warts%20-%20cutaneous
WARTS - CUTANEOUS
Cutaneous warts, also called verrucae, are benign proliferations of skin caused by human papillomavirus (HPV).
Most common warts on the hands and feet are due to HPV types 1, 2, 4, 27 & 57.
HPV is usually transmitted by contact with skin of an infected individual or by transmission of virus living in warm moist environment.
Autoinoculation may occur from traumatizing lesions by biting or scratching.
Incubation period is unknown but may range from months to years.

Classification

Common Warts

  • Most frequent type (approximately 70% of warts seen in clinical practice)
    • Typically found on hands but may appear anywhere on skin (eg palmar & plantar surfaces, neck, face & lips)
  • Present initially as smooth, confined, flesh-colored papule
  • Enlarge into grayish-brown, dome-shaped, hyperkeratotic nodule or papule
  • Capillaries become trapped w/in the wart & may be viewed by debridement of wart surface
    • This may be used to differentiate from corns

Plantar Warts

  • More commonly found in adolescents & young adults
  • Approximately 33% of patients w/ warts have plantar warts or its variants (mosaic or myrmecia)
    • Mosaic warts are coalesced warts on the plantar or palmar surface that form into a tile-like pattern
    • Myrmecia warts are dome-shaped, large & deep endophytic growths that are typically painful
  • Typically found on wt-bearing areas of the foot
  • Plantar warts tend to become calloused & grow into the foot
    • Usually found as multiple lesions which are firm & typically painful
  • Capillaries become trapped w/in the wart & may be viewed by debridement of wart surface
    • This may be used to differentiate from corns

Filiform Warts

  • Variant of common warts
  • Commonly found on the face
  • Characterized by long frond-like projections which can grow rapidly

Periungual Warts

  • Occur anywhere along the nail margins, including the proximal nail fold & hyponychium
  • May lead to onychodystrophy from nail matrix damage & onycholysis from nail bed warts
  • Many times found in children who bite their nails but can also affect adults
  • Tend to be hyperkeratotic papules that often show peeling & roughening of the surface

Flat Warts

  • Flat-topped papules w/ minimal scaling & only slight elevation
  • Typically present on the face & extremities of children
  • Often small, 2-4 mm in diameter

History

May include but is not limited to:

  • Duration of wart(s) & progression
  • Location
  • Current & past treatment modalities
  • Family history of warts
    • Epidermodysplasia verruciformis is a rare familial disorder w/ HPV that can lead to squamous cell carcinoma
  • Medical history
    • Eg immunosuppression [acquired immune deficiency syndrome (AIDS), organ transplant, etc], diabetes mellitus (DM), cold intolerance (may affect liquid nitrogen therapy)
  • Medication history (eg corticosteroids, chemotherapeutic agents, etc)
  • Pregnancy status
    • Warts may worsen in pregnancy & then regress afterwards
  • Sunlight exposure
    • Sunlight may serve as cocarcinogen in transplant patients & patients w/ epidermodysplasia

Physical Examination

  • Cutaneous warts are diagnosed by clinical appearance

Laboratory Tests

  • Histology may be needed for warts resistant to therapy & for verrucous warts in immunocompromised patients
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