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Warts (Verruca Vulgaris)

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Introduction

warts-anatomy

Verruca Vulgaris (warts) is an infection caused by human papillomavirus(HPV). There are over 100 types of HPV and it may occur at any site. One is more likely to get a wart if the skin is damaged.

Most common type of presentation of HPV is common warts, genital warts, flat warts, deep palmoplantar warts, epidermodysplasia verruciformis and plantar cysts. HPV type 6, 11, 16, 18, 31 and 35 are usually associated with malignancy.

Causes

Warts are caused by Human papillomavirus (HPV). It can spread through skin contact and people with disrupted skin barrier are more prone to the infection.

warts-causes

• Common warts are mostly commonly caused by HPV type 2,4, at times by types 1,3,27,29 and 57

• Flat warts or planar warts are caused by type 3,10 and 28

• Deep palmoplantar warts are most commonly caused by type 1 followed by type 2,3,4,27 and 57.

Risk Factors

• Children and teens

• People with weakened immune system like HIV/AIDS or people who are on immunosuppressant.

Signs & Symptoms

warts_1

Most of the warts do not have any symptoms, besides cosmetic disfigurement and localized pain. Plantar (foot) warts can be painful due to friction and compression.

The type of wart is determined by which body part if affected and what’s the appearance of the wart.

On examination

Common warts- they are commonly seen on the fingers, back of the hand and around the nails as irregular skin colored or black colored growth.

Flat warts- they are commonly seen on the face in children, on beard area in men and on the legs in women as fleshy growth ranging from 1 to 7mm and over the time it may appear black. They can be multiple in number.

Plantar (Foot) warts- they are commonly seen on the soles with black dots which depicts the broken blood vessels. They grow inwards which causes pressure hence pain during walking.

Filiform warts- they are commonly seen on the face, around the eyes, mouth and nose as thin finger like projections.

Genital warts- they are common seen over the genital area as dome or round, flesh colored or brown shaped growth, usually occurring in cluster.

Differential Diagnosis

• Molluscumcontagiosum

• Seborrheic keratosis

• Lichen Planus

• Squamous cell cancer

• Keratoacanthoma

Diagnosis

Usually warts can be diagnosed clinically but in case of doubt non-invasive technique like dermatoscopy can be done to confirm the diagnosis. On dermatoscopy multiple prominent hemorrhages with a yellowish surface with skin lines.

Prevention

• Avoid touching the wart as it can spread to other sites too.

• Don’t try to manipulate/ remove the wart on our own.

• If the wart is in the beard region avoid shaving or using clipper so that it doesn’t spread to other areas.

• Don’t bite your fingernails or pick at hangnails as warts are more likely to develop where the skin is broken.

• Gardasil (HPV4)- this vaccine is FDA approved and can be used by young women between the age group of 9 years to 26 years. It prevents against HPV types 16 & 18. In addition, it prevents against HPV 6, 11, 16 and 18.

• Cervarix (HPV2) it is ideal for females between the age group of 10 years to 35 years and it acts against HPV 16 &18.

Treatment

Common warts can go away without treatment, though the chances to spread to other areas increases and it may take an year or two to resolve on its own. The treatment option depends on the symptoms, what the patients prefers and the cost. Before starting the treatment it’s important to understand that recurrences are common with warts.

Research behind this article:

• Thappa DM, Chiramel MJ. Evolving role of immunotherapy in the treatment of refractory warts. Indian Dermatol Online J [serial online] 2016 [cited 2020 Apr 20];7:364-70. Available from: http://www.idoj.in/text.asp?2016/7/5/364/190487

• Al Aboud AM, Nigam PK. Wart (Plantar, Verruca Vulgaris, Verrucae) [Updated 2019 Sep 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431047/

Dr Rupika

Dr. Rupika Singh

MBBS, MD Dermatology
Fellow in Dermatology Laser Surgery

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