Домой Бородавки Бородавки на руках, подошвенные, шипицы

Бородавки на руках, подошвенные, шипицы

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Что такое бородавки

Бородавки (verrucae) это наиболее распространенный тип кератоза у человека, представляющий собой мелкие эпидермальные доброкачественные образования кожи и слизистых оболочек пролиферативного невоспалительного характера, вызываемые вирусами папилломы человека (ВПЧ) разных типов. Опасности они не представляют, но вызывают эстетический и психологический дискомфорт у человека.

ВПЧ чрезвычайно широко распространены среди людей и животных на всей планете. Ими инфицировано около 70% населения Земли. В настоящее время изучено около 200 типов ВПЧ, из которых более 80 являются патогенными для человека. Из них около 40 типов являются причиной развития бородавок разного вида.

ВПЧ при бородавках проникают в организм человека контактно-бытовым путем, в случае развития кондилом (бородавки аногенитальной области) — при половых контактах.

В 90% случаев вульгарные и юношеские бородавки излечиваются самостоятельно. Во всех остальных случаях для лечения новообразований применяется деструктивная терапия (разрушение новообразований физическими и химическими путями). Эффективность лечения составляет от 50 до 80%.

Характеристика вируса папилломы человека

Причиной развития ВПЧ-инфекции является фильтрующийся безоболочечный ДНК-содержащий вирус Tumefaciens verrucarum. Вирусы имеют сферическую форму. Их диаметр составляет от 45 до 55. Капсид кубического типа симметрии состоит из 72 капсомеров. Геном представлен двуспиральной циклически замкнутой ДНК с молекулярной массой от 3 до 5 мД. В процессе репликации геном экспрессирует 8 — 10 белковых продуктов, регулирующих репликацию вирусов, транскрипцию, клеточную трансформацию, формирование капсомеры, репликацию ДНК и экспрессию генов.

Из 200 идентифицированных видов ВПЧ около 40 инфицируют слизистые оболочки и кожу. Вирусы папилломы человека относятся к семейству папавирусов (Papavaviridae). Подразделяются на 5 эволюционных групп: альфа (поражают генитальный тракт), бета, гамма, мю и ню (поражают кожные покровы). Наиболее часто при появлении вирусных бородавок выявляются ВПЧ 1, 2, 4, 27 и 57 типов, реже — ВПЧ 3, 7, 10, 28, 41, 65, 88 и 95 типов.

Рис. 2. Микрофотография вируса папилломы человека.

Клинические проявления и типы ВПЧ

ВПЧ обладают тканевой специфичностью — определенные типы вирусов поражают свойственные для их локализации ткани. Шифр по МКБ-10: В07.

Клинические формы Типы ВПЧ
Группа неонкогенных (не вызывающие злокачественного перерождения) ВПЧ
1 Бородавки вульгарные Чаще 1, 2, 3, 4, 27 и 57.

Реже — 5, 7, 10, 26, 28, 29, 38, 41, 48, 49, 60, 63, 65,75 — 77

Нитевидные 3, 5 и 9
Плоские (юношеские) Чаще 3 и 5, реже — 10, 27, 28, 30, 41, 49 и 75
Бородавки «мясников» 7 и 27
Кистозные 60
Мозаичные
2 Фокальная эпителиальная гиперплазия 13, 32
Группа онкогенных ВПЧ низкой степени озлокачествления
5, 6, 7, 8, 11, 12, 14, 15, 17, 19, 20, 21, 22, 23, 24, 25, 42, 43, 44
1 Остроконечные кондиломы В 90% случаев 5, 6 и 11 типов
2 Бородавчатая эпидермодисплазия 5, 8, 9, 10, 12, 14, 15, 17, 19, 20 — 23, 24, 25, 36, 39, 40, 47
3 Ларингеальный папиломатоз 6, 11, 30
4 Гигантская кондилома Бушке- Левенштейна 6 и 11
Группа онкогенных ВПЧ высокой степени озлокачествления
6, 11, 16, 18, 30-31, 33, 39-40, 42-43, 51-52, 55, 57, 61-62, 64, 67
1. Бовеноидный папуллез 16, 18, 31 и 33
2. Плоские кондиломы и дисплазия шейки матки 6, 11, 16, 18, 30-31, 33, 39-40, 42-43, 51-52, 55, 57, 61-62, 64, 67

Рис. 3. Бородавки вульгарная (слева), нитевидная (в центре) и плоские (справа).

