Cutaneous warts, also known as verrucae are small, rough growths that occur as a result of infection of keratinocytes by human papilloma virus (HPV).
They are elevated, round skin papules with a rough greyish appearance. They can occur on any part of the body, most commonly on hands and feet, but may be termed differently depending on their location.
They are transmitted by skin-to-skin contact.
Pathophysiology
HPV types 1, 2, 4, 27, 57 and 63 are most commonly implicated with cutaneous warts. HPV-1 is most commonly associated with plantar warts while butcher warts (warts that occur due to repetitive trauma) are most commonly associated with HPV-7.
They enter the skin and infect keratinocytes to form koilocytes - these are epithelial cells that have undergone structural changes after infection from HPV.
⚠️ Risk factors
- Water immersion (swimming and dishwashing)
- Butchers and fishermen
- Nail biting
- <35 years old
- Immunocompromised
😷+ 🔢 Presentation and classification
The warts have a typical raised, round greyish papular appearance. They average around 5mm in size.
We can classify them based on their location and appearance:
- Verruca vulgaris
This is the common wart.
- Verruca plana
A flat or plane wart
- Verruca plantaris
Wart on the sole of the foot.
- Periungual wart
Wart around the fingernails or toenails.
- Filiform warts
These have a finger-like appearance with a stalk. More commonly found on the face and neck.
- Mosaic warts
This is when there is coalescence of warts into larger ones, commonly on hands and feet.
🧰 Management
Most people do not need treatment and they resolve spontaneously within months (at most 2 years).
Treatment may be indicated if:
- Wart is painful
- Wart is cosmetically unsightly
- Persistent wart and patient requests treatment.
Options for treatment include:
- 🥇 Topical salicylic acid (15-50%) - applied daily for up to 12 weeks.
- 🥇 Cryotherapy - every 2 weeks until it is gone (maximum of 6 treatments)
A combination of both is recommended by applying topical salicylic acid between cryotherapy session.