Warts%20-%20cutaneous Diagnosis
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