Dermoscopic Features Of Genital Warts In Male Patients

BackgroundGenital wart (GW) is a sexually transmitted disease (STD) caused by human papillomavirus (HPV). Genital warts so far are among the most common sexually transmitted diseases in Europe and America; in China, they are still the third most common sexually transmitted diseases since 2002, although they had been ranked the second heretofore. Typical genital warts can usually be diagnosed by clinical examination with naked eye; whereas it's necessary to undertake further laboratory examinations to render diagnosis for the atypical genital warts, and they should be differentiated from seborrheic keratosis, lichen planus, condyloma lata, pseudocondyloma, pearly penile papule, and Bowenoid papulosis, and so on.Dermocopy is a noninvasive in-vivo diagnostic technique mainly applied in pigmented skin diseases. It can increase the accuracy in the diagnosis of pigmented skin lesions and reduce the biopsy rate. And it's also helpful in evaluating non-pigmented skin lesions, because it can identify the vascular structures, which are invisible or are difficult to be recognized by naked eye. Our clinical observation indicated that genital warts might have distinctive dermoscopic manifestations, which might be helpful in the diagnosis of genital warts, especially in the diagnosis and differential diagnosis of atypical genital warts. In the literature no specific dermoscopic criteria of genital warts have been published. The objectives of this research are to study the dermoscopic features of genital warts in male patients in order to evaluate the role of dermoscopy in the diagnosis and differential diagnosis of genital warts.Material and methodsThe clinical data, digital clinical and dermocopic images of 43 lesions of genital warts were recruited sequentially in Out-patient Department of Dermatology and Venereology of the First Affiliated Hospital, University of Zhengzhou from April 18, 2006 to September 13, 2006. All the patients had no topital management history before enrollment and were confirmed diagnosis dermatopathologically. Clinical images of each lesion were taken with digital camera (Cyber-shot DSC-F707, Sony, Tokyo, Japan). Dermoscopic images of each lesion were shotted with digital dermoscopic system (Dermlite FOTO, 3Gen, LLC, Northern California, USA). Demoscopic patterns in genital warts were defined by experienced dermoscopist, and the frequency of each pattern was analyzed statistically with SPSS10.0.Results1. General clinical features of the 43 male genital wart lesionsThe lesions were obtained from 43 male patients ranging in age from 17 to 64 years (median age 33 years). The course of the disease ranged from 4 days to 2 years (median course 6 months). The distribution of the lesion was: penis shaft 60.47%, pubic symphysis 11.63%, scrotum 9.30%, coronary sulcus 9.30%, anal area 4.65%, groin4.65%. Clinically, smooth papular wart consisted 36.11%, keratotic genital wart 36.11%, condyloma acuminatum 27.78%, flat wart 16.28%.2. General dermoscopic features of male genital wartsThe dermoscopic patterns exiting in the 43 lesions of genital warts were defined as exophytic papillary pattern, vascular pattern, yellow-whitish keratotic pattern, homogenous pattern, and hyperpigmentation. The exophytic papillary pattern was further classified into mosaic type, finger-like type, and compound type. And the exophytic papillary patterns usually were tightly clustered and have similar diameter in lesions. The vascular pattern was further categorized into dotted vessel pattern, looped vessel pattern, hairpin vessel pattern and thrombosed vessel pattern. The frequencies of dermoscopic patterns in the 43 lesions were: exophytic papillary pattern in 38 (88.37%), vascular pattern in 36 (83.72%), yellow-whitish keratotic pattern in 20 (46.51%), homogenous pattern in 5 (11.63%), hyperpigmentation in 5 (11.63%), gyri and sulci structure in 2 (4.65%) and Vascular pattern were mainly found in the center of exophytic papillary pattern; only in 3 lesions with homogenous pattern, dotted vessels were