El VPH es un virus de ADN heterogéneo que pertenece a la familia Papillomaviridae. Este virus se replica justo en el núcleo de las células epiteliales escamosas (queratinocitos) y establece lesiones en el epitelio estratificado de la piel y mucosa. Existen más de 100 subtipos de VPH y se van a dividir en alto y bajo riesgo oncológico.
Su trasmisión se va a dar por contacto directo sostenido con la piel, puede ser durante el acto sexual o por auto-inoculación. Se sugiere que las infecciones orales por algunos tipos de VPH, se transmiten durante:
- Conducta sexual.
- Número de parejas sexuales.
- Edad temprana de inicio de actividad sexual.
Papiloma Escamoso
Son lesiones tumorales orales que se asocian a los 30 y 50 años de predilección, Pertenece a los subtipos 6 y 11 de VPH. Estas lesiones pueden ser papulares o tumorales, el cual posee una forma verrucosa (característico de las lesiones por VPH) y sus sitios de predilección son en la lengua, paladar blando, úvula y el frenillo.
Sus características clínicas son un tanto específicas y se pueden identificar con facilidad ya que su aspecto es muy parecido a una coliflor, tienen superficies digitiformes con crecimiento exofítico (hacia arriba), puede ser sésil o pediculado con entrantes y salientes. Su coloración puede ir de blanco al color de la mucosa adyacente. Por lo general son lesiones solitarias, indoloras y no excede el cm.
Verruga Vulgar
Estas lesiones no aparecen en mucosa, solo en piel. Son lesiones papilomatosas, escamosas y pertenecen a los subtipos 2, 57, 4, 6 y 40. Estas lesiones al igual que las lesiones de papiloma escamoso, son lesiones papulares o tumorales con la diferencia que no se ven en mucosa. Por lo general, son lesiones solitarias pero pueden ser múltiples en algunos casos.
Se localizan en el labio, borde bermellón y piel, son lesiones blancas o rosas. También siente la típica forma característica en forma de coliflor.
Condiloma Acuminado
Estas son lesiones planas en placa, pertenecen a los subtipos 6, 11 y 42. Son lesiones exofíticas (hacia arriba) y sus características siguen siendo las mismas a las anteriores solo que un poco más planas, con superficie rugosa y se asemejan a una coliflor, el tamaño puede variar.
Hiperplasia epitelial multifactorial
Estas lesiones son muy comunes en niños y se pueden encontrar con más frecuencia en etnias indígenas pero involucionan solo en la adolescencia. Pertenece a los subtipos 13 y 32. Su predisposición es genética, se asocia a la desnutrición, poca higiene y con las condiciones de la vivienda.
Sus características clínicas si son diferentes a las anteriores, ya que estas son lesiones múltiples, bien definidas tipo pápulas o placa con superficies rugosas o lisas. Afectan la mucosa oral y tienen un crecimiento lento del color de la mucosa o blanco algunas veces. Estas lesiones cuando el niño llega a la adolescencia llegan a involucionar pero se retiran por estética.
Para un diagnostico específico para determinar qué tipo de VPH tiene el paciente, se requiere de una rigurosa interrogación para la historia clínica, seguido de un examen clínico y posterior a esto el profesional puede sugerirle al paciente la realización de una biopsia excisional para un estúpido histopatológico. En la hiperplasia epitelio multifactorial no se realiza biopsia excisional. Por lo general los profesionales encargados de realizar estos diagnósticos a nivel bucal, son los Odontólogos con una especialidad en Patología, a nivel general se encargan los Ginecólogos en el caso de las mujeres y el Urólogo especialista en Andrología en el caso de los hombres.
El tratamiento para lesiones de VPH va a depender del tipo que sea. Para el papiloma escamoso, las verrugas vulgares y el condiloma acuminado se necesitarán escisiones quirúrgicas con sus respectivas biopsias excisionales anteriormente realizadas por el profesional. En caso de la hiperplasia epitelial multifactorial, se requiere realizar excisión quirúrgica si interfiere con la masticación o la estética.
Es importante recurrir a una cita médica para el correcto diagnóstico de la misma, ya que pueden ser confundidas con fibromas traumáticos, granulomas piogénicos, carcinomas verrugosos (lesiones malignas) y el Mucocele.
Subtipos de alto y bajo riesgo
Subtipo 16 y 18 relación con carcinoma orofaríngeo y CBCE
Vph de alto riesgo: 16, 18, 26, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68, 82.
Vph de bajo riesgo: 6, 11, 40, 42, 43, 44, 54, 61, 72, 81, CP6108.
Distintos tipos de VPH agrupados según el riesgo que representan (muñoz et al., 2003)
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