Эпидемиология

Вирусные бородавки достаточно широко распространены в человеческой популяции. До 45% людей являются носителями инфекции без видимых проявлений на коже. У 10% детей и подростков и у 30% взрослых регистрируются клинические проявления бородавок.

ВПЧ при бородавках проникают в организм человека контактно-бытовым путем, в случае развития кондилом — при половых контактах. Риск инфицирования зависит от места проникновения возбудителя, вирусной нагрузки, степени и характера контактов, иммунного статуса человека. Распространению инфекции на кожных покровах способствуют расчесы, царапины, ссадины и привычка грызть ногти. Нередко наблюдаются семейные случаи заболевания и вспышки инфекции среди школьников. Некоторое время вирусы остаются жизнеспособными в туалетных комнатах, банях, бассейнах и спортзалах. Определенная роль отводится состоянию нервной системы.

ВПЧ-инфекция при кондиломах передается во время половых контактов. Способствуют распространению вирусов микротравмы и воспалительный процесс, часто связанный с инфекцией, передающейся половым путем. Пик инфицирования ВПЧ приходится на возраст от 18 до 25 лет. Отмечается, что носителями возбудителей чаще являются мужчины. Женщины в процессе беспорядочной половой жизни могут набрать целый букет ВПЧ разных типов.

Рис. 4. На фото бородавки на руках.

Патогенез

Инкубационный период при бородавках длится в среднем от 4 до 5 месяцев, в некоторых случаях — до нескольких лет. Его длительность зависит от вирусной нагрузки, типа вируса и состояния иммунной системы организма. В борьбе с инфекцией ведущая роль отводится клеточному иммунитету.

При проникновении ВПЧ неонкогенного типа развиваются бородавки, онкогенного типа — кондиломы, дисплазии и злокачественные новообразования. У лиц с нормальной иммунной системой элиминация вирусов регистрируется в 70 — 90% случаев, у иммунокомпроментированных лиц развиваются клинические формы заболевания.

В основе развития инфекции лежат пролиферативные процессы в эпидермисе и сосочковом слое дермы, где развивается гиперплазия и гиперкератоз. Репликация вирусов происходит в высокоспециализированных клетках многослойного плоского эпителия базального слоя, в результате чего внутренний слой эпидермиса деформируется и утолщается. На кожных покровах появляются новообразования, а инфицированные клетки становятся постоянным источником инфекции для новых клеток.

Рис. 4. На фото гистологическая картина бородавки простой. Отмечается избыточное ороговение внешних слоев эпидермиса (желтая окраска) и разрастание его базальных слоев (зеленая окраска).

Не путать понятия «Бородавки» и «Папилломы». ВПЧ к возникновению папиллом не имеет никакого отношения. Оба понятия пересекаются только терминологически! Папилломы являются доброкачественными образованиями. Растут из соединительной ткани. Снаружи покрыты эпителием, содержат сосуды и соединительную ткань.

Рис. 5. Папилломы (мягкие фибромы) на шее и верхнем веке. Располагаются на тонкой ножке.

Бородавки вульгарные на руках

Бородавки вульгарные (простые, обыкновенные, verrucae vulgaris) являются самыми распространенными. Среди всех видов новообразований данного вида они составляют до 70%. Чаще обнаруживаются у детей 7 — 14 лет.

