Introduction

Benign (non-cancerous) lesions that occur in the mucosa and skin.

---

Aetiology

Agent:

• Human papillomavirus (HPV) (DNA virus)
  • Enter via breaks in skin/mucosa
  • M/C strains:
    • Common warts: Type 2, 4
    • Plantar warts: Type 1
    • Genital warts: Type 6, 11
    • Flat warts: Type 3, 10, 28
    • Butcher’s warts: Type 7

Risk factors:

• Use of public showers
• Butcher’s warts (working with meat) (8.5-23.8% prevalence)
• Eczema
• Weakened/compromised immune system

---

Clinical features

Warts have a finely “verrucous” surface

Primary manifestations:

• Common wart
• Flat wart
• Genital wart
• Filiform wart
• Periungual wart
• Plantar wart

Common wart “Verruca vulgaris” or Palmer wart or Junior wart

Raised wart with roughened surface, most common on hands, but can grow anywhere on the body

 

 

 

Flat wart “Verruca plana”

Small, smooth flattened wart, flesh-coloured, which can occur in large numbers M/C on face, neck, hands, wrists and knees.

Genital/venereal wart “Verruca acuminata” or Condyloma acuminatum:

• Wart occurring on genitalia
  
• Type of STD

 

 

 

Filiform/digitate wart:

Thread- or finger-like wart, M/C on face, especially near eyelids and lips.

Periungual wart:

Cauliflower-like cluster of warts that occurs around the nails.

• Often cause:
  • Loss of the cuticle and paronychia.
  • Damage to the nail (either by lifting the nail from the skin or causing the nail to partially detach)
  • Pain (if extends under the nail)
• Nail biting increases susceptibility to these warts

 

 

 

Plantar wart “Verruca plantaris” or verruca:

Hard, sometimes painful lump, often with multiple black specks in the center, usually only found on pressure points on the soles of the feet.

• Colour is typically similar to that of skin.
• May result in pain with pressure such that walking is difficult.
• Commonly mistaken for corns and calluses

 

 

 

Mosaic wart (group of tightly clustered plantar-type warts, commonly on the hands or soles of the feet.)

Other manifestations:

• Deep palmoplantar warts (Myrmecia)
• Focal epithelial hyperplasia (Heck disease)
• Epidermodysplasia verruciformis

---

Diagnosis

Histopathology

• Hyperkeratosis (thickening of the stratum corneum)
• Acanthosis (thickening of the stratum spinosum)
• Thickening of the stratum granulosum
• Rete ridge elongation
• Large blood vessels at dermoepidermal junction

 

 

 

Differential diagnosis

• Molluscum contagiosum
• Seborrheic keratosis
• Lichen planus
• Squamous cell carcinoma
• Keratoacanthoma

---

Management

Prevention

Gardasil 6 vaccine

• Approved in 2014 protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
• Do not currently protect against plantar warts (verrucas) strains

Treatment

Salicylic acid solution

Put on hardened skin of wart several times a day over the course of a few weeks to gradually dissolve it

• Salicylic acid may cause skin irritation, but it is usually well tolerated.

Cryotherapy

Freezing the wart by applying liquid nitrogen which is extremely cold, and destroys cells in the skin’s outer layer.

• Treatment is repeated several times with a break of at least 1 week between each session.
• Liquid nitrogen is very cold so it may cause brief stabbing pain, and the skin may turn red or swell afterwards. Blisters sometimes develop too.

 

 

 

Podophyllum resin, aka podophyllin:

Resin made from the roots of the American mandrake, used as a medication to treat genital warts and plantar warts, including in people with HIV/AIDS.

• Not recommended in HPV infections without external warts.