
 In Molluscum contagiosum
seen solid and scattered
lesion in the form of papules
1-2 mm in diameter. at the
center there is an umbilical
region called dele containing
the body of molluscum
TREATMENT
 TREATMENT

TOPICAL SYSTEMIC

Salicylic acid Cimetidine

Glutaraldehyde Retinoids

Formalin Antiviral

Imiquimod
(Aldara)

Topical 5-
fluorouracil

Photodynamic
Therapy
TOPICAL TREATMENT
Salicylic acid The keratolytic effect of salicylic acid helps to reduce the
thickness of the warts

Glutaraldehyde The virucidal nature of glutaraldehyde can be used in the

treatment of warts. The preparation contains 10%
glutaraldehyde in aqueous ethanol or gel formulations.
Formalin Wetting or compressing lesions with 2-3% formaldehyde in
water (formaldehyde about 37% formaldehyde in water) is
effective for plantar warts, but it is time consuming and
difficult to limit the exposed skin
Imiquimod (Aldara) This topical immunomodulator promises a new treatment for
warts. Imiquimod as a 5% cream.
Topical 5-fluorouracil A 5% solution of 5-fluorouracil (5-FU) applied every day for a
month under the occlusion is more effective than placebo,
but if periungually used can cause onycholysis
Photodynamic Therapy Systemic or topical aminolevulinic acid can be taken up by
cells, metabolized to protoporfirin and then photo activated
to produce damaging effects on cells.
SYSTEMIC TREATMENT

CIMETIDINE RETINOIDS ANTIVIRAL

Cimetidine has also

been used in Oral retinoids are used Cidofovir can be used
children with small to treat warts because systemically with
doses to treat of their ability in the infusion (5 mg / kg /
common warts after process of keratin once per week) or
failed treatment with reduction and topically with 1% gel
contact sensitization acceleration of wart or cream or
indicating a clots by inducing intralesional injection
potentially response. irritant dermatitis (2.5 mg / ml).
 SURGICAL TREATMENT

Cryotherapy
• It is a • Cauter is used for
chemotherapeutic •Cryotherapy with liquid nitrogen is
used on warts that are not
warts with relatively
agent that inhibits successfully treated with large size and
DNA synthesis in ointments.
•Can use simple equipment such
painful or resistant
cells and viruses as cutton bud, this tool is inserted warts
into liquid nitrogen and then it is
proposed on the warts until the
warts and surrounding skin that
Intralesional surrounds it freezes. ELECTRICAL
Bleomycin SURGERY
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LASER • Carbon dioxide lasers have been used to treat different

forms of warts, both skin and mucosa

INFRARED • As another method, the infrared coagulator can be used to

treat warts. One study reported the cure rate in a series of
KOAGULATORS 44 verructs is 70%, which is better than cryotherapy.

• Methods with excision are performed using a scalpel

EXISTING (scalpel) and under local anesthesia.
• Then the former excision wound is covered with stitches and
SURGERY usually scar tissue can not be avoided and the recurrence of
the warts on the wound often occurs.
COMPLICATIONS

 In verruca vulgaris, there is no literature or

research showing any significant complications.
But this does not match the genital verruca.
The risk of cervical cancer in women with high
genital deficits.
 Cosmetic problems
PROGNOSIS

 Range of 23% spontaneous regression

occurred within 2 months, 30% within 3
months and 65% -78% in 2 years
CONCLUSION
Verucca
vulgaris

predilection
prognosis
area

Complication diagnosis

treament