Warts%20-%20cutaneous Diagnosis

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

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

• Cutaneous warts are diagnosed by clinical appearance

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