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Warts and verrucae (Clinical presentation (Common warts Firm, raised,…
Warts and
verrucae
Definition
Wart
Small, rough growths on the skin
due to infection of keratinocytes by
strains of HPV virus
Verruca
Subtype of wart on the plantar
aspect of the foot
Pathophysiology
Development
Direct skin-skin spread of HPV virus or
indirectly by contaminated surfaces e.g. swimming
Trauma to skin or moist skin increases transmission
Incubation period weeks to >year
Classification
Common wart (verruca vulgaris)
Flat/plane wart (verruca plana)
Plantar wart (verruca plantaris)
Clinical
presentation
Common warts
Firm, raised, rough 'cauliflower' surface
Knuckles, fingers, knees
Plane wart
Round, flat top, yellow
Back of hands
Filiform wart
Long, slender wart
Face and neck
Palmar/plantar warts
Soles of hands/feet, dark centre, painful
Mosaic warts
Coalescence of palmer/plantar warts
Diagnosis
Examination
Site, size, symmetry, rough/flat, pigmented
Any tenderness
History
PC/HPC: site, slow growing, spread, any pain/itch, red flags
PMH: previous warts, immunocompromised
DH: current meds, allergies
FH: others affected, skin cancers
SH: swimming/barefeet, occupation, smoking
Management
Conservative
Information and advice
Preventing spread to others (not barefoot)
Often resolve spontaneously months-2y
Referral if facial wart, uncertain diagnosis, extensive area involved, unresponsive to treatment
Medical
Salicyclic acid
Indication: painful, unsightly, patient request
E.g. topical salicylic acid
MOA: kills proliferating keratinocytes
can take 2-3 months to resolve
SEs: local skin irritation
Cryotherapy
Indication: painful, unsightly, patient request
MOA: liwuid nitrogen to freeze wart, takes several treatments
SEs: pain, blistering, infection, scar, depigmentation
Laser treatment
Indication: large warts refractory to conservative measures (specialist use)
MOA: laser beam to wart, kills highly proliferative cells
Topical medications
Indication: refractory to conservative measures (specialist use)
E.g. antimitiotics (retinoids, bleomycin), immunomodulators (imiquimod), virucidals (formaldehyde)
Surgery
Ablation
Indication: large warts unresponsive to conservative measures (specialist use)
MOA: physical removal of wart by curettage and cautery
Epidemiology
Common
School years, adolescence
to early adulthood
Prognosis
Often self resolve
after few months to a year
May be large and extensive
if immunosuppressed
Complications
Local spread
Due to picking
Infection
Local infection of wart
Malignant change
Very rare, immunocompromised
Usually evolve to SCC
