Pathophysiology of cutaneous commensal human papillomaviruses

Cutaneous human papillomaviruses (HPVs), particularly those of the β-genus, have traditionally been viewed as harmless constituents of the skin microbiome. However, a debate has emerged over the past few years regarding their possible contribution to cancer development. In immunocompetent hosts, commensal β-HPVs may contribute to immune education and cutaneous homeostasis. In contrast, under immunosuppression, their increased viral load (combined with UV-induced DNA damage) can promote early oncogenic events and facilitate cancer initiation, through a "hit-and-run" mechanism. This context-dependent behavior defines β-HPVs as dynamic modulators of skin health, capable of exerting protective or pathogenic effects within the cutaneous ecosystem depending on host and environmental factors.