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Common wart in Adult
See also in: External and Internal Eye,Anogenital
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Common wart in Adult

See also in: External and Internal Eye,Anogenital
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Contributors: Rajini Murthy MD, Susan Burgin MD
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Synopsis

Common wart : Fingers, Verrucous scaly papule, Feet, Knees, Dorsal hands
Common warts (verruca vulgaris) are benign skin proliferations caused by infection of the epidermis with human papillomavirus (HPV), most frequently types 1, 2, and 4. Verruca vulgaris lesions may be acquired from direct contact with HPV-infected skin or, less commonly, from contact with HPV-carrying fomites. Autoinoculation is very common. Warts are frequent at locations that are traumatized. HPV types 2 and 4 may infect virtually any epidermal surface, including mucosal surfaces, but common warts are most often seen on the hands, feet, and knees. They may occur in tattoos.

Verruca manifest as skin-colored, hyperkeratotic papules. They may be pruritic, and scratching can produce a linear array of lesions via autoinoculation. Verruca vulgaris lesions are more prevalent in children and in immunocompromised patients; widespread, persistent lesions may be a clue to an underlying inherited or acquired immunodeficiency.

For unknown reasons, the incidence of common warts is approximately twice as high in White patients as in individuals of African descent and 10 times more common in Hispanic patients than individuals of African descent. In persons of African descent, the majority of warts are solitary, while most Hispanic patients present with multiple warts.

Immunocompromised patients often demonstrate larger confluent verruca that are more resistant to standard therapies. The presence of warts per se is not a reason for expensive immunological testing, however.

Codes

ICD10CM:
B07.8 – Other viral warts

SNOMEDCT:
57019003 – Verruca vulgaris

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Seborrheic keratosis – Has a characteristic "stuck-on," waxy appearance.
  • Clavus / corn – A painful hyperkeratotic lesion with a central core that lacks the pinpoint thrombosed capillaries and retains normal skin dermatoglyphics. Clavi occur in sites of pressure and repeated friction.
  • Foreign body reaction – May have a history of trauma or inoculation.
  • Molluscum contagiosum – Lesions are smooth, dome-shaped papules with a central umbilication.
  • Actinic keratosis – Tends to be a scaly, erythematous papule on sun-exposed areas of elderly individuals.
  • Lichen planus – Lesions are typically more planar, violaceous, and pruritic.
  • Keratoacanthoma – Has a central keratin crater.
  • Squamous cell carcinoma – Can arise in preexisting warts and may be recalcitrant to therapy.
  • Prurigo nodularis – Characterized by pruritic papules and nodules.
  • Perforating folliculitis – Tends to be follicularly based with a central core.
  • Cutaneous horn – Can arise from warts, hypertrophic actinic keratoses, seborrheic keratoses, and squamous cell carcinomas.
  • Lichen nitidus – Characterized by discrete, dome-shaped papules.

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed:01/26/2021
Last Updated:01/26/2021
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Common wart in Adult
See also in: External and Internal Eye,Anogenital
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A medical illustration showing key findings of Common wart : Fingers, Verrucous scaly papule, Feet, Knees, Dorsal hands
Clinical image of Common wart - imageId=885707. Click to open in gallery. caption: 'A close-up of a verrucous plaque with overlying white scale and a similar smaller papule.'
A close-up of a verrucous plaque with overlying white scale and a similar smaller papule.

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