  • Локализуются чаще на руках — тыльной стороне кистей и пальцев, а так же на боковых поверхностях пальцев, реже — подбородке, красной кайме губ, лице, иногда в области волосистой части головы. Встречаются целующиеся бородавки (располагаются на 2-х соседних пальцах).
  • Бородавки имеют округлую форму, возвышаются над поверхностью кожи, в диаметре составляют 3 — 10 мм.
  • Четко отграничены от окружающих тканей.
  • Иногда имеют перетяжку у основания и тогда напоминают по форме гриб.
  • Располагаются изолированно, иногда сливаются.
  • Бывают множественные (чаще) и единичные (реже).
  • Поверхность шершавая, неровная.
  • Цвет сероватый, у некоторых — телесный или желтоватый.
  • Воспалительный компонент отсутствует.
  • При появлении в роговом слое трещин возможно вторичное инфицирование.

В большинстве случаев вульгарные бородавки спустя 6 — 8 месяцев проходят самостоятельно (без лечения). Новообразования следует отличать от кератомы себорейной, контагиозного моллюска и эпидермального невуса.

Рис. 6. На фото бородавки вульгарные на руках. Типичная локализация на тыле кисти.

Рис. 7. Вульгарные бородавки на пальцах рук. Типичная локализация.

Рис. 8. На фото бородавки на руках. Редкая локализация. Расположены на ладонной поверхности руки.

Рис. 9. На фото бородавки на лице и красной кайме губы.

Бородавки на руках околоногтевые

Данный вид новообразований является разновидностью бородавок вульгарных. Они располагаются рядом с ногтевыми пластинами — в зонах ногтевых валиков. При их разрастании отмечается деформация ногтя, при прорастании под ноготь ногтевая пластина отделяется от ногтевого ложе.

Рис. 10. На фото бородавки околоногтевые на руках.

Рис. 11. На фото бородавки на руках — околонегтевые и подногтевые.

Бородавки подошвенные

Бородавки на ногах (подошвенные, шипицы, verrucae plantaris) представляют собой разновидность вульгарных бородавок. Они составляют около 34% всех видов новообразований данного вида. Причиной их появления являются ВПЧ 1 и 2 типов.

Подошвенные бородавки всегда имеют плотную структуру (мозолистые) и шершавую поверхность. В центре располагается стержень, состоящий из дермальных сосочков, по периферии окружен роговыми наслоениями. Бывают единичными и множественными. Имеют сероватую окраску.

Бородавки, имеющие выпуклую поверхность, называют шипицами. Они имеют вид грубых папул. Часто прорастают в глубину тканей, из-за чего во время ходьбы человек испытывает боль. Способствует распространению новообразований повышенная потливость ног. При массивных разрастаниях и резко выраженном болевом синдроме происходит деформация стопы.

Различают несколько разновидностей подошвенных бородавок:

  • Мозаичные. Представляют собой диффузные очаги гиперкератоза. Часто локализуются в области переднего отдела стопы. Нередко покрыты глубокими трещинами.
  • Кистозные. Представляют собой мягкие узловые образования с гиперкератозом на поверхности и часто с трещинами. При вскрытии выделяется содержимое творожистого вида. Основное место локализации — давящая поверхность подошвы.

Подошвенные бородавки следует отличать от мозолей, точечного кератоза и веррукозной карциномы.

Лечение наростов затруднено. Они часто рецидивируют. Основным методом лечения является их разрушение или удаление хирургическим путем.

Рис. 12. Подошвенная бородавка на пальце стопы

Рис. 13. Бородавки подошвенные. Иногда в их центре наблюдаются коричневого или черного цвета точки затромбированных капилляров (фото слева). При повреждении развивается кровотечение (фото справа).

Рис. 14. Множественные и единичные подошвенные бородавки.

Рис. 15. Бородавки на пальцах ног. Слева «целующиеся бородавки».

Рис. 16. Обширный нарост (бородавка) на коже пяточной области.

