Eyebrow hairs from actinic keratosis patients harbor the highest number of cutaneous human papillomaviruses

Abstract

Background: Cutaneous human papillomavirus (HPV) infections seem to be associated with the onset of actinic keratosis (AK). This study compares the presence of cutaneous HPV types in eyebrow hairs to those in tissues of normal skin and skin lesions of 75 immunocompetent AK patients.

Methods: Biopsies from AK lesions, normal skin and plucked eyebrow hairs were collected from each patient. DNA from these specimens was tested for the presence of 28 cutaneous HPV (betaPV and gammaPV) by a PCR based method.

Results: The highest number of HPV prevalence was detected in 84% of the eyebrow hairs (63/75, median 6 types) compared to 47% of AK lesions (35/75, median 3 types) (p< 0.001) and 37% of normal skin (28/75, median 4 types) (p< 0.001), respectively. A total of 228 HPV infections were found in eyebrow hairs compared to only 92 HPV infections in AK and 69 in normal skin. In all three specimens HPV20, HPV23 and/or HPV37 were the most prevalent types. The highest number of multiple types of HPV positive specimens was found in 76% of the eyebrow hairs compared to 60% in AK and 57% in normal skin. The concordance of at least one HPV type in virus positive specimens was 81% (three specimens) and 88-93% of all three combinations with two specimens.

Conclusions: Thus, eyebrow hairs revealed the highest number of cutaneous HPV infections, are easy to collect and are an appropriate screening tool in order to identify a possible association of HPV and AK.

Figure 1

Concordance of HPV infections. Concordant infections of HPV positive specimens with at least 1–6 cutaneous HPV types in eyebrow hairs, actinic keratosis (AK), and normal skin are presented. The overall agreements of four combinations are shown with different definitions of concordance. Specimens were classified as concordance if they contained the same HPV of at least one HPV type, two types et cetera. The overall HPV agreement of at least one HPV type was 81-93%, and of at least two HPV types was 42-54% of all 4 combinations, respectively. The kappa values calculated with all 75 specimens of at least one (≥1) and two (≥2) type(s) in common of hairs versus AK was 0.314 (95% CI: 0.167-0.460) and 0.321 (95% CI: 0.178-0.463) (fair agreement), hairs versus normal skin was 0.217 (95% CI: 0.099-0.335) and 0.259 (95% CI: 0.129-0.390) (fair agreement), and AK versus normal skin was 0.692 (95% CI: 0.527-0.856) and 0.621 (95% CI: 0.410-0.833) (good agreement). No., numbers.

Figure 2

Prevalence of cutaneous HPV types. HPV infections of all 28 examined cutaneous HPV types (beta-1, -2, -3, -4, -5, and gamma PV) in three different specimens of 75 AK patients. The total of HPV infections was found highest in eyebrow hairs (228) compared to significantly lower viral infections in AK (92) and in normal skin (69). No., numbers.

Figure 3

Muliplicity of HPV infections. The percentages of single (1 type) and multiple infections (2–10 types) of HPV positive eyebrow hairs, actinic keratosis (AK) and normal skin are shown. The highest number of multiple infections was observed in 76% of the eyebrow hairs (48/63; median 6 types), compared to lower numbers of 60% in AK (21/35; median 3 types), and of 57% in normal skin (16/28; median 4 types), respectively.