papillomatosis

Papillomatosis is a condition defined by the presence of multiple papillomas, which are benign proliferations of squamous epithelium that project above the surface as finger- or frond-like projections. The disease can affect skin or mucous membranes and may be localized or diffuse. In humans, papillomatosis most often results from infection with human papillomavirus (HPV), but other non-HPV causes are described in specific contexts.

Clinical forms vary by location. Laryngeal papillomatosis, also known as recurrent respiratory papillomatosis (RRP), typically presents in children or adults with progressive hoarseness and sometimes airway obstruction due to growths in the vocal folds and airway. Cutaneous papillomatosis includes common warts (verruca vulgaris) and plantar warts, while mucosal forms include genital condylomata acuminata. HPV types 6 and 11 are frequently associated with RRP, whereas a broader range of HPV types can cause cutaneous or mucosal warts.

Diagnosis relies on clinical examination and site-directed evaluation (for example, laryngoscopy for suspected RRP). Confirmation is usually obtained by biopsy with histology showing exophytic papillary projections, acanthosis, hyperkeratosis, and, when HPV is present, koilocytosis. HPV testing by molecular methods may aid typing.

Management is tailored to the site and severity. RRP typically requires repeated surgical debulking with laser or microdebridement; adjuvant therapies such as intralesional cidofovir have been used, though recurrences are common. Non-laryngeal papillomatosis is generally managed with standard wart therapies (topical keratolytics, cryotherapy, curettage) or antiviral/immunomodulatory approaches as appropriate. Vaccination against HPV can reduce risk of new lesions by preventing infection with common HPV types. Prognosis is variable; recurrence is common, and airway compromise can occur with extensive laryngeal disease. Malignant transformation is rare.