Рис. 17. Бородавки на ногах «шипицы».

Рис. 19. На фото подошвенные бородавки: мозаичные (слева) и кистозные (справа).

Акрохорды (бородавки нитевидные)

Бородавки нитевидные или акрохорды (acrochordon) представляют собой тонкие роговые выросты. Они часто встречаются у пожилых людей, в 50% случаев — у стариков. Локализуются на коже лица (часто на веках) и шее, в области подмышек и под молочными железами.

Акрофорды на начальных этапах развития по внешнему виду напоминают шишку, далее — цилиндр, состоящий из нитевидных образований высотой до 1 см.

Единственным методом лечения является их удаление.

Рис. 20. Нитевидные бородавки.

Рис. 21. Бородавки на лице нитевидные.

Рис. 43 и 44. Акрохорды на лице — красной кайме губ и на носу.

Бородавки плоские

Бородавки плоские (юношеские) представляют собой плоские образования (узелки), незначительно возвышающиеся над кожей. Встречаются в 4% случаев у детей и лиц молодого возраста, в 10% случаев у детей 6 — 12 лет. Они округлые, гладкие, небольшого размера (0,5 — 3 мм), с блестящей (чаще) или матовой поверхностью, часто желтоватого или коричневатого цвета. Располагаются изолированно, иногда сливаются. Порой их можно рассмотреть только под лупой. Локализуются чаще всего на лице, тыльной стороне кистей, предплечьях и голенях.

Рис. 23. На фото плоские бородавки. Роговой слой образований имеет вид плетеной корзинки.

Рис. 23а. Плоские бородавки на лице.

Рис. 24. Бородавки юношеские на лице.

Рис. 25. Плоские бородавки на голени и предплечье.

Бородавки мясников

Бородавки мясников представляют собой разрастания на коже пальцев тыла кистей рук, по внешнему виду напоминают цветную капусту. Возникают у лиц, разделывающих мясо животных, рыбу и птицу.

Рис. 26. Бородавка мясников.

Кондиломы

Бородавки, располагающиеся в аногенитальной области называют кондиломами. Они ежегодно регистрируются у 30 млн. мужчин и женщин. Относятся к факультативным предракам.

Инфекция распространяется в основном половым путем. Инфицирование человека происходит в первые годы сексуальной жизни. Поражаются слизистые оболочки половых органов мужчин и женщин, наружная часть уретры у мужчин, кожные покровы промежности и зоны вокруг ануса. Кондиломы бывают остроконечные (растут наружу) и плоские (растут вглубь эпителия). Различают так же такие клинические формы, как папулезные бородавки, гигантскую кондилому Бушке-Левенштейна и бовеноидный папулез.

Остроконечные кондиломы представляют собой мягкие дольчатые разрастания, по внешнему виду напоминающие петушиный гребень или цветную капусту, часто множественные, склонны к слиянию, с элементами ороговения и мацерации, в высоту составляют от 3 до 5 мм. У больных со сниженным иммунитетом новообразования разрастаются значительно и образуют одну гигантскую кондилому Бушке-Левенштейна.

Рис. 27. На фото кондиломы остроконечные.

Рис. 28. Остроконечные кондиломы у мужчин.

Рис. 29. Остроконечные кондиломы у женщин.

Рис. 30. Остроконечные кондиломы в зоне ануса.

Бородавчатая эпидермодисплазия

Бородавчатая дисплазия эпидермиса (верруциформная эпидермодисплазия Левандовского-Лютца) есть одна из форм проявления ВПЧ-инфекции. Ее причиной являются ВПЧ 5, 8, 9, 10, 12, 14, 15, 17, 19, 20 — 23, 24, 25, 36, 39, 40 и 47 типов. Характеризуется появлением плоских достаточно большого размера гиперкератотических папул, слегка выступающих над поверхностью кожи, местами сливающихся. Новообразования часто похожи на бородавки. Имеют бурую или желтоватую окраску. Располагаются часто на коже кистей, предплечий, стоп, голеней, лице и шее. Заболевание возникает в детстве и длится многие годы.