presented in background of the homogenous pattern. In the 38 lesions with exophytic papillary patterns, 14 were mosaic type (36.84%), 15 were finger-like type (39.47%), and 9 were compound type (23.68%). In the 36 lesions with vascular pattern, 26 had dotted vessels (72.22%), 9 had looped vessels (25.00%), 15 had hairpin vessels (41.67%), and 12 had thrombozed vessels (33.33%).3. Dermoscopic features in various subtypes of genital wartsIn the 43 lesions, 7 (16.28%) were clinically classified as flat warts, 13 (36.11%) smooth papular warts, 13 (36.11%) keratotic genital wart, 10 (27.78%) condyloma acuminatum.In the 7 flat warts, 5 showed homogenous pattern, in which dotted vessels were presented in 3; and the other 2 revealed mosaic exophytic pattern, in which one had both dotted and looped vessels, and one had only dotted vessels.In the 13 smooth popular warts, exphytic papillary pattern were presented in all the lesions, and vascular patterns in 11, yellow-whitish keratotic pattern in 6, and hyperpigmentation in 5. In the 13 lesions with exphytic papillary pattern, 9 were mosaic, 1 finger-like, 3 compound. Among the lesions with vascular pattern, dotted vessels were found in 11, looped vessels in 3, hairpin-like vessels in 2, and thrombosed vessels in 5.In the 13 keratotic genital warts, both exphytic papillary pattern and yellow-whitish keratotic pattern were presented in all the lesions, and vascular patterns were presented in 10. Concerning exphytic papillary pattern, 3 were mosaic, 8 finger-like, 2 compound. Among the lesions with vascular pattern, dotted vessels were found in 5, looped vessels in 1, hairpin-like vessels in 4 and thrombosed vessels in 5.In the 10 condyloma acuminatum, both exphytic papillary pattern and vascular pattern were presented in all the lesions, and yellow-whitish keratotic pattern in 1. Concerning exphytic papillary pattern, 6 were finger-like, 4 were compound, and no mosaic was found. Regarding to the vascular pattern, dotted vessels were found in 5, looped vessels in 4, hairpin-like vessels in 10, and thrombosed vessels in 2. 4. Correlation between dermoscopic and dermotopathological features of genital wartsIn the 7 flat warts, 5 showed homogenous pattern through dermoscope and 5 acanthosis were seen in the corresponding pathologic slides; 2 showed mosaic exphytic papillary pattern and 2 papillomatous hyperplasia were seen correspondingly; 5 showed vascular pattern and 5 vasodilatation in superficial layer of dermiswere seen correspondingly.In the 36 exophytic warts, 36 showed exophytic papillary pattern through dermoscope and 36 papillomatous hyperplasia were seen in the corresponding pathologic slides; 31 showed vascular pattern and 24 vasodilatation in superficial layer of dermis were seen correspondingly; 20 showed yellow-whitish keratotic pattern and 20 hyperkeratesis, 18 parakeratosis were seen; 5 showed hyperpigmentation and 5 hyperpigmentation were seen in the corresponding slides; 2 showed gyri and sulci structure and 2 papillomatous hyperplasia were seen in the pathologic slides. ConclusionsThe main dermoscopic features of male genital warts are exophytic papillary pattern and vascular pattern. Exophytic papillary pattern can be subdivided into 3 types: mosaic type, finger-like type, and compound type. And the exophytic papillary patterns usually were tightly clustered and have similar diameter in lesions. Vascular pattern consists of dotted vessel, looped vessel, hairpin vessel and thrombosed vessel subtypes. Vascular pattern can only be seen in the center of exophytic papillary pattern except in the background of homogeneous pattern. Besides, yellow-whitish keratotic pattern, homogeneous pattern and hyperpigmentation are also presented in genital warts. The frequencies of aforementioned dermoscopic patterns in different clinical subtypes of male genital warts vary.There is correlation between dermoscopic features and dermotopathological features.The dermoscopic features of male genital warts may facilitate the diagnosis of genital warts, especially the atypical lesions and differential diagnosis.