Butcher wartsB 07

HPV 7 was originally identified in 1981 and finally cloned in 1986 from the hand warts of butchers. HPV-7-induced digital warts are therefore also referred to as butcher's warts.

Digital vulgar war ts (verrucae vulgares) are known as butchers' warts and occur much more frequently in butchers and people who handle or cut meat or fish than in the general population.

The prevalence of digital warts in butchers is 34.1 %, in slaughterhouse workers 33.3 %, in mechanical engineers 19.5 % and in office workers 14.7 % (Keefe M et al. 1994). In contrast, the prevalence of HPV 7 is 15.5 % in butchers, 15.6 % in slaughterhouse workers, 0 % in machinists and 0.6 % in office workers (Keefe M et al. 1994). Other authors reported that HPV 7 was found in 49 of the 160 butchers from various slaughterhouses (Jabłońska S et al. 1988). It can therefore be assumed that meat can serve as a vector for the transmission of HPV 7 (Miyata K et al. 2020). Fish were also found to be possible vectors (Rüdlinger R et al. 1989). From 12 samples of hand warts from 11 people, all of whom were involved in catching, gutting, filleting or smoking fish. HPV 7 was found in 6 of these fishmongers (Rüdlinger R et al. 1989). Epidemiologic reports of viral warts caused by HPV 7 are very rare worldwide. According to Hagiwara et al. (2005), HPV 7 was found in only one of 213 common warts in Japan. In contrast, HPV 2, 27 and 57 have been shown to be the predominant causative viruses for plantar warts (Mitsuishi T et al. 2010). However, there is no evidence that HPV 7 plays a pathogenic role in plantar warts. Whether meat and/or fish are vectors of HPV 7 is ultimately unknown. Traumatic injuries to the skin barrier may also contribute to the transmission of HPV.

The main cause is human papillomavirus type 7 (HPV7). In contrast, HPV 2, 27 and 57 are generally the cause of benign common warts. It is assumed that meat and/or fish components are possible vectors for the transmission of HPV7. The clinical appearance of butcher's warts and common warts is similar and clinical diagnosis can be difficult.

Histologically, flesh warts resemble common warts in their morphology, with conspicuous acanthosis and hyperkeratosis.

see below Verrucae vulgares

Butcher's warts as an occupational disease:

If HPV7-induced butcher's warts were an occupational disease in the butcher's trade (fish trade) and the dermatologist were to receive treatment authorization "without delay" on the basis of an occupational disease report in accordance with § 45 of the contract between doctors/UV, he could carry out the wart treatment "with all suitable means", i.e. also with those that the insurance companies do not normally pay for.

The issue therefore has a medical and an insurance law aspect (Schindera I). The prevalence of HPV-7 in the butcher's trade has been documented, although the route of infection has not been fully clarified. Obviously, there is no evidence in the available literature that HPV-7 viruses are transmitted from slaughtered animals to humans. Obviously, certain conditions must be met for the HPV7 diseases typical of the butcher's trade to occur. These include working in a constantly damp and cold environment and contact with meat juices. There is no evidence of autoinoculation or human-to-human transmission of this disease.

Pathogens: In a screening of "fishmonger's warts", HPV4 was found in one sample, HPV1 in three, a virus that hybridizes with both HPV27 and HPV2 in five and HPV7 in seven (six people). More than one type was detected in four individuals. These results indicate that HPV7 is not exclusive to meat handlers, as previously thought, and suggest that environmental conditions are likely to be a factor in the clinical manifestation of HPV7 infection (Rüdlinger R et al. 1989).

There is no doubt that this is an occupational disease, as it was "somehow" caused occupationally. According to § 1 No. 1 SGB V, there are clearly "work-related health hazards". The employers' liability insurance associations are responsible for preventing occupational illnesses, but do not generally provide compensation. The treatment costs are therefore borne by the health insurance funds.

Conclusion: Not every occupational disease is a compensable occupational disease within the meaning of the law. According to the so-called list principle, these are only those diseases that are expressly named in the list of occupational diseases (Annex to the Ordinance on Occupational Diseases - BKV).

A 35-year-old male patient presented with a small number of verrucous lesions on his right hand that had been present for two years. He works in a butcher's shop as a meat/fish processor. At the same time, he was diagnosed with severe atopic dermatitis (AD). Clinical examination revealed a warty, skin-colored lesion on his thumb and a lesion with dark brown papules on the index finger of his right hand. A sample from the skin biopsy of the lesion was routinely examined histopathologically. The surface of the lesions was hyperkeratotic with vacuolated parakeratotic and granular cells and centered nuclei. Total cellular DNA from the frozen sample was extracted as previously described and subjected to PCR amplification using SK primers. The results showed the detection of HPV 7. The lesions were resistant to cryotherapy and were treated with CO2 laser. The lesion completely regressed after laser treatment and no recurrence was observed during the 6-month follow-up period.

1. Hagiwara K et al. (2005) A genotype distribution of human papillomaviruses detected by polymerase chain reaction and direct sequencing analysis in a large sample of common warts in Japan. J Med Virol 77:107-12
2. Jabłońska S et al. (1988) Epidemiology of butchers' warts. Arch Dermatol Res. 1988;280(Suppl):S24-28.
3. Keefe M et al (1994) Cutaneous warts in butchers. Br J Dermatol 130:9-14.
4. Mitsuishi T et al. (2010) Combination of carbon dioxide laser therapy and artificial dermis application in plantar warts: human papillomavirus DNA analysis after treatment. Dermatol Surg 36:1401-1405.
5. Miyata K et al. (2020) So-Called Butcher's Warts Appeared on the Hands of a Meat Handler. Case Rep Dermatol 12:219-224.
6. Poochareon V et al. (2003) Successful treatment of butcher's warts with imiquimod 5% cream. Clin Exp Dermatol 28 Suppl 1:42-4.
7. Rüdlinger R et al (1989) Warts in fish handlers. Br J Dermatol 120:375-381.
8. Schindera I: Environmental and Occupational Dermatology Bulletin 99