Новообразования склонны к озлокачествлению — развитию плоскоклеточного рака кожи (болезнь Боуэна), чему способствуют частые повреждения и чрезмерная инсоляция. Отмечается семейный характер заболевания, что говорит о его генетической предрасположенности. Передача осуществляется по аутосомно-рецессивному признаку.

Рис. 31. На фото эпидермодисплазия верруциформная Левандовского-Лютца.

Рис. 65 и 66. ВПЧ у животных.

Бовеноидный папуллез

Причиной развития бовеноидного папуллеза являются ВПЧ 16, 18, 31 и 33 типов. Заболевание характеризуется появлением на коже крайней плоти, головке и стволе полового члена у мужчин, больших и малых половых губах и клиторе у женщин, а так же в области паха, перианальной области и на слизистых оболочках полости рта коричневатого цвета образований. Болеют только взрослые. Регистрируются случаи злокачественного перерождения в плоскоклеточный рак кожи.

Рис. 32. Бовеноидный папулез у мужчин.

Рис. 33. Бовеноидный папуллез у мужчин. Папулы локализуются на головке полового члена.

Рис. 34. Бовеноидный папуллез. Папиломы располагаются на половом члене, лобковой области, в паху и на коже бедер.

Диагностика

Диагностика бородавок проводится в основном визуально и основывается на клинической картине заболевания. В ряде случаев требуется подтверждение диагноза с помощью гистологического исследования. В случаях применения деструктивных методов лечения бородавок аногенитальной области, больного следует обследовать на сифилис, ВИЧ и гепатиты.

Дифференциальная диагностика

Бородавки следует отличать от целого ряда патологических образований на коже — контагиозного моллюска, эпидермального бородавчатого невуса (родинок), себорейной кератомы, базиломы, базальноклеточного рака кожи в случае единичного образования.

Ладонно-подошвенные бородавки следует отличать от кератодермии, сифилидов, омозолелостей, точечного кератоза и веррукозной карциномы.

Бородавки на лице следует отличать от сирингомы, ангиокератомы Мибелли и красного плоского лишая.

Бородавки, располагающиеся на лице (области висков, окружности глаз, щеках) и туловище, следует отличать от старческих бородавок, при расположении в себорейных зонах — от болезни Дарье.

Бородавки на верхних и нижних конечностях следует отличать от бородавчатого акрокератоз (акpoкератоз верруциформный Гопфа).

Рис. 35. На фото слева образования на коже рук при бородавчатом акрокератозе, справа — старческие бородавки.

Рис. 36. Старческие бородавки (себорейная кератома) — доброкачественные эпителиальные опухоли не вирусной природы.

Лечение бородавок

В 90% случаев вульгарные и юношеские бородавки излечиваются самостоятельно. Во всех остальных случаях для лечения новообразований применяется деструктивная терапия (разрушение новообразований физическими и химическими путями). Эффективность лечения составляет от 50 до 80%. Существует много методов удаления бородавок, но ни один из них не гарантирует полного избавления от заболевания, так как не обеспечивает полного уничтожения ВПЧ.

Наиболее эффективной методикой является комбинированное лечение, сочетающее одновременное или поэтапное применение деструктивной терапии и использование противовирусных и иммунопротективных средств. Применение только одной методики дает высокой процент (от 20 до 50%) рецидивов уже в течение первых 6 месяцев, что объясняется по-видимому стадиями жизненного цикла ВПЧ и нарушением как местного, так и общего иммунитета.

Деструкция новообразований в первую очередь используется при наличии больших по размеру разрастаний, вызывающих дискомфорт, болезненность при ходьбе или косметический дефект.

Деструктивная терапия

Несмотря на то, что эффективность применения деструктивной терапии составляет от 50 до 80%, данная методика является ведущей. Более часто рецидивы регистрируются при распространенных бородавках, оклоногтевых и подошвенных. Выбор методики зависит от локализации и площади очагов поражения.

Для разрушения новообразований применяются в основном методы физического воздействия:

  • Криодеструкция (применение жидкого азота).
  • Электрокоагуляция (прижигание электрическим током).
  • Лазерокоагуляция (уничтожение лазерным лучом).
  • Хирургический (иссечение скальпелем).

Криодеструкция

Лечебная методика криодеструкции предполагает нанесение в виде апликации на бородавку жидкого азота в течение 1 — 3 минут, что приводит к замораживанию внутри- и внеклеточной жидкости с последующей гибелью и лизисом пораженных клеток. Эффективность при применении криодеструкции достигает 70 — 75%. Показаниями к применению данной методики являются вульгарные (простые), плоские и подошвенные бородавки. При лечении простых и плоских бородавок применяется одна апликация, при лечении подошвенных бородавок используется методика «олимпийских колец» — два воздействия с интервалом 7 — 10 дней. По окончании процедуры поверхность очага обрабатывается антисептиком и накладывается сухая повязка с антисептиком.

Рис. 37. Лечение бородавок на ноге и руке с применением криотерапии.

Рис. 38. Лечение с помощью криотерапии. На фото вид очагов поражения после воздействия жидкого азота. В 90% случаев на коже в местах воздействия жидким азотом появляются пузыри.

Рис. 39. Препарат Веруклин и губчатый апликатор. Применяется для лечения простых бородавок на руках и ногах в домашних условиях. С помощью охлажденного газа замораживается корневая часть нароста, который в последствии самостоятельно отваливается.

Лазеротерапия

При неэффективности применения других методик используется лазеротерапия. Данный вид лечения является дорогим, болезненным и характеризуется развитием рубцовых изменений. Применяется в качестве терапии второй линии при подошвенных бородавках, третей — при простых и плоских. Деструкция проводится под местной анестезией. Используется высокоинтенсивное инфракрасное излучение, под воздействием которого мягкие ткани вскрываются, а внутриклеточная вода вскипает, что приводит к послойному удалению новообразования.

Радиохирургическая деструкция

Данная методика основана на воздействии на очаг поражения радиоволны большой мощности. При этом ткани в местах прикасания разрываются (иссекаются). Процедура проводится под местной анестезией.

Рис. 41. На фото применение радиохирургической деструкции новообразования на коже.

Электрокоагуляция

Иногда для удаления новообразований на коже применяется электрический ток (электрокоагуляция) — одна из старейших методик. Методика применяется с целью деструкции бородавок подошвенных и вульгарных.

Методы химической деструкции

Методика разрушения бородавок с применением химических веществ (химическая деструкция) является безболезненной и может применяться пациентами в домашних условиях самостоятельно. С этой целью используются:

  • препараты, содержащие кислоты: фрезол (трикрезол, фенол), трихлоруксусную, щавелевую, азотную и молочную;
  • препараты, содержащие щелочи: гидроксид калия или гидроксид натрия.

В качестве прижигающих средств используются:

Солкодерм (содержит азотную, уксусную, щавелевую и молочную кислоты).

Салициловая кислота является в терапии бородавок препаратом первой линии. Наиболее распространена методика, сочетающая местное применение салициловой кислоты и криотерапии жидким азотом.

При применении любого из указанных препаратов следует узнать природу новообразований и посоветоваться с врачом о выборе метода лечения.

Рис. 42. Эффективное излечение от бородавок на руках.

Иммунотропные препараты

Всвязи с тем, что вирусы папилломы человека способны длительно персистировать в организме человека с иммунодефицитом, следует включать в схему лечения таких больных препараты, нарушающие репликацию возбудителей и способствующие регенерации тканей. Рекомендуется параллельно или последовательно с методами деструктивной терапии использовать местные противовирусные средства и препараты с иммуномодулирующим эффектом.

Прямым противовирусным эффектом обладают препараты группы интерферонов:

  • Интерферон альфа можно вводить подкожно (обкалывание). Близким к нему является препарат Аллокин-альфа.
  • Место применяется препарат с противовирусной антивностью Виферон (интерферон альфа-2b). Выпускается в виде мази, геля и суппозиториев.
  • Препарат группы интерферонов Генферон выпускается в виде суппозиториев. Широко применяется при кондиломах.

При лечении бородавок в ряде случаев назначают индукторы интерферонов — веществ, стимулирующих выработку интерферонов организмом самого больного. С этой целью применяются:

  • Имиквимод в виде крема (аналогами являются крема Кераворт и АЛДАРА).
  • Панавир в виде геля для наружного применения и суппозиториев. Препарат растительного происхождения. Содержит полисахариды побегов Solanum tuberosum.
  • Эпиген-спрей — препарат растительного происхождения. Действующим веществом является активированная глицирризиновая кислота, получаемая путем экстракции из корня солодки.

Для повышения общей реактивности организма в некоторых случаях показан прием иммуностимуляторов, которые назначаются после консультации врача иммунолога:

  • Неспецифическим противовирусным действием и иммуностимулирующей активностью обладает препарат Изопринозин (действующее вещество инозина пранобекс).
  • Полиоксидоний (действующее вещество азоксимера бромид) обладает противовоспалительным, антиоксидантным, детоксицирующим и иммуномодулирующим действием.
  • Ронколейкин (действующее вещество интерлейкин-2 человека рекомбинантный) является стимулятором клеточного иммунитета.
  • Иммунал — препарат растительного происхождения. Изготовлен на основе сока травы эхинацеи пурпурной. Оказывает иммуностимулирующее действие.

В ряде случаев при устойчивых формах ладонно-подошвенных бородавок в схему подключаю топические ретиноиды — вещества, влияющие на процессы кератинизации.

  • Тазаротен (Зорак) является синтетическим ретиноидом. Обладает мощным пилинговым, заживляющим и противовоспалительным эффектом. Применяется только по назначению врача.

Рис. 43. Лечение бородавок на руке методом криотерапии в лечебном учреждении.

Особенности лечения некоторых видов бородавок

Следует знать, что бородавки вульгарные (простые) без лечения исчезают спустя 3 — 8 месяцев, иногда через 1 — 1,5 года. Основным видом их лечения является разрушение с применением жидкого азота (криотерапия). Процедура проводится как в лечебном учреждении, так и в домашних условиях (применение спрея Веруклин).

При множественных и резистентных к лечению подошвенных бородавках следует выявить причины снижения локального иммунитета (повышенная потливость ног, ношение тесной и резиновой обуви, нарушение кровотока в нижних конечностях (сахарный диабет, атеросклероз сосудов), ВИЧ -инфекция и др.) и постараться их устранить.

При лечении подошвенных бородавок в качестве терапии первой линии применяется криотерапия, второй линии — лазеротерапия. Местно назначаются инъекции противовирусных препаратов (интерфероны) и индукторы интерферона (крема Имиквимод, Кераворт, АЛДАРА). С целью снижения интенсивности болевого синдрома показаны обкалывания 1% новокаином. В зарубежной практике при устойчивых формах ладонных и подошвенных бородавках крем Имиквимон чередуется с ретиноидом — гелем Тазаротеном. При множественных шипицах используют иммунные препараты.

Нитевидные бородавки всегда подлежат лечению, так как сами по себе не излечиваются. К тому же при локализации на лице представляют собой косметический дефект, а находясь в подмышечной области нередко подвергаются травмированию. Для лечения используются методы деструктивной терапии.

Бородавки на лице не следует лечить самостоятельно, так как при применении агрессивных методик на тонкой коже могут остаться рубцовые изменения.

Рис. 44. Использование криотерапии при лечении шипиц.

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