Skin & Soft Tissue: Cutaneous Wart

Cutaneous Wart

Basics

  • Benign Skin Lesions Caused by Human Papillomavirus (HPV) Infection
  • Most Common in Children & Young Adults
  • Often See Spontaneous Remission
    • Two-Thirds of Children by Two-Years
    • Adults May Take Longer
  • More Common in Caucasians

Presentation/Types

  • Verruca Vulgaris (Common Wart)
    • Cauliflower-Like Papule
    • Rough, Papillomatosis & Hyperkeratotic Surface
    • Most Common on Arms & Legs
  • Verruca Plantaris (Plantar Wart)
    • Painful Lesions of the Sole of the Feet
    • Surrounded by Yellow Hyperkeratotic Callus-Like Skin
  • Verruca Plana (Flat/Plane Wart)
    • Multiple Skin-Colored Papules
    • Small & Flat-Topped
    • Most Common on Face, Hands & Shins – May Be Spread by Shaving
  • Filiform Wart
    • Cluster of Fine Projections from a Narrow Pedicle
    • Most Common on Face
  • Butcher’s Wart
    • Resemble Common Warts
    • Numerous Lesions Found on the Hands of Butchers
      • Also Seen in Other Professions Exposed to Cold Moist Environments

Verruca Vulgaris 1

Verruca Plantaris 2

Verruca Plana 3

Filiform Wart 4

Butcher’s Wart 5

Diagnosis

  • Mostly Clinical (Based on History and Physical Exam)
  • May Consider Skin Biopsy if Uncertain or to Rule Out Malignancy

Treatment

  • Generally Require No Treatment
  • Indications for Treatment:
    • Symptomatic/Painful
    • Parent Preference (Cosmesis)
    • Persistence
    • Immunosuppression
  • Treatment Options:
    • Liquid Nitrogen Cryotherapy
    • Salicylic Acid
    • Less Common Options:
      • Surgical Excision
      • Electrodessication
      • Topical Imiquimod
      • Intralesional Bleomycin
      • 5-Fluorouracil (5-FU)
      • Duct Tape Regimen (Debated)

Wart Cryotherapy

References

  1. Abbassyma. Wikimedia Commons. (License: Public Domain)
  2. Wegrowski. Wikimedia Commons. (License: CC BY-SA-4.0)
  3. Hassan I, et al. Wikimedia Commons. (License: CC BY-4.0)
  4. Schweintechnik. Wikimedia Commons. (License: Public Domain)
  5. Perveen, Fauzia et al. “Genotype Distribution of Human Papillomavirus in Warts.”British journal of medicine and medical research 15 (2016): 1-10. (License: CC BY-4.0)