Skin nontumor
Infectious disorders

Topic Completed: 1 December 2015

Minor changes: 17 August 2020

Copyright: 2003-2020,, Inc.

PubMed Search: Condyloma [title] skin

Abha Soni, D.O., M.P.H.
Page views in 2019: 3,776
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Cite this page: Soni A, Slominski A. Condyloma. website. Accessed October 26th, 2020.
Definition / general
  • 20 million people are infected with HPV in the United States
  • Lifetime incidence is greater than 50%
  • Highest rate of infection in adolescents and young adults
  • Average age of presentation in children is between 2.8 - 5.6 years (Pediatr Rev 2011;32:115)
  • Human papillomavirus (HPV): double stranded DNA virus, with greater than 100 serotypes (Pediatr Dermatol 2006;23:199)
  • HPV infects the basal keratinocytes of the epidermis, where it remains latent
  • With successive replications, the virus matures and is shed in the exfoliative cells of the keratitic layer
  • The virus morphologically alters the epidermis yielding mucosal and cutaneous warts (eMedicine - Condyloma Acuminata)
  • Young age at first intercourse and number of sexual partners both increase the risk of acquiring this infection at an early age
  • HPV proteins E6 and E7 inactivate tumor suppressor proteins p53 and Rb in the host resulting in uncontrolled proliferation and malignant transformation (eMedicine - Condyloma Acuminata)
  • HPV infection: the virus lacks an envelope making it sturdy in the environment and resistant to therapy (Int J Dermatol 2001;40:373)
  • HPV types 6 and 11 are most frequently detected in condyloma acuminata
  • HPV types 16, 18, 31, 33, 35 and 45 have oncogenic potential
  • Infection spreads via direct skin contact and sexual activity
Clinical features
  • Soft, tan, flat or cauliflower-like masses, varying in size and shape (eMedicine: Condyloma Acuminata)
  • Rarely can become irritated and bleed
  • Majority of cases are asymptomatic and underreported
  • Cytologic / histologic interpretation of cells can reveal the presence of koilocytes
  • Koilocytosis: a cellular change that occurs in an HPV infected cell, characterized by nuclear darkening, irregularity, enlargement and a perinuclear halo (Obstet Gynecol 1976;47:540)
  • Application of acetic acid can aid in detecting grossly inapparent warts (J Urol 1988;139:777)
  • PCR identifies HPV 6 and 11
  • Prevention
    • Gardasil vaccine protects against types 6, 11, 16 and 18
    • This vaccine must be given prior to HPV exposure, as early as 9 years of age in men and women (J Pediatr Nurs 2016;31:e155)
Case reports
Clinical images

Contributed by Dr. Dhiraj B Nikumbh

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External genital warts

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Large external genital wart

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Perianal warts

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Pearly penile papules

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Labial warts

Gross description
  • Flesh colored, brown or grey
  • Flat or cauliflower-like exophytic growth, varying in size
Gross images

Contributed by Dr. Dhiraj B Nikumbh
Microscopic (histologic) description
  • Numerous papillary and polypoid fronds with prominent parakeratosis
  • Koilocytosis with wrinkled nuclei and occasional binucleated cells in epidermis
Microscopic (histologic) images

Contributed by Dr. Dhiraj B Nikumbh
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Cytology description
  • Koilocytic change can be appreciated on pap smear specimens
Cytology images

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Koilocytic change

Positive stains
  • p16 is a useful marker for identifying high risk HPV
  • Most condylomas are associated with low risk HPV
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