Warts Disease
- Common wart (verruca vulgaris)
- Plantar wart (verruca plantaris)
- Flat wart (verruca plana)
- Venereal wart (condyloma acuminatum)
- Epidermodysplasia verruciformis
- System(s) affected: Skin/Exocrine
- Genetics: N/A
- Incidence/Prevalence in USA: 7-10% of the population
- Predominant age: Young adults and children
- Predominant sex: Female > Male
- Verruca vulgaris: Rough surfaced, raised, skin-colored papules 5-10 mm in diameter. They may coalesce into a mosaic 1-3 cm in diameter. Most frequently seen on hands.
- Verruca plantaris: Rough surfaced (although smoother than the common wart), flat, skin-colored papules not infrequently attaining 2-3 cm in diameter.
- Verruca plana: Slightly elevated, flat-topped, skin-colored papules 1-3 mm in diameter sometimes in a linear arrangement often on hands and face.
- Condyloma acuminatum: Thin, flexible, tall papules sometimes demonstrating a confluent growth resembling cauliflower. They do not have the visible or palpable keratin of the previous warts. In infants, laryngeal papillomatosis may occur if condyloma is transmitted during vaginal delivery.
- Epidermodysplasia verruciformis: Flat, reddish lesions on the hands and shoulders presenting in childhood with lifelong persistence.
- AIDS and other immunosuppressive diseases (e.g., lymphomas)
- Immunosuppressive drug use
- Atopic dermatitis
- Locker room use
- Skin trauma
HPV cannot be cultured
Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A
- Papillomavirus found in the nuclei and nucleoli of the stratum granulosum and keratin layers of the epidermis.
- Plantar warts have rete pegs (a downward proliferation of epidermal ridges).
- Thrombosed dermal capillaries.
Definitive diagnosis can be achieved with the following, but are not clinically relevant for most presentations:
- Electron microscopy
- Immunohistochemical study
- Nucleic acid hybridization
N/A
Paring or débridement and simple visualization will be diagnostic in most cases.
Outpatient
Spontaneous remissions are common, probably related to a host immune response. Conservative, non-scarring treatments are preferred. Each treatment is associated with a 60-70% cure rate. Cure is achieved when skin lines are restored to a normal pattern.
- Pretreat with anesthetic cream such as EMLA
- Cryotherapy – often preferred because scar formation is minimized. Freezing periungual warts may result in nail deformation.
- Excision with electrocautery, laser ablation, curettage (the virus may be found in smoke so masks should be worn)
- Disfiguring scars and wart recurrence are problems
If plantar warts are on weight-bearing surface, they may cause significant discomfort and subsequent decrease in activity
N/A
Infectious nature should be discussed; keep warts covered while under treatment to avoid auto-inoculation and transmission to others.
- Cover warts under treatment. Avoid the wound fluid after cryotherapy.
- Use personal footwear in locker room settings.
- Auto-inoculation
- Scar formation
- Chronic pain after plantar wart removal and scar formation
- Nail deformity after injury to nail matrix
Good; complete resolution with or without treatment
- Acquired immunodeficiency syndrome
- Renal transplantation
- Other conditions with immunosuppression
- Lewandowsky-Lutz disease (associated with epidermodysplasia)
Pediatric: Generally more prevalent in children
Geriatric: Less common in non-immunocompromised adults
Others: N/A
Podophyllin is contraindicated
N/A
HPV = Human papillomavirus
Clinical Investigations
- Cardiology
- Dermatology
- General Destistry
- Cardiology
- Dermatology
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