Cutaneous warts

• Common (HPV 1,2,4,27,57)

Hands, trauma sites, filiform in periorificial, periungual, onychodystrophy, 10 nail dystrophy (HPV 57)

• Palmar/plantar (as common)

Myrmecia, mosaic (coalesce into large painful plaques)

• Inclusion warts

Plantar cysts from (HPV4,60,63,65)

• Flat (HPV 3,10> 28,29)
• Butcher (HPV 7>2)
• Digital squamous cell carcinoma & Bowen (HPV 16>31) oncogenic
• Epidermodysplasia verruciformis (HPV 3,5,8)

Autosomal recessive, mutation in EVER1 (TMC6)/ EVER2 (TMC8) genes encoding proteins that form a complex with the zinc transporter 1 (ZnT1) down-regulating zinc-associated transcription factors. Inhibition of ZnT1-TMC6/8 function→ facilitate viral infection → flat warts + actinic keratosis & squamous cell carcinoma in sun-exposed areas

Mucosal warts

• Condylomata acuminata/Buschke Löwenstein tumor (HPV 6,11)
• High-grade intraepithelial neoplasias (cervical condylomata plana, bowenoid papulosis, erythroplasia of Queyrat) & invasive cancer (HPV 16 >18, 31, 33, 45, 52, 58)
• Heck disease (focal epithelial hyperplasia) (HPV 13,32)
• Recurrent respiratory papillomatosis (HPV 6,11)

Forms: juvenile & adult-onset

• Juvenile: vertical transmission from mother to child by aspiration → insufficient evidence to support cesarean section for prevention
• Adult-onset: genital-oral
• Triad of hoarseness, stridor, & respiratory distress
• Conjunctival papilloma (HPV 6,11)