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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Two new human papillomavirus &#40;HPV&#41; vaccines have recently become available in Spain&#58; Gardasi &#40;Sanofi Pasteur MSD&#41;&#44; a quadrivalent vaccine that protects against HPV types 6&#44; 11&#44; 16&#44; 18&#44; and Cervarix &#40;Glaxo-SmithKline&#41;&#44; a bivalent vaccine that protects against HPV types 16 and 18&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Both are indicated for the prevention of cervical cancer&#46; They are composed of virus-like particles containing viral proteins and are administered in 3 doses to girls and young women prior to sexual debut&#59; the preferred age for administration is 13 or 14 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; cervical cancer is not the only disease caused by these small cutaneotropic or mucosotropic DNA viruses&#44; of which over 150 types have been identified to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> They are also implicated in numerous other conditions&#44; mainly dermatologic&#44; including common warts &#40;100&#37; of cases&#41;&#44; genital warts &#40;100&#37; of cases&#41;&#44; vaginal&#44; vulvar&#44; and penile cancer &#40;40&#37; of cases&#41;&#44; anal cancer &#40;90&#37; of cases&#41;&#44; certain cancers of the oral cavity and the oropharynx&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and skin lesions in patients with epidermodysplasia verruciformis and in immunosuppressed individuals&#44; including organ transplant recipients&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> This begs the question&#58; might some of these patients thus also benefit from HPV vaccines&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Most HPV infections are latent and resolve spontaneously in 1 or 2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However&#44; a small proportion develop into a persistent infection&#44; which&#44; when caused by oncogenic HPV types&#44; can progress to precancerous lesions of varying severity over the course of years&#46; Some of these precancerous lesions may progress to in situ or invasive carcinomas&#46; It is thus important to prevent HPV-related conditions&#44; not only because of the associated morbidity but also because of their carcinogenic potential&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">HPV types 16 and 18 are included in both the bivalent and quadrivalent vaccine because they are high-risk strains responsible for 70&#37; of high-grade precancerous cervical lesions &#40;cervical intraepithelial neoplasia &#91;CIN&#93; grades 2 and 3&#41;&#46; They are&#44; however&#44; also responsible for 70&#37; of anogenital cancers &#40;70&#37;&#8211;90&#37; of vaginal and anal cancers and 40&#37; of vulvar and penile cancers<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; and 10&#37; of oral cavity and oropharyngeal cancers&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">While types 6 and 11 have low oncogenic potential&#44; they are included in the quadrivalent vaccine because they can cause low-grade precancerous lesions &#40;CIN&#160;1&#41;&#46; They are also responsible for the vast majority &#40;90&#37;&#41; of genital warts and cases of oral papillomatosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The quadrivalent vaccine thus has enormous potential value in dermatology as it should&#44; in theory&#44; provide indirect protection against numerous conditions other than cervical cancer&#46; Clinical trials have shown this vaccine to offer complete protection against warts caused by HPV types 6 and 11&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although Spain has a low prevalence of HPV infection &#40;estimated at 4&#37; in women aged 15&#8211;74 years&#41;&#44; data from other countries suggest that 1 in 8 women will develop genital warts at least once before the age of 50 years and that 10&#37; of the population will have at least 1 episode of genital warts within 25 years of becoming sexually active&#46; Because of the psychological&#44; physical&#44; and economic repercussions associated with the diagnosis and treatment of HPV infection&#44; prevention is very important&#46; The bivalent and quadrivalent HPV vaccines have proven to be safe&#44; minimally reactogenic&#44; and highly immunogenic&#46; Furthermore&#44; because the quadrivalent vaccine induces robust immune memory&#44; its protective effect is likely to last for life&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Both vaccines are currently licensed for the prevention of cervical cancer in girls and women aged 12 to 25 years&#44; essentially because they have been studied for this indication in females in this age group&#46; There is nothing&#44; however&#44; to indicate that they might not also be effective in other skin infections associated with the HPV types contained in these vaccines&#44; or even in males<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and other age groups&#46; In fact&#44; studies are already underway to assess the efficacy of HPV vaccination in males and other age groups&#46; Thus&#44; the bivalent and quadrivalent vaccines have enormous&#44; unexplored potential in the prevention of a range of dermatologic conditions&#46; Hypothetically&#44; they could prevent 90&#37; of genital warts&#44; 40&#37; of penile carcinomas&#44; 70&#37;&#8211;90&#37; of anal cancers&#44; and 10&#37; of oral cavity cancers&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Opinion Article
The Human Papillomavirus Vaccine: Is it of Value in Dermatology?
La vacuna frente al papilomavirus humano, ¿tiene interés en dermatología?
R. Pedragosa-Jovéa,
Corresponding author
, M. Salleras-Redonetb, Miembros fundadores del Grupo de trabajo de Epidemiología y Prevención de la Salud en Dermatología
a Servicio de Dermatología, Hospital Plató, Barcelona, Spain
b Servicio de Dermatología, Hospital del Sagrado Corazón, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Two new human papillomavirus &#40;HPV&#41; vaccines have recently become available in Spain&#58; Gardasi &#40;Sanofi Pasteur MSD&#41;&#44; a quadrivalent vaccine that protects against HPV types 6&#44; 11&#44; 16&#44; 18&#44; and Cervarix &#40;Glaxo-SmithKline&#41;&#44; a bivalent vaccine that protects against HPV types 16 and 18&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Both are indicated for the prevention of cervical cancer&#46; They are composed of virus-like particles containing viral proteins and are administered in 3 doses to girls and young women prior to sexual debut&#59; the preferred age for administration is 13 or 14 years&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However&#44; cervical cancer is not the only disease caused by these small cutaneotropic or mucosotropic DNA viruses&#44; of which over 150 types have been identified to date&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> They are also implicated in numerous other conditions&#44; mainly dermatologic&#44; including common warts &#40;100&#37; of cases&#41;&#44; genital warts &#40;100&#37; of cases&#41;&#44; vaginal&#44; vulvar&#44; and penile cancer &#40;40&#37; of cases&#41;&#44; anal cancer &#40;90&#37; of cases&#41;&#44; certain cancers of the oral cavity and the oropharynx&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and skin lesions in patients with epidermodysplasia verruciformis and in immunosuppressed individuals&#44; including organ transplant recipients&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> This begs the question&#58; might some of these patients thus also benefit from HPV vaccines&#63;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Most HPV infections are latent and resolve spontaneously in 1 or 2 years&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> However&#44; a small proportion develop into a persistent infection&#44; which&#44; when caused by oncogenic HPV types&#44; can progress to precancerous lesions of varying severity over the course of years&#46; Some of these precancerous lesions may progress to in situ or invasive carcinomas&#46; It is thus important to prevent HPV-related conditions&#44; not only because of the associated morbidity but also because of their carcinogenic potential&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">HPV types 16 and 18 are included in both the bivalent and quadrivalent vaccine because they are high-risk strains responsible for 70&#37; of high-grade precancerous cervical lesions &#40;cervical intraepithelial neoplasia &#91;CIN&#93; grades 2 and 3&#41;&#46; They are&#44; however&#44; also responsible for 70&#37; of anogenital cancers &#40;70&#37;&#8211;90&#37; of vaginal and anal cancers and 40&#37; of vulvar and penile cancers<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; and 10&#37; of oral cavity and oropharyngeal cancers&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">While types 6 and 11 have low oncogenic potential&#44; they are included in the quadrivalent vaccine because they can cause low-grade precancerous lesions &#40;CIN&#160;1&#41;&#46; They are also responsible for the vast majority &#40;90&#37;&#41; of genital warts and cases of oral papillomatosis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The quadrivalent vaccine thus has enormous potential value in dermatology as it should&#44; in theory&#44; provide indirect protection against numerous conditions other than cervical cancer&#46; Clinical trials have shown this vaccine to offer complete protection against warts caused by HPV types 6 and 11&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although Spain has a low prevalence of HPV infection &#40;estimated at 4&#37; in women aged 15&#8211;74 years&#41;&#44; data from other countries suggest that 1 in 8 women will develop genital warts at least once before the age of 50 years and that 10&#37; of the population will have at least 1 episode of genital warts within 25 years of becoming sexually active&#46; Because of the psychological&#44; physical&#44; and economic repercussions associated with the diagnosis and treatment of HPV infection&#44; prevention is very important&#46; The bivalent and quadrivalent HPV vaccines have proven to be safe&#44; minimally reactogenic&#44; and highly immunogenic&#46; Furthermore&#44; because the quadrivalent vaccine induces robust immune memory&#44; its protective effect is likely to last for life&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Both vaccines are currently licensed for the prevention of cervical cancer in girls and women aged 12 to 25 years&#44; essentially because they have been studied for this indication in females in this age group&#46; There is nothing&#44; however&#44; to indicate that they might not also be effective in other skin infections associated with the HPV types contained in these vaccines&#44; or even in males<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and other age groups&#46; In fact&#44; studies are already underway to assess the efficacy of HPV vaccination in males and other age groups&#46; Thus&#44; the bivalent and quadrivalent vaccines have enormous&#44; unexplored potential in the prevention of a range of dermatologic conditions&#46; Hypothetically&#44; they could prevent 90&#37; of genital warts&#44; 40&#37; of penile carcinomas&#44; 70&#37;&#8211;90&#37; of anal cancers&#44; and 10&#37; of oral cavity cancers&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of Interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Article information
ISSN: 15782190
Original language: English
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