Targeting Complex Cutaneous Viral Infections in Search of Inborn Errors of Immunity

Area of Science:

• Immunology
• Dermatology
• Genetics

Background:

• Inborn errors of immunity (IEI) are rare conditions often presenting with skin issues.
• Dermatological manifestations occur in 50-80% of individuals with IEI.
• Cutaneous human papillomavirus (HPV) infections can be challenging to treat and may indicate immune dysfunction.

Purpose of the Study:

• To evaluate difficult-to-treat cutaneous HPV infections.
• To identify associations between these infections and immunological defects.
• To propose criteria for identifying patients with warts who require further investigation for IEI.

Main Methods:

• Retrospective analysis of 632 patient records from a Dermatological Outpatient Clinic.
• Inclusion criteria: severe/persistent warts (common warts, molluscum contagiosum, flat warts) resistant to therapy.
• Selection of 6 patients for immunological evaluation based on clinical criteria and questionnaires.

Main Results:

• Immunological testing revealed neutropenia, low immunoglobulin levels (IgA, IgM, IgG), and reduced lymphocyte subsets in selected patients.
• Family history, specific wart types (flat warts), and recurrent viral infections were indicators for further immunological assessment.
• 6 out of 173 evaluated patients met criteria for further immunological investigation.

Conclusions:

• Difficult-to-treat cutaneous warts can be a sign of underlying inborn errors of immunity.
• Specific clinical features and patient history can prompt further immunological evaluation.
• Proposed criteria may aid in the early identification of IEI in patients with recalcitrant warts.