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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: Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
Other Resources UpToDate PubMed

Synopsis

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. 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 underlying inherited or acquired immunodeficiency.

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

Immunocompromised Patient Considerations:
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 – Common wart

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 reactions – May have a history of trauma or inoculation.
  • Molluscum contagiosum – Lesions are smooth, dome-shaped papules with a central umbilication.
  • Actinic keratoses – Tend to be scaly erythematous papules in sun-exposed areas of elderly individuals.
  • Lichen planus – Lesions are typically more planar, violaceous, and pruritic.
  • Keratoacanthomas – Have 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 horns – 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 Updated: 06/11/2019
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Common wart in Adult
See also in: External and Internal Eye,Anogenital
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Common wart : Knee, Verrucous scaly papule, Verrucous scaly plaque, Feet, Hands
Clinical image of Common wart
A close-up of a verrucous plaque with overlying white scale and a similar smaller papule.
Copyright © 2019 VisualDx®. All rights reserved.