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Common wart in Adult
See also in: External and Internal Eye,Anogenital
Other Resources UpToDate PubMed

Common wart in Adult

See also in: External and Internal Eye,Anogenital
Contributors: Rajini Murthy MD, Susan Burgin MD
Other Resources UpToDate PubMed


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.


B07.8 – Other viral warts

57019003 – Verruca vulgaris

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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.

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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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Last Reviewed:01/26/2021
Last Updated:01/26/2021
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Patient Information for Common wart in Adult
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Contributors: Medical staff writer


Warts are growths of the skin and mucous membranes (inside the mouth or genitals) that are caused by a virus known as the human papillomavirus (HPV). Common warts (verruca vulgaris) are usually found on areas of the body prone to trauma, such as the elbows, knees, and hands. The virus causes thickening of the top skin layer. They are usually painless and go away on their own, sometimes taking a few months or up to a couple years to resolve.

Warts are usually acquired from person-to-person contact. The virus is not highly contagious but can cause an infection by entering through a small break in the skin. In the same way, warts can be spread to other places on your own body (self-inoculation). The virus can sometimes be transferred by touching an object used by an infected person.

Who’s At Risk

Warts can affect people of any age, but they are most common between the ages of 12-16 years. It is estimated that 20% of schoolchildren and about 10% of the general population have warts. Warts can affect any race / ethnicity. People with HIV, organ transplants, or those who are on chemotherapy have a higher incidence of warts due to their weakened immune system.

Signs & Symptoms

Warts may occur singly or in multiples and often have what appear as multiple small black "dots" at the surface from tiny blood vessels.
  • Common warts are rough, thick papules (solid bumps) ranging in size from 1 mm to over 10 mm, often on the hands, face, elbows, and knees.
  • Filiform warts are long and narrow, like tufts of thread, and usually small at the base (1-3 mm); they often affect the face, eyelids, or nose.
  • In lighter skin colors, warts may be pink, skin-colored, or light brown. In darker skin colors, warts may be pink, skin-colored, purple, brown, or gray.
  • Warts can be covered with scale, which can be whitish, yellow, brown, or gray.

Self-Care Guidelines

Because warts can resolve on their own, it is not necessary to treat all warts. Additionally, treating warts may not always destroy them, nor will it necessarily keep other warts from appearing. Treatment can be painful, cause scars, and need to be repeated, so treatment should only be done in cases where the warts are highly bothersome or interfere with daily life.
  • Over-the-counter wart removers (eg, Compound W) have a high percentage of salicylic acid and work by dissolving away the layer of skin infected with the virus. This treatment needs to be used daily and can sometimes be irritating to skin around the wart.
  • Duct tape applied daily to the affected area can help remove warts. The tape should be very sticky and kept on for a few days at a time.
  • Over-the-counter freezing medications are available but have not been found to be very effective.
  • Coupled with the above therapies, the wart should be soaked in warm water, and any loose skin should be removed every few days with a mild abrasive, like a pumice stone.
  • Family members should avoid sharing personal items such as towels.

When to Seek Medical Care

See a health professional in the case of:
  • Painful or bleeding warts.
  • Warts on the face and those interfering with daily life that do not respond to self-care measures.
  • Diabetes – Warts of the feet should be treated by a health professional.


  • Destruction with freezing (cryosurgery); burning (electrocautery); laser; or cantharidin (Ycanth), podophyllin (Condylox), tretinoin (Retin-A), or acid (Tri-Chlor) application
  • Application of imiquimod (Aldara, Zyclara), an immunotherapy agent, to cause an immune reaction to destroy the wart
  • Injection of Candida antigen, which also causes an immune reaction that may destroy the wart
  • Injection of a chemotherapy drug (bleomycin [Blenoxane]) into the wart
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Common wart in Adult
See also in: External and Internal Eye,Anogenital
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.
Copyright © 2023 VisualDx®. All rights reserved.