Common warts; verruca vulgaris; filiform warts; digitate warts; wart; verruca.
2.1.4 Warts
Synonyms
Epidemiology
Affects 7-10% of the population, most commonly in first three decades of life.
Definition
Infection caused by human papilloma viruses (HPV), a DNA virus with more than 100 types, karyotropic. Transmission: human to human or animal to human. Incubation period: weeks to months. Predisposing factors: impaired skin barrier, immunosuppression, hyperhidrosis, impaired peripheral circulation, occupation (e.g. butchers).
Aetiology & Pathogenesis
Superficial keratinocyte infection by human papilloma virus.
Signs & Symptoms
Dome-shaped, firm papules with a papillomatous, hyperkeratotic (verruciform) surface, along with typical dark punctae (capillary thrombi). Plantar warts are flat (mosaic or thorn-like) with pressure-induced inward growth. Warts may be pigmented and painful.
Localisation
Any part of the body, particularly hands and feet.
Classification
According to HPV subtype. E.g. verruca vulgaris: common wart (HPV 1, 2); v. plantaris: plantar, mosaic warts (HPV 2, 4); v. plana: (HPV 1, 3).
Laboratory & other workups
Usually not required.
Dermatopathology
Usually not required. Acanthotic epidermis with vacuolation of keratinocytes and parakeratotic plug (church-spire feature).
Course
Usually self-limiting.
Complications
May persist and become disseminated in immunocompromised individuals. Rarely mMay lead to fingernail destruction. Some HPV subtypes may lead to neoplasia including squamous cell carcinoma.
Diagnosis
Clinical.
Differential diagnosis
Corns, macrocomedones, lichen planus, Darier's disease, condylomata lata (Lues II), squamous cell carcinoma.
Prevention & Therapy
Spontaneous resolution in 95% within 2 years. Therefore aggressive therapy should be avoided. Beware scarring from over- treatment (no surgery). Cryosurgery, keratolytics (e.g. salicylic acid), topical retinoids (for facial involvement), 5-fluorouracil (5-FU), diphenylcyclopropenone immunotherapy (DCP), imiquimod.
Special
Consider underlying immunosuppression in extensive or treatment-resistant warts.
Differential Diagnosis
Podcasts
Tests
- Which of the following statements are true?
- Statement 1: Plantar warts usually develop in plantar areas which are exposed to pressure
- Statement 1: Verruca vulgares always need treatment
- Which of the following answers are correct?
- Which of the following statements are not correct? The following factors can be predisposing for an infection with verruca vulgares
- True or false?
- Which statements are true about warts?
- Statement 1 Plantar warts are most common at sites of mechanical pressure
- Statement 1 Verrucae vulgares must always be treated
- Which of the following statements is true?
- Which of the following statements are true?
- Which of the following factors do not predispose to warts?
- Which statement is true about the causative agent of verrucae vulgares?
Comments
Be the first one to leave